A dementia diagnosis is based on the degree to which cognitive impairment interferes with independence in everyday activities. Measures to assess functional impairment can be used to support the initial diagnostic process, to assist intervention planning or to measure change in a person’s function as dementia progresses.
The following measures are covered by DOMS:
Quality Rating: Good
Time Required: 20–30 min
The ADCS-MCI-ADL is a dementia-specific measure of functional impairment, with a combination of items for basic and instrumental activities of daily living (ADL/IADL). It is a modification of the original ADCS-ADL scale designed to increase sensitivity to functional change in persons with mild cognitive impairment (MCI) or mild-moderate dementia. The ADCS-MCI-ADL can accurately distinguish persons without cognitive impairment from persons with MCI, and has been extensively used in drug treatment studies.
The ADCS-MCI-ADL is administered by a healthcare professional or clinical staff using an informant interview.
Permissions & Cost:
Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.
Downloads & Tools:
References
Quality Rating: Very good
Time Required: 5–15 min
The Barthel Index is a brief scale that assesses basic activities of daily living (ADL). It requires little expertise to use. The Barthel Index may be most useful in the moderate to severe stages of dementia since it is focused on motor rather than cognitive function. The Functional Independence Measure (FIM) is based on the Barthel index.
The Barthel Index is administered by a healthcare professional, clinical staff, or informant/carer.
Permissions & Cost:
The Maryland State Medical Society holds the copyright for the Barthel Index and permission requests are handled via MAPI Research Trust. To obtain a free downloadable copy or permission/licensing, register via their online platform.
Downloads & Tools:
N/A
References
Quality Rating: Very good
Time Required: 15–20 min
The Bayer ADL is designed to detect functional impairments in persons with mild cognitive impairment (MCI) or mild-moderate dementia. It has been shown to accurately detect functional decline due to MCI and therefore may be most useful in a community setting to detect the initial stages of dementia. The Bayer ADL is very user-friendly and can be completed by an informant/carer.
The Bayer Activities of Daily Living (Bayer ADL) is administered by a healthcare professional, clinical staff, or research assistant based on interview with an informant/carer.
Permissions & Cost:
No information available.
Downloads & Tools:
References
Quality Rating: Excellent
Time Required: 5 min
The BDS is a brief staging instrument that can be completed by the carer. It has a very long history of use and its simplicity makes it suitable for use by nursing staff working in care facilities or in the community.
The Blessed Dementia Scale (BDS)is administered and completed by the carer.
Permissions & Cost:
No information available.
Downloads & Tools:
References
Quality Rating: Good
Time Required: 25 min
The CS-ADL is a dementia-specific functional measure with a combination of items for basic and instrumental activities of daily living (ADL/IADL). It can distinguish persons without dementia from those with mild, moderate, or severe dementia. The CS-ADL has normative data in persons with dementia, and is also able to predict the level of carer dependency and risk of mortality.
The CS-ADL is administered by a healthcare professional or clinical staff, or from interview with an informant/carer.
Permissions & Cost:
Free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.
Downloads & Tools:
References
Quality Rating: Very good
Time Required: 25–40 min
The DAFS and revised (also referred to as ‘extended’) DAFS objectively measures the performance of basic and instrumental activities of daily living (ADL/IADL).The DAFS-Extended includes changes to the original DAFS to increase sensitivity to mild, cognitively-mediated functional impairment. The DAFS-Extended and the original DAFS have been shown to distinguish persons without dementia from those with Alzheimer’s disease or behavioural-variant frontotemporal dementia (bvFTD).
The Direct Assessment of Functional Status (DAFS) is administered by a healthcare professional or clinical staff with training in the scale. Equipment is required to administer the scale (e.g., phone, letters, coins and bills, eating utensils) and the original DAFS requires access to a kitchen and bathroom facility.
Permissions & Cost:
The DAFS-Extended can be used free of charge to healthcare professionals for non-commercial clinical or research purposes. For other uses, please contact the original authors to seek permission.
Downloads & Tools:
References
Quality Rating: Very good
Time Required: 15 min
The DAD is a dementia-specific functional measure with a combination of items for basic and instrumental activities of daily living (ADL/IADL). It is designed to be sensitive to a wide range of dementia severities and can be used to discriminate between persons with Alzheimer’s disease (AD), behavioural-variant frontotemporal dementia (bvFTD), and other forms of frontotemporal dementia (FTD). The DAD can also distinguish persons with mild cognitive impairment (MCI) from those with mild dementia. Its sensitivity to change has been validated in many drug treatment studies. The DAD is available in an abbreviated form, the DAD-6.
The Disability Assessment for Dementia (DAD) is administered by a healthcare professional, clinical staff, or research assistant based on interview with an informant/carer.
Permissions & Cost:
The DAD is copyrighted and reproduced here with permission. Please contact the original authors to seek permission for use.
Downloads & Tools:
References
Quality Rating: Good
Time Required: 20–30 min
The FIM scale assesses impairment in physical and cognitive function. It is designed for assessing basic activities of daily living (ADL) in a hospital setting, and is very widely used. The FIM is based on the motor function items of the Barthel Index (BI) with additional items for communication and social cognition.
The Functional Independence Measure (FIM) is administered by a healthcare professional or clinical staff member. Training is required for its use.
Permissions & Cost:
The FIM™ is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. Licenses are provided for day-to-day clinical use by healthcare facilities and on a short-term basis for individual research studies. It is also a requirement that anyone administering the instrument be trained and pass a test prior to using the tool to collect data.
Downloads & Tools
N/A
References
Quality Rating: Good
Time Required: 5–10 min
The Katz Index of ADL (Katz ADL) measures impairment in basic activities of daily living (ADL). The Katz ADL has a long history of use worldwide. It is sensitive to clinically significant change in basic ADLs after rehabilitation. The Katz ADL can also detect differences in function between persons with mild cognitive impairment (MCI) versus Alzheimer’s disease (AD).
The Katz Index of ADL (Katz ADL) is administered by a healthcare professional or clinical staff member.
Permissions & Cost:
No information available.
Downloads & Tools:
References
Quality Rating: Very good
Time Required: 5 min
The Lawton & Brody IADL is a measure of instrumental activities of daily living (IADL) that has a very long history of use and has been extensively validated in persons with dementia. Some of the items in this scale are known to be less applicable to male respondents and the use of corrected cut-offs or the alternative OARS-IADL scale is recommended to overcome this limitation.
The Lawton & Brody Instrumental Activities of Daily Living (Lawton & Brody IADL) is administered by a self-report by the person assessed or from direct observation by a healthcare professional or clinical staff member.
Permissions & Cost:
Copyrighted by the Gerontological Society of America and Oxford University Press.
Downloads & Tools:
N/A
References
Quality Rating: Good
Time Required: 5 min
The OARS-IADL is a brief scale that measures instrumental activities of daily living. It has demonstrated sensitivity to clinically significant change in IADLs, is a significant predictor of nursing home admission and service utilisation, and is reliable in a number of settings. The OARS-IADL is an adaptation of the Lawton & Brody scale, with changes to items to reduce the gender bias of the latter.
The Older Americans’ Resources and Services Instrumental Activities of Daily Living (OARS-IADL) is administered by self-report by the person assessed or from direct observation by a healthcare professional or clinical staff member.
Permissions & Cost:
The OARS-IADL can be used for non-commercial clinical or research purposes in upper and middle income countries (as the items of the OARS-IADL may not apply to lower income countries). Users reporting on findings based on the OARS-IADL are asked to acknowledge the source by citing: Fillenbaum, G.G. Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services Procedures. Erlbaum, Hillsdale, N.J., 1988; updated 1996 (available only from Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710).
Downloads & Tools:
References