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Instrumental activities of daily living scales to detect cognitive impairment and dementia in low- and middle-income countries: a systematic review

Lookup NU author(s): Dr Heather Yemm, Dr Stella Paddick, Dr Catherine DotchinORCiD, Dr Michaela Goodson, Dr Alla Narytnyk, Dr Marie Poole, Dr RĂ­ona McArdle



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n=6), translated and adapted for cultural differences (n=6), or newly developed for target LMIC populations (n=7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

Publication metadata

Author(s): Yemm H, Robinson L, Paddick SM, Dotchin C, Goodson ML, Narytnyk A, Poole M, Mc Ardle R

Publication type: Article

Publication status: Published

Journal: Journal of Alzheimer's Disease

Year: 2021

Volume: 83

Issue: 1

Pages: 451-474

Print publication date: 31/08/2021

Online publication date: 27/07/2021

Acceptance date: 19/06/2021

Date deposited: 20/06/2021

ISSN (print): 1387-2877

ISSN (electronic): 1875-8908

Publisher: IOS Press


DOI: 10.3233/JAD-210532


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