Instrumental Activities Of Daily Living Questionnaire Research Articles

Patient‐related benefits of amyloid PET imaging in unclear dementia: rationale and study design of the randomized ENABLE study

AbstractBackgroundDementia detection rate is very low in German primary care, as well as internationally. Amyloid PET imaging can reliably clarify an unclear diagnosis of dementia or an uncertain diagnosis of Alzheimer’s Disease (AD), improving diagnostic confidence and patient management. At present, systematic evidence of such benefits is still lacking. The patient‐related benefits of amyloid PET imaging (ENABLE) study will test whether amyloid PET will have a benefit on patients' functional status. Here, we describe the design of ENABLE, a randomized controlled two‐armed coverage with evidence development study in Germany.MethodApproximately 1,126 patients from 20 German academic memory clinics with a clinical diagnosis of mild‐moderate dementia of unclear etiology or of AD with low diagnostic certainty will be included in the study. Those patients will be randomly assigned to amyloid‐PET or routine diagnostics (no amyloid‐PET) (see Figure). The primary endpoint is change from baseline in the ability to perform instrumental activities of daily living (IADL) at 18 months as measured by the Amsterdam IADL Questionnaire. Secondary endpoints include the change in diagnosis, diagnostic confidence, cognition and clinical outcomes of patients and caregivers up until 24 months. We will apply linear and mixed linear models to assess primary and secondary endpoints.ResultWe expect patients' and caregivers' quality of life to be improved after receiving an amyloid PET formal diagnosis, as this will result into timely pharmacological and non‐pharmacological interventions.ConclusionThis study will benefit physicians’ and payers’ decisions on the provision of health care for patients with dementia in Germany.

Patient‐related benefits of amyloid PET imaging in unclear dementia: rationale and study design of the randomized ENABLE study

AbstractBackgroundDementia detection rate is very low in German primary care, as well as internationally. Amyloid PET imaging can reliably clarify an unclear diagnosis of dementia or an uncertain diagnosis of Alzheimer’s Disease (AD), improving diagnostic confidence and patient management. At present, systematic evidence of such benefits is still lacking. The patient‐related benefits of amyloid PET imaging (ENABLE) study will test whether amyloid PET will have a benefit on patients' functional status. Here, we describe the design of ENABLE, a randomized controlled two‐armed coverage with evidence development study in Germany.MethodApproximately 1,126 patients from 20 German academic memory clinics with a clinical diagnosis of mild‐moderate dementia of unclear etiology or of AD with low diagnostic certainty will be included in the study. Those patients will be randomly assigned to amyloid‐PET or routine diagnostics (no amyloid‐PET) (see Figure). The primary endpoint is change from baseline in the ability to perform instrumental activities of daily living (IADL) at 18 months as measured by the Amsterdam IADL Questionnaire. Secondary endpoints include the change in diagnosis, diagnostic confidence, cognition and clinical outcomes of patients and caregivers up until 24 months. We will apply linear and mixed linear models to assess primary and secondary endpoints.ResultWe expect patients' and caregivers' quality of life to be improved after receiving an amyloid PET formal diagnosis, as this will result into timely pharmacological and non‐pharmacological interventions.ConclusionThis study will benefit physicians’ and payers’ decisions on the provision of health care for patients with dementia in Germany.

Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users.

Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) sixmonths post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL. Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire. Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers. This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.

ASSESSMENT OF THE INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA DUE TO ALZHEIMER'S DISEASE: DIAGNOSTIC ACCURACY OF THE SERBIAN VERSION OF THE AMSTERDAM IADL QUESTIONNAIRE

To establish a diagnosis of dementia, it is necessary, in addition to cognitive impairment, to prove the existence of a disorder of instrumental activities of daily living (IADL). The Amsterdam IADL Questionnaire is a reliable instrument translated into different languages. This study aims to assess the diagnostic accuracy of the Serbian version of the Amsterdam IADL Questionnaire. The study included 75 patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease. The questionnaire was scored using the weighted average (WA) and item response theory (IRT) scoring method. Diagnostic accuracy was examined using receiver–operating characteristic (ROC) curves. The area under the curves (AUC) was calculated with 95% confidence intervals (CI). The correlation between IRT and WA scores was strong and significant (r=-0.980, p<0.001). The AUC for the IRT scores of A-IADL-Q was 0.832 (95% CI: 0.729 to 0.909), while the AUC for the WA scores of A-IADL-Q was 0.848 (95% CI: 0.746 to 0.920). Both were significantly different from the AUC of 0.5 (p<0.001). There was no significant difference between the AUCs of IRT and WA scoring (z=1.157; p=0.247). Cutoffs and the highest combination of sensitivity and specificity for the IRT (sensitivity 0.767; specificity 0. 844) and WA (sensitivity 0.744; specificity 0. 844) scores of A-IADL-Q were calculated. We have shown that A-IADL-Q has moderate diagnostic accuracy in differentiating dementia and MCI. This instrument can be used in combination with cognitive measures to diagnose dementia in its early stages.

Assessment of Instrumental Activities of Daily Living in Preclinical Alzheimer Disease.

Questionnaires are used to assess instrumental activities of daily living (IADL) among individuals with preclinical Alzheimer disease (AD). They have indicated no functional impairment among this population. We aim to determine among cognitively normal (CN) older adults with and without preclinical AD whether: (a) performance-based IADL assessment measures a wider range of function than an IADL questionnaire and (b) biomarkers of AD are associated with IADL performance. In this cross-sectional analysis of 161 older adults, participants in studies of AD completed an IADL questionnaire, performance-based IADL assessment, cognitive assessments, and had biomarkers of AD (amyloid, hippocampal volume, brain network strength) assessed within 2 to 3 years. Performance-based IADL scores were more widely distributed compared with the IADL questionnaire. Smaller hippocampal volumes and reduced brain network connections were associated with worse IADL performance. A performance-based IADL assessment demonstrates functional impairment associated with neurodegeneration among CN older adults.

Functional decline after surgery in older patients with head and neck cancer

IntroductionIn addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer. MethodsWe present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively. ResultsIn total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12). ConclusionApproximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.

A-61 Predictors of Subjective and Objective Everyday Functioning in Middle-Aged and Older Adults with HIV

Abstract Objective Older adults with HIV are at increased risk for difficulties with instrumental activities of daily living (IADLs). Awareness of their functional capacity has emerged as an important area for research, but it is not well studied in PWH. The purpose of this study is: (1) to identify factors associated with subjective and objective IADL difficulty in PWH and (2) to identify factors associated with under- or over-reporting of IADL difficulties. Methods This cross-sectional study included 261 adults with HIV. Participants completed a neuropsychological battery, self-report and performance-based measures of IADLs. Self-report measures included the Patient’s Assessment of Own Functioning Inventory (PAOFI) and the Lawton and Brody IADL Questionnaire. The Timed Instrumental Activities of Daily Living (TIADL) task was used as an objective measure. Hierarchical multiple regressions were performed to identify factors associated with subjective and objective assessment of everyday functioning as well as factors associated with discrepancy between self-report and actual performance of IADLS. Results On the PAOFI, higher depression (p = 0.001), lower conscientiousness (p > 0.001), and better processing speed (p = 0.017) predicted worse functioning. On the Lawton and Brody, higher depression (p = 0.049) predicted of worse functioning. On the TIADL, older age (p = 0.1), lower WRAT-4 score (p > 0.001), worse processing speed (p > 0.001), and worse motor function (p = 0.1) were associated with worse performance. Processing speed predicted discrepancy between subjective and objective performance of IADLs (p = 0.1). Conclusions Several demographic, cognitive, and personality variables are associated with worse subjective and objective everyday functioning, as well as an individual’s ability to accurately self-appraise their functional capacity.

Cognitive functioning in everyday life: The development of a questionnaire on instrumental activities of daily living in multiple sclerosis.

Neuropsychological test scores in people with MS (PwMS) do not fully reflect cognitive functioning in daily life. Therefore, we developed a questionnaire based on instrumental activities of daily living (IADL), using the Amsterdam IADL-Q© for Alzheimer’s disease as starting point. Forty-eight items were evaluated on relevance and clarity by (inter)national experts (n = 30), PwMS (n = 61) and proxies (n = 30). Consequently, four items were omitted, two items were merged and seven items were added. Fifty items were included in the IADL questionnaire specific to cognitive functioning in MS (the MS-IADL-Q). Future studies are warranted to assess the psychometric properties of the MS-IADL-Q.

Study partner‐ and self‐reported difficulties in cognitively complex everyday activities in participants without objective cognitive impairment

AbstractBackgroundStudy partner report is used to assess cognitively complex everyday activities, or instrumental activities of daily living (IADL). Because a study partner is not always available, the question arises whether IADL can also be evaluated using self‐report. The aim of this study is to investigate the relationship between study partner‐ and self‐report IADL in individuals without objective cognitive impairment, and to explore its associated factors.MethodParticipants (N=3,295; mean age 61.0±12.1 years, 70.3% female; Table 1.) and their study partners (N=1,225) were recruited from the Dutch Brain Research Registry. They completed self‐ and study partner‐report versions of the Amsterdam IADL Questionnaire. For the 1,225 dyads, linear regression analyses were used to investigate the relationship between self‐ and study partner report. Age, sex, cohabitation, marital status, education and subjective memory complaints were explored as potential confounders and effect‐modifiers.ResultA total of 1,544 (46.9%) participants and study partners (n=497, 40.6%) reported an increased level of difficulty in at least one IADL activity (Figure 1). Absolute agreement between self and study partner on item level was high, ranging from 93.3–99.2%. Participants self‐reported more IADL difficulties (M=65.9±SD=4.7), compared to their study partners (M=66.1±SD=4.6; p<0.05). The study partner‐ and self‐ reported IADL scores were significantly associated (B=0.54). When participants experienced memory complaints, both the participant and study partner reported more IADL difficulties (both p<0.001, Figure 2). Furthermore, we found an interaction effect indicating that the association between self and study partner was lower for those without memory complaints (B= 0.42, Figure 3). In addition, the association between self‐ and proxy was slightly lower for highly educated participants (B=0.47).ConclusionSubtle difficulties in IADL were present in about half of the population, and a high level of agreement between self and study partner was observed on both item and scale level IADL. We found several factors influencing the level of agreement, and in a next step we will include objective cognitive markers to explore the etiology of these differences. These findings provide support for the use of IADL self‐report in cognitively unimpaired individuals, in particular for use in primary or secondary prevention trials.

Enhancing 'meaningfulness' of functional assessments: UK adaptation of the Amsterdam IADL questionnaire.

Commonly used measures of instrumental activities of daily living (IADL) do not capture activities for a technologically advancing society. This study aimed to adapt the proxy/informant-based Amsterdam IADL Questionnaire (A-IADL-Q) for use in the UK and develop a self-report version. An iterative mixed method cross-cultural adaptation of the A-IADL-Q and the development of a self-report version involving a three-step design: (1) interviews and focus groups with lay and professional stakeholders to assess face and content validity; (2) a questionnaire to measure item relevance to older adults in the U.K.; (3) a pilot of the adapted questionnaire in people with cognitive impairment. Community settings in the UK. One hundred and forty-eight participants took part across the three steps: (1) 14 dementia professionals; 8 people with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia due to Alzheimer's disease; and 6 relatives of people with MCI or dementia; (2) 92 older adults without cognitive impairment; and (3) 28 people with SCD or MCI. The cultural relevance and applicability of the A-IADL-Q scale items were assessed using a 6-point Likert scale. Cognitive and functional performance was measured using a battery of cognitive and functional measures. Iterative modifications to the scale resulted in a 55-item adapted version appropriate for UK use (A-IADL-Q-UK). Pilot data revealed that the new and revised items performed well. Four new items correlated with the weighted average score (Kendall's Tau -.388, -.445, -.497, -.569). An exploratory analysis of convergent validity found correlations in the expected direction with cognitive and functional measures. The A-IADL-Q-UK provides a measurement of functional decline for use in the UK that captures culturally relevant activities. A new self-report version has been developed and is ready for testing. Further evaluation of the A-IADL-Q-UK for construct validity is now needed.

Comparison of Instrumental Activities of Daily Living assessment by face-to-face or telephone interviews: a randomized, crossover study

BackgroundThe functional autonomy assessment is essential to manage patients with a neurodegenerative disease, but its evaluation is not always possible during a consultation. To optimize ambulatory autonomy assessment, we compared the Lawton Instrumental Activities of Daily Living (IADL) questionnaire collected by telephone and face-to-face interviews.MethodsA randomized, crossover study was carried out among patients attending a memory clinic (MC). The IADL questionnaire was collected for patients during telephone and face-to-face interviews between nurses and patients’ caregivers. The agreement between the two methods was measured using the proportion of participants giving the same response, Cohen’s kappa, intraclass correlation (ICC) coefficient, and Bland and Altman method. The associations between patients’ characteristics, events occurring between the two assessments, and agreement were assessed.ResultsAmong the 292 patients (means ± SD age 81.5 ± 7, MMSE 19.6 ± 6, 39.7% with major neurocognitive disorders) analyzed, the proportion of agreement between the two modes was 89.4% for the total IADL score. Weighted kappa coefficient was 0.66 and ICC score was 0.91 for total IADL score. The mean difference between the IADL score by telephone or face-to-face was 0.32. Overall, 96.9% of measures lay within the 95% limits of agreement. The occurrence of fall was less likely associated with the probability to lie within the 95% limits of agreement (OR = 0.07 [0.02–0.27]).ConclusionThe administration of IADL by telephone with the caregiver appears to be an acceptable method of assessment for MC patients compared to face-to-face interview. The events such as falls which could occur in a time close to the evaluation should be reported.Study registrationClinicalTrials.gov, NCT02654574. Retrospectively registered: 13 January 2016

The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in eight countries.

IntroductionTo understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences.MethodsA total of 3571 individuals (67.1 ± 9.5 years old, 44.7% female) from The Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia, and Finland were included. Functional impairment was measured using the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis.ResultsThere were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: Effect sizes were low (ΔR 2 range 0‐0.03). Impact on total scores was minimal.DiscussionThe results imply a limited bias for age, gender, education, and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia research.

Compensatory strategy use improves real-world functional performance in community dwelling older adults.

Compensatory strategies such as assistive technology, external reminders, and environmental cues may help support instrumental activities of daily living (IADLs) and independence. However, functional ability is most often evaluated in clinical settings where everyday compensation cannot be readily observed. The present study used a novel, real-world evaluation of everyday activities (prospective memory, household chores, complex IADLs, and planning tasks) to examine the impact of compensation. Fifty community dwelling older adults were recruited with cognitive status ranging from healthy to mildly impaired. Participants completed a battery of validated performance-based and cognitive tasks, an IADL questionnaire (also completed by an informant), and real-world activities carried out in their own homes. The real-world evaluation demonstrated adequate interrater reliability (intraclass coefficient = 0.92) and construct validity (r = 0.55). Compensation improved real-world task outcome on prospective memory and household chores tasks. Further, cognition emerged as a moderator between compensation and prospective memory task outcome. Participants' ratings on an IADL questionnaire were related to real-world and performance-based functioning whereas informants' ratings were related to performance-based tasks and cognition. Our results suggest that proxy measures of functional ability (i.e., performance-based, cognitive, and IADL questionnaire measures) do not fully capture the complexity of real-world performance for nondemented community dwelling older adults. Compensation appeared to improve prospective memory performance, particularly for individuals with average to low average cognitive abilities. A difference in IADL questionnaire ratings suggest that participants may be better able to judge their real-world performance than informants. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impairment in complex activities of daily living is related to neurodegeneration in Alzheimer's disease–specific regions

Impairment in instrumental activities of daily living (IADL) is an early clinical feature of Alzheimer's disease (AD). The neurobiology underlying IADL disruptions is still unclear. We aimed to investigate the relationship between IADL functioning and cortical atrophy across the AD spectrum. We selected 162 memory-clinic subjects with subjective cognitive decline (n = 49), mild cognitive impairment (n = 26) or AD dementia (n = 87), and an available structural MRI acquired at 3.0 Tesla and Amsterdam IADL Questionnaire (A-IADL-Q) assessment. We used linear regression correcting for age, sex, education, vascular injuries, and total intracranial volume to investigate the association between gray matter volume and A-IADL-Q score, and voxel-based morphometry to investigate whether any associations were specific for distinct regions. Less gray matter volume was associated with lower A-IADL-Q scores (β = 0.346, 95% CI = [0.185-0.507], p < 0.001), specifically in cortical regions covering the medial temporal lobes, cingulate cortex, and precuneus (all p(familywise error–corrected) < 0.05). Results were similar when repeating the analyses in amyloid-positive subjects (n = 78). Our findings illustrate that the A-IADL-Q detects functional impairment related to AD-specific neurodegeneration.

Assessing Everyday Activities Across the Dementia Spectrum with the Amsterdam IADL Questionnaire.

Instrumental activities of daily living (IADL) are complex activities which involve multiple cognitive processes, and which are expected to be susceptible to the early effects of cognitive impairment. Informant-based questionnaires are the most common tools used to assess IADL performance in dementia, but must be adjusted for use in early stages of impairment. To investigate the differences in IADL on the continuum of cognitive decline (i.e. no cognitive decline - subjective cognitive decline - mild cognitive impairment- mild dementia - moderate dementia) using the Spanish version of the Amsterdam IADL Questionnaire (A-IADL-Q). A total of 500 volunteer participants were included: 88 participants with no signs of cognitive decline, 109 participants with subjective cognitive complaints, 114 participants with mild cognitive impairment (MCI), 81 participants with mild dementia and 108 participants with moderate dementia. IADL was assessed with the A-IADL-Q, a computerized and adaptive questionnaire that calculates scores according to the specific pattern of responses of each participant. The data were examined by ANOVAs and regression analysis. Multinomial logistic regression analysis was used to evaluate the capacity of the A-IADL-Q to distinguish between diagnostic groups. Participants with no cognitive decline and those with subjective cognitive decline obtained higher A-IADL-Q scores than MCI participants, and participants with MCI obtained higher scores than patients with dementia. The A-IADL-Q showed excellent discrimination between non-cognitive impairment and dementia, and significant but low discrimination between non-cognitive impairment and MCI. A-IADL-Q can discriminate IADL functioning between groups across the dementia spectrum.

Functional Ability, Participation, and Health-Related Quality of Life After Hip Fracture

Hip fracture is prevalent among older adults impacting on all aspects of daily life. The gaols of this study were: (a) Examine the trajectory of activities of daily living (ADL)/instrumental activities of daily living (IADL) functioning and participation among older adults with hip fracture from prefracture to 6-months postrehabilitation; (b) determine the relationship between health-related quality of life (HRQoL), functional abilities, and participation 6-months postrehabilitation; and (c) examine whether functional outcomes can predict HRQoL. Both retrospective and prospective data were analyzed. Fifty-five participants (Mean age = 80.82) completed the motor component of the functional independence measure (mFIM), IADL questionnaire, Activity Card Sort, and SF-12. Prefracture levels of function and participation were not attained. Significant correlations were found between HRQoL, functional abilities, and participation. ADL functioning and mobility predicted Physical SF-12, whereas social-cultural activity predicted Mental SF-12. Significant loss of functioning and participation was found, persisting 6 months after rehabilitation that impede their HRQoL. Improving functioning, mobility, and social participation can be achieved by occupational therapy intervention for promoting HRQoL among elderly with hip fracture.

Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training.

Task shifting has been suggested as one way to help manage the increasing burden of dementia in sub-Saharan Africa (SSA). However, brief, easy-to-use and valid screening tools are needed to support this approach. Our team has developed an 11-item questionnaire to assess instrumental activities of daily living (IADLs) in SSA, the Identification and Intervention for Dementia in Elderly Africans (IDEA)-IADL questionnaire. We aimed to externally validate the questionnaire and develop a shorter, more efficient version. A community-based sample of 329 older adults in 4 rural villages was screened for dementia using the validated IDEA cognitive screen and the 11-item IDEA-IADL questionnaire. A stratified sample was assessed for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) dementia by a United Kingdom-based doctor, who was blinded to the results of screening. Area under the receiver operating characteristic (AUROC) curve analysis was used to assess validity, and factor analysis and regression modeling were used to develop a shorter version of the questionnaire. A 3-item IDEA-IADL questionnaire was developed and externally validated in the study sample. The questionnaire was deemed to be valid and enhanced screening performance in 2 villages (AUROC: 0.857 and 0.895) but detracted from the accuracy of the IDEA cognitive screen in the other 2 villages (AUROC: 0.591 and 0.639). These differences appeared to be due to differences in interpretation of responses to questions by the assessors. A brief IDEA-IADLs scale was developed and worked well in some villages. However, our study highlights a training need if brief screening tools to assess IADLs are to be effectively used by nonspecialists in low-resource settings.

Association of Anticholinergic Risk Score With Functional Status in Patients Preparing for Pelvic Reconstructive Surgery.

Anticholinergic medication use has been associated with cognitive impairment and other functional limitations, particularly in older patients. The anticholinergic risk score (ARS) can be used to measure a patient's cumulative exposure to medications with anticholinergic properties. Our primary objective was to evaluate the correlation between ARS and functional status, as measured by instrumental activities of daily living (IADL), in patients preparing to undergo urogynecologic surgery. The secondary objective was to examine the correlation between ARS and physical function in this same cohort. This was a planned cross-sectional analysis of a prospective cohort study to evaluate the impact of urogynecologic surgery on functional status. The ARS was calculated by summing the ARSs of each patient's medications and classified as high (ARS > 5) or low (ARS ≤ 5). A patient's ability to live independently was determined using the IADL questionnaire. The patient's physical function status was determined using the functional comorbidity index. One hundred twenty-two patients were evaluated. A total of 89.3% of subjects had a low and 10.7% had a high ARS score. For our primary outcome, high ARS was associated with low IADL in logistic regression controlling for age and formal education level (odds ratio, 8.0; 95% confidence interval, 1.4-46.9). For our secondary outcome, ARS was not associated with the functional comorbidity index (P = 0.24). These data support recognition of ARS as a potential risk factor for low functional status in patients planning urogynecologic surgery.

DOES BRAIN AMYLOID DEPOSITION IMPACT EVERYDAY FUNCTIONING IN SUBJECTS WITH COGNITIVE COMPLAINTS? RESULTS FROM THE INSIGHT COHORT

Subjective cognitive decline (SCD) is increasingly identified as a potential at-risk stage for Alzheimer's disease (AD). A key issue in SCD is to identify the earliest clinical symptoms indicative of preclincal AD, when these subjects are considered to be predominantly asymptomatic. Experiencing difficulties with performing instrumental activities of daily living (IADL) is potentially such an early symptom. Because amyloid is one of the earliest pathological changes in AD, the objective of the current study is to investigate the relationship between amyloid deposition and IADL in SCD. Subjects were included from the prospective INSIGHT pre-AD cohort, which is conducted at the University Salpêtrière Hospital, Paris, France. We used baseline cross-sectional data, and included subjects with SCD who had amyloid Florbetapir PET and IADL assessments available. β-Amyloid deposition was measured by the standard uptake value ratio (SUVr) in cortical regions; frontal, temporal, parietal, anterior cingulate, posterior cingulate and precuneus, using whole cerebellum and pons as reference regions. Subjects' partners completed the French version of the Amsterdam IADL Questionnaire. IADL and SUVr data data were log transformed to obtain normal distributions. The relationship between amyloid (global and local effects) and IADL was investigated using linear regression analyses, with correction for age, sex and education if necessary. A total of 304 participants were included (Mean age=76, SD=3.45, 64% female). Global amyloid SUVr was related to IADL scores (β=.246, 95% CI .052 -.441, p=.013), which remained significant after correction for confounding. When looking at amyloid deposition in specific brain regions, IADL was associated with SUVr in frontal, parietal and temporal regions. Subsequently, a total of 82 (27%) participants was defined by cut-off as amyloid positive, and we found a trend for amyloid positive subjects to have more IADL difficulties (β=.090, 95% CI -.001-.181, p=.053). Specific activities that differed between both groups were primarily related to everyday technology use. Our findings suggest that in subjects with SCD a greater amyloid burden impacts IADL functioning. This indicates that IADL is an early clinical symptom, and potentially a useful clinical marker of preclinical AD. As a next step, we aim to study longitudinal trajectories of IADL functioning.

Development of a questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumors: a pilot study

Both dementia and brain tumor patients exhibit cognitive decline during the course of their disease. They might therefore experience similar problems with cognitively complex daily activities (i.e., instrumental activities of daily living (IADL)). The study's objective is to evaluate if the Amsterdam IADL Questionnaire© (A-IADL-Q), a 70-item IADL questionnaire developed for and validated in early dementia patients, is also applicable to glioma patients. The evaluation consisted of three steps. Predetermined decision rules defined which activities were retained, altered, added or excluded. In the first step, 6 neuro-oncology health care professionals (HCP) and 10 glioma patient-proxy dyads were asked to evaluate the 70 A-IADL-Q activities. In the second step, in-depth interviews were conducted with 6 HCPs and 6 other patient-proxy dyads to generate relevant activities specific to glioma patients not covered by the A-IADL-Q. In the third step, 6 new patient-proxy dyads were cognitively debriefed with the list of activities constructed in the previous steps. Results indicated that in step 1, after alterations and exclusions, 28/70 activities could be retained. Nine newly generated activities were subsequently added in step 2. In step 3, the 37 activities were presented to the patient-proxy dyads. Based on their input, several additional alterations and exclusions were made resulting in a list of 32 activities. In conclusion, this evaluation of the A-IADL-Q showed that dementia-specific IADL activities are only partly applicable to glioma patients, and that the addition of glioma specific IADL activities is necessary to capture the IADL construct. This underlines the need for a disease-specific IADL questionnaire for brain tumor patients.