Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

Abstract

Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

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

“…Cultural differences may influence the level of IADL performance that is considered abnormal. Expectations regarding the activities of older adults within different societies can vary and lead to a lower probability of the recognition of dementia by the patient's family members and community in lower and middle-income countries such as Serbia [17]. Also, living in the urban centers of a developed country might objectively require more complex skills in everyday life than living in a smaller town or rural environment of a developing country [18].…”

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities–focused research

“…Cultural factors are critical to take into considerations in the assessment of functional impairment. For example, in certain cultures, it may be customary for younger members of the family to manage the household and take care of financial matters, while elders play a more social role within the community as they are aging 122 . Similarly, older individuals who are illiterate or low educated may always have been dependent on others to support them in administrative and financial matters.…”

High-Mobility Group Box-1 and Its Potential Role in Perioperative Neurocognitive Disorders

“…Dementia is expected to affect 75 million patients worldwide by 2030 [32]. The catastrophic impact that dementia has for the patient, their caregivers and healthcare systems cannot be overestimated [33]; however, there are no studies detailing the effect that the perioperative progressive dementia states will have globally. The additional costs of providing healthcare to patients that develop postoperative delirium in the US has been estimated to be USD 32.9 billion/year [34].…”