DOMS: Function Measures & Tools

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:

Alzheimer’s Disease Cooperative Study MCI Activities of Daily Living Inventory (ADCS-MCI-ADL)

Authors: Pedrosa et al., 2010
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

Galasko, D., Bennett, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M., & Ferris, S. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. Alzheimer Disease & Associated Disorders, 11, S33–S39.
Pedrosa, H., De Sa, A., Guerreiro, M., Maroco, J., Simões, M. R., Galasko, D., & de Mendonça, A. (2010). Functional evaluation distinguishes MCI patients from healthy elderly people—the ADCS/MCI/ADL scale. The Journal of Nutrition, Health & Aging, 14(8), 703–709.

Barthel Index

Authors: Mahoney & Barthel, 1965
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

Kidd, D., Stewart, G., Baldry, J., Johnson, J., Rossiter, D., Petruckevitch, A., & Thompson, A. J. (1995). The Functional Independence Measure: A comparative validity and reliability study. Disability and Rehabilitation, 17(1), 10–14.
Mahoney, F.I & Barthel, D. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 56–61.
Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703–709.

Bayer Activities of Daily Living (Bayer ADL)

Authors: Hindmarch et al., 1998
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:

Test form

References

Hindmarch, I. (1998). The Bayer Activities of Daily Living Scale (B-ADL). Dementia and Geriatric Cognitive Disorders, 9, Suppl 2(2), 20–26.
Erzigkeit, H. (2001). The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries. Dementia and Geriatric Cognitive Disorders, 12(5), 348–358.
Reppermund, S. (2013). Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney Memory and Ageing Study. Psychological Medicine, 43(11), 2437.

Blessed Dementia Scale (BDS)

Authors: Blessed et al., 1968
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:

Test form

References

Blessed, G. (1988). Blessed-Roth Dementia Scale (DS). Psychopharmacology Bulletin, 24(4), 705–707.
Erkinjuntti, T. (1988). The blessed dementia scale as a screening test for dementia. International Journal of Geriatric Psychiatry, 3(4), 267–273.

Cleveland Scale for Activities of Daily Living (CS-ADL)

Authors: Patterson et al., 1992
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

Neundorfer, M. M., McClendon, M. J., Smyth K. A., Stuckey J. C., Strauss, M. E., & Patterson, M. B. (2001). A longitudinal study of the relationship between levels of depression among persons with Alzheimer’s disease and levels of depression among their family caregivers. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 56(5), 301–313.
Patterson, M. B., Mack, J. L., Neundorfer, M. M., Martin, R. J., Smyth, K. A., & Whitehouse, P. J. (1992). Assessment of functional ability in Alzheimer disease: A review and a preliminary report on the Cleveland Scale for Activities of Daily Living. Alzheimer Disease and Associated Disorders, 6, 145–163.
Patterson, M. B., & Mack, J. L. (2001). The Cleveland Scale for Activities of Daily Living (CSADL): Its Reliability and Validity. Journal of Clinical Geropsychology, 7(1), 15–28.
Patterson, M. B., & Mack, J. L. (2008). Cleveland Scale for Activities of Daily Living (CSADL): Manual, Revised Edition.

Direct Assessment of Functional Status (DAFS)

Authors: McDougall et al., 2010
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:

DAFS-Extended protocol

References

Lima-Silva, T. B., Bahia, V. S., Carvalho, V. A., Guimarães, H. C., Caramelli, P., Balthazar, M. L. F., Damasceno, B., Bottino, C. M., Brucki, S. M., Nitrini, R., & Yassuda, M. S. (2015). Direct and indirect assessments of activities of daily living in behavioral variant frontotemporal dementia and alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 28(1), 19–26.
Loewenstein, D. A., Amigo, E., Duara, R., Guterman, A., Hurwitz, D., Berkowitz, N., Wilkie, F., Weinberg, G., Black, B., Gittelman, B., & Eisdorfer, C. (1989). A new scale for the assessment of functional status in Alzheimer’s disease and related disorders. Journals of Gerontology, 44(4), 114–21.
McDougall, G. J., Becker, H., Vaughan, P. W., Acee, T. W., & Delville, C. L. (2010). The Revised Direct Assessment of Functional Status for Independent Older Adults. The Gerontologist, 50(3), 363–370.

Disability Assessment for Dementia (DAD)

Authors: Gelinas et al., 1999
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

de Rotrou, J. (2012). DAD-6: A 6-Item Version of the Disability Assessment for Dementia Scale Which May Differentiate Alzheimer’s Disease and Mild Cognitive Impairment from Controls. Dementia and Geriatric Cognitive Disorders, 33(2-3), 210–218.
Gélinas, I., Gauthier, L., McIntyre, M., & Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53(5), 471–481.

Functional Independence Measure (FIM)

Authors: Granger & Hamilton, 1987
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

Kidd, D., Stewart, G., Baldry, J., Johnson, J., Rossiter, D., Petruckevitch, A., & Thompson, A. J. (1995). The Functional Independence Measure: A comparative validity and reliability study. Disability and Rehabilitation, 17(1), 10–14.
Turner-Stokes, L., Nyein, K., Turner-Stokes, T., & Gatehouse, C. (1999). The UK FIM+FAM: development and evaluation. Clinical Rehabilitation, 13, 277–87.

Katz Index of ADL (Katz ADL)

Authors: Katz et al., 1963
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:

Test form

References

Asberg, K. H. (1987). Disability as a predictor of outcome for the elderly in a department of internal medicine. A comparison of predictions based on index of ADL and physician predictions. Scandinavian Journal of Social Medicine, 15(4), 261–265.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185(12), 914–919.
Stolee, P., Stadnyk, K., Myers, A. M., & Rockwood, K. (1999). An individualized approach to outcome measurement in geriatric rehabilitation. Journals of Gerontology Series A-Biological Sciences And Medical Sciences, 54(12), M641–7.

Lawton & Brody Instrumental Activities of Daily Living (Lawton & Brody IADL)

Authors: Lawton & Brody, 1969
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

Fillenbaum, G. G. (1988). Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services Procedures. Erlbaum, Hillsdale, N.J.
Juva, K., Mäkelä, M., Erkinjuntti, T., Sulkava, R., Yukoski, R., Valvanne, J., & Tilvis, R. (1997). Functional assessment scales in detecting dementia. Age and Ageing, 26(5), 393–400.

Older Americans’ Resources and Services Instrumental Activities of Daily Living (OARS-IADL)

Authors: Fillenbaum, 1988
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:

Test form

References

Duke University Center for the Study of Aging and Human Development (1978). Multidimensional functional assessment: the OARS methodology. Durham, NC: Duke University Press.
Fillenbaum, G. G. (1988). Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services Procedures. Erlbaum, Hillsdale, N.J.