title: Development and community-based validation of the IDEA study Instrumental Activities of Daily Living (IDEA-IADL) questionnaire.
abstract: BACKGROUND
  The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly due to difficulties in assessing function, an essential step in diagnosis.
  
  
  OBJECTIVE
  As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, to develop, pilot, and validate an Instrumental Activities of Daily Living (IADL) questionnaire for use in a rural Tanzanian population to assist in the identification of people with dementia alongside cognitive screening.
  
  
  METHODS
  The questionnaire was developed at a workshop for rural primary healthcare workers, based on culturally appropriate roles and usual activities of elderly people in this community. It was piloted in 52 individuals under follow-up from a dementia prevalence study. Validation subsequently took place during a community dementia-screening programme. Construct validation against gold standard clinical dementia diagnosis using DSM-IV criteria was carried out on a stratified sample of the cohort and validity assessed using area under the receiver operating characteristic (AUROC) curve analysis.
  
  
  RESULTS
  An 11-item questionnaire (IDEA-IADL) was developed after pilot testing. During formal validation on 130 community-dwelling elderly people who presented for screening, the AUROC curve was 0.896 for DSM-IV dementia when used in isolation and 0.937 when used in conjunction with the IDEA cognitive screen, previously validated in Tanzania. The internal consistency was 0.959. Performance on the IDEA-IADL was not biased with regard to age, gender or education level.
  
  
  CONCLUSIONS
  The IDEA-IADL questionnaire appears to be a useful aid to dementia screening in this setting. Further validation in other healthcare settings in SSA is required.
authors.affiliation: The Medical School, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Collingwood
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Stella-maria.paddick@ncl.ac.uk.
authors.forename: Stella-Maria
authors.initials: SM
authors.lastname: Paddick
authors.affiliation: Hai District Medical Office, Hai, Tanzania.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Kisoli
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dotchin
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.affiliation: Community Health Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbowe
authors.affiliation: Community Health Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mkenda
authors.affiliation: Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Urasa
authors.affiliation: Community Health Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: Hai District Medical Office, Hai, Tanzania.
authors.forename: Paul
authors.initials: P
authors.lastname: Chaote
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012424:Rural Population; D011795:Surveys and Questionnaires / Q000592:standards; D013636:Tanzania
keywords: Africa; Tanzania; dementia; instrumental activities of daily living; screening; validation