Mathuranath, PSGeorge, ACherian, PJMathew, RSarma, PS2012-12-042012-12-042005INTERNATIONAL PSYCHOGERIATRICS. 17; 3; 461-474http://dx.doi.org/10.1017/S1041610205001547http://www.ncbi.nlm.nih.gov/pubmed/16252378https://dspace.sctimst.ac.in/handle/123456789/637Objective: To develop and validate an Instrumental Activities of Daily Living Scale for elderly people (IADL-E) to use in conjunction with cognitive screening tests for dementia in an educationally and socioculturally heterogeneous population.Method: Eleven IADL items were selected and weighted for major factors causing heterogeneity in the population-gender, education, social (rural/urban) setting and age. Each item was rated for its applicability (yes/no), degree of disability (scored from 0 to 2) and causative impairment (cognitive and/or physical). From this a composite index of cognitive (CDI) or physical (PDI) disability was derived. Validation was performed retrospectively on 240 subjects: 135 without and 105 with dementia by DSM-IV.Results: The IADL-E had a high internal consistency (alpha = 0.95). The area under the receiver operating characteristic (ROC) curve was 0.97 (CI = 0.94-0.99). A cutoff score of 16 on CDI provided a sensitivity of 0.91, specificity 0.99 and positive predictive value 0.76 (at 5% base rate). IADL-E correlated highly with clinical (DSM-IV, K = 0.89), functional (CDR, 0.82) and cognitive (Mini-mental Status Examination, MMSE, 0.74) diagnoses. It showed good responsiveness, with the change on CDI over a median of 23 months correlating significantly with that on MMSE (coefficient =-0.382, CI=-0.667 to -0.098; p=0.009). Individual items had good interrater and test-retest reliability.Conclusions: The IADL-E is a reliable, sensitive and responsive scale of functional abilities useful in dementia screening in a socioculturally heterogeneous population.Neurology