Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
J Alzheimers Dis. 2021;83(1):451-474. doi: 10.3233/JAD-210532.
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).
This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools.
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.
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.
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.
全球范围内，痴呆症患者中比例最大的是中低收入国家（LMICs），而且痴呆症的患病率还在持续上升。评估和诊断痴呆症需要确定认知能力下降对功能的影响，通常通过工具性日常生活活动（IADLs）来衡量。
本综述旨在确定专门为中低收入国家开发、验证或改编的 IADL 测量方法，以指导此类工具的选择。
进行了系统搜索（十四种数据库），截至 2020 年 4 月。仅包括报告中低收入国家（50 岁以上）老年人痴呆症或认知障碍的 IADL 测量方法的开发、验证或改编的研究。使用 QUADAS 2 评估诊断准确性研究的质量。
22 篇论文符合纳入标准；确定了 11 个中低收入国家的 19 种离散的 IADL 工具。这些工具要么是从高收入国家使用的 IADL 测量工具中翻译而来（n=6），要么是针对文化差异进行翻译和改编（n=6），要么是专为目标中低收入国家人群开发的（n=7）。有七种工具在多项研究中进行了调查；总体诊断准确性的研究质量为中等至良好。
报告了中低收入国家支持痴呆症诊断的 IADL 测量的可靠性、有效性和准确性。当为这些环境选择 IADL 工具时，强调了需要考虑的关键因素，包括选择文化适宜、时间效率高的工具，这些工具考虑了性别和文化程度的偏差，并可以由任何经过适当培训的志愿者进行操作。需要在不同地区、国家、人群和文化中对 IADL 工具进行更多的技术和外部验证。
