title: ADCS Prevention Instrument Project: assessment of instrumental activities of daily living for community-dwelling elderly individuals in dementia prevention clinical trials.
abstract: BACKGROUND
  In primary prevention trials for Alzheimer disease, the inception cohort typically has normal or minimally impaired complex activities of daily living (ADL). ADL change during a trial could trigger detailed evaluation or serve as an outcome measure. A brief, easily administered, and reliable ADL rating scale would assist prevention studies.
  
  
  OBJECTIVE
  To develop an ADL scale for prevention trials that allows self-rating or completion by informants.
  
  
  METHODS
  The Activities of Daily Living-Prevention Instrument (ADL-PI) was developed, comprising 15 ADL and 5 physical function questions. Six hundred forty-four elderly subjects participating in the Prevention Instrument Project completed a self-rated version of the ADL-PI, and informants for 632 subjects completed an informant version. Informants also completed a Mild Cognitive Impairment (MCI) ADL questionnaire to allow comparisons.
  
  
  RESULTS
  Subjects performed well on all ADL scales at baseline. Completion of the ADL-PI questionnaires at home or in-clinic yielded comparable information. Scores from baseline to 3 months had good reliability. The ADL-PI, obtained from either self-report or informants, discriminated between subjects rated as CDR 0 and CDR 0.5. Subjects with worse baseline cognitive performance also had slightly worse ADL-PI scores. Preliminary analysis indicates that subjects who triggered cognitive evaluations had slightly lower baseline ADL-PI scores by both self and informant reports.
  
  
  CONCLUSIONS
  The ADL-PI can be completed at home or in clinic, and has adequate reliability. The utility of self-administered and informant versions and predictive value of reported deficits requires further follow-up.
authors.affiliation: Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0624, USA. dgalasko@ucsd.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Galasko
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
authors.forename: Mary
authors.initials: M
authors.lastname: Sano
authors.forename: Daniel
authors.initials: D
authors.lastname: Marson
authors.forename: Jeff
authors.initials: J
authors.lastname: Kaye
authors.forename: Steven D
authors.initials: SD
authors.lastname: Edland
mesh_terms: D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D000554:Ambulatory Care Facilities; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011322:Primary Prevention; D019727:Proxy; D011594:Psychometrics; D015203:Reproducibility of Results; D012647:Self-Assessment; D014481:United States