title: Development and validation of a new performance-based measurement of instrumental activities of daily living in Taiwan.
abstract: BACKGROUND
  The performance-based instrumental activities of daily living (IADL) measurement is thought to improve the validity and reliability of conventional tools that rely on proxy reports. The aims of this study were to develop and validate a performance-based measurement of IADL for use in elderly patients with cognitive impairment in Taiwan and other Chinese-speaking communities.
  
  
  METHODS
  Referring to current versions of performance-based IADL, we developed the new Taiwan Performance-Based IADL (TPIADL) measurement to minimize literacy dependency and render it compatible with local culture. Participants performed tasks, including finding a telephone number, calculating the correct amount of change, reading the ingredients on a tin of food, finding food items on a shelf, and reading instructions on a medicine container. The internal consistency and convergent and criteria validity of the TPIADL were examined.
  
  
  RESULTS
  Altogether, 117 elderly subjects were invited to participate in this study, including 39 patients with dementia due to Alzheimer's disease, 29 with amnestic mild cognitive impairment, and 49 without cognitive impairment. The internal consistency of the TPIADL was 0.82. The TPIADL scores were significantly correlated with the Lawton Instrumental Activities of Daily Living Scale (r = 0.76, P < 0.001). The area under the relative operating characteristic curve was 0.90 (95% confidence interval = 0.84-0.97) to differentiate dementia due to Alzheimer's disease and others. The optimal cut-off point for the TPIADL was 6/7, which gives a sensitivity of 84.6% and a specificity of 75.6%.
  
  
  CONCLUSIONS
  The TPIADL is a validated instrument for the measurement of IADL in elderly subjects. It might replace conventional assessment as a valid and easily administered measurement.
authors.affiliation: Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.|Graduate School of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hui-Mei
authors.initials: HM
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Graduate School of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Wei-Lieh
authors.initials: WL
authors.lastname: Su
authors.affiliation: Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Graduate School of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Mei-Feng
authors.initials: MF
authors.lastname: Huang
authors.affiliation: Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Cheng-Sheng
authors.initials: CS
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology*; D060825:Cognitive Dysfunction / Q000175:diagnosis; D003704:Dementia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011932:Reading; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013624:Taiwan
keywords: cognitive correlates of everyday functioning; dementia; instrumental activities of daily living; performance-based measures