School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Occupational Therapy, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Age Ageing. 2018 Jul 1;47(4):551-557. doi: 10.1093/ageing/afy021.
many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection.
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.
population-based cross-sectional observational study.
all 19 counties in Taiwan.
community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03).
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.
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.
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.
许多患有痴呆症的人仍然未被诊断和识别。筛查策略对于早期发现很重要。
检验洛顿工具性日常生活活动（IADL）量表与其他认知筛查工具（简易精神状态检查（MMSE）和确证痴呆症 8 项知情者问卷（AD8））相比，是否能识别老年（≥65 岁）患有痴呆症的成年人。
基于人群的横断面观察性研究。
台湾所有 19 个县。
居住在社区的老年人（n=10340；平均年龄 74.87±6.03 岁）。
所有参与者均接受了结构化的面对面访谈。使用国家老龄化研究所-阿尔茨海默病协会的所有病因痴呆核心临床标准来确定痴呆症。使用受试者工作特征曲线来确定 IADL 量表、MMSE 和 AD8 区分有和无痴呆症参与者的能力。
我们确定了 917 名（8.9%）患有痴呆症的参与者和 9423 名（91.1%）无痴呆症的参与者。MMSE、AD8 和 IADL 量表的区分能力（临界值：6/7；曲线下面积=0.925；敏感性=89%；特异性=81%；阳性似然比=4.75；准确性=0.82）相当。将 IADL 与 AD8 评分相结合可显著提高总体准确性：特异性=93%；阳性似然比=11.74；准确性=0.92。
我们的研究结果支持使用 IADL 量表筛查老年社区居住居民的痴呆症：其具有与 AD8 和 MMSE 相当的区分能力。将 IADL 与 AD8 相结合可提高特异性。
