Assessing functioning and self-care abilities in Alzheimer disease research.

Functional performance is a critical outcome to examine in dementia. The authors review some of the limitations of current research on functional performance and identify a conceptual framework for outcomes research. When considering conceptual frameworks to apply to functional assessment for outcomes research, five broad issues emerge: variability in definitions, an assumed equality between functional performance and capacity, measurement of global task abilities but not abilities for task components, lack of a contextual perspective, and use of a physical disability framework that excludes cognitive disability. When selecting assessment methods, researchers also must consider the implications of informant-based instruments and performance-based instruments. The authors also discuss a conceptual framework for evaluating current functional performance assessment instruments.