A new tool to assess complex everyday activities in people with cognitive impairment

Image - A new tool to assess complex everyday activities in people with cognitive impairment

A new instrument to assist in research and clinicial assessments has been developed by Dr Simone Reppermund and her colleagues at the Centre for Healthy Brain Ageing (CHeBA) and The Department of Developmental Disability Neuropsychiatry (3DN) at UNSW. 

This tool is designed to assess instrumental activities of daily living (IADL), which are complex everyday functional skills necessary for independent living (such as managing medications, shopping, or handling finances).  Preserved IADL is one of the defining features distinguishing mild cognitive impairment (MCI) from dementia. 

While many researchers and clinicians rely on measuring IADL to monitor cognitive function, surprisingly there is no “gold-standard” instrument that is time-efficient and can be easily administered to assess complex everyday activities.  Self- and informant-ratings of IADL performance are the most popular because of their brevity and ease of administration. However, subjective measures have limitations.  Self-reports are prone to underestimate IADL deficits due to cognitive decline and lack of insight, whereas informant reports are prone to overestimate IADL deficits due to caregiver burden and depressive symptoms, or limited time that the informant spends with the patient.

Dr Simone Reppermund said that the new performance-based instrument, called the STAM (Sydney Test of Activities of daily living in Memory disorders) will assess everyday activities in a time-efficient and reliable way.  It has the advantage of objectively scoring individuals on their ability to perform everyday activities rather than relying on subjective self-ratings or second-party judgements.

“With an average administration time of 16 minutes, the STAM has the potential to be used widely in research as well as in clinical assessments,” said Dr Reppermund.

“It can be used to determine the level of functional impairment. This will be important in helping clinicians to diagnose dementia more reliably. It will assist with diagnostic classification for the detection of IADL impairment in the early stages of dementia.”

“A major advantage is STAM’s strong value to distinguish groups with normal cognition, MCI and dementia,” said Dr Reppermund. “In particular, we are able to distinguish between MCI and dementia with high sensitivity and specificity, whereas other performance-based instruments have been shown to have ceiling effects.”

Future work requires replication of the validation in an international sample.

The STAM and its psychometric properties were published in JAMDA.

Date Published: 
Thursday, 20 October 2016
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