Instrumental Activities of Daily Living as a Screening Tool for Cognitive Impairment and Dementia in Elderly Community Dwellers

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Abstract
Objective To identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers. Design Survey based on the baseline interview of the PAQUID study on functional and cerebral aging. Setting Community survey in 37 randomly selected parishes in Gironde, France. Subjects Random sample of 2,792 community dwellers aged 65 and over (participation rate: 69%). Measurements Two‐phase screening: (1) functional assessment, Mini‐Mental State Examination (MMSE) and DSM‐III criteria for dementia; (2) in DSM‐III‐positive patients, NINCDS‐ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM‐III and NINCDS‐ADRDA criteria. Results Four IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut‐off point (score > 0) for the diagnosis of cognitive impairment. The same score at the same cut‐off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL. Conclusion The four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.