2018/02/16 by Hui-Fen Mao, Hui‐Fen Mao, Ling-Hui Chang +17 · 61 citations
Health Professions · Medicine · #Activities of daily living #Clinical psychology #Dementia #Dementia and Cognitive Impairment Research #Discriminant validity #Environmental health #Geriatric Care and Nursing Homes #Gerontology #Intensive Care Unit Cognitive Disorders #Internal medicine #Medicine #Observational study #Population #Psychiatry #Psychometrics #Receiver operating characteristic
paper · pdf · doi:10.1093/ageing/afy021
published in Age and Ageing 47(4), 551-557 (Oxford University Press)
openalex publication_date 2018/02/16 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
BACKGROUND: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. OBJECTIVE: to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. DESIGN: population-based cross-sectional observational study. SETTING: all 19 counties in Taiwan. PARTICIPANTS: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). METHODS: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. RESULTS: we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. CONCLUSIONS: our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.