title: Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia.
abstract: OBJECTIVE
  While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia.
  
  
  METHODS
  A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative's everyday functioning.
  
  
  RESULTS
  Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative.
  
  
  CONCLUSIONS
  Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.
authors.affiliation: 1 School of Health Sciences, University of East Anglia, Norwich, United Kingdom.|2 Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, United Kingdom.
authors.forename: Clarissa M
authors.initials: CM
authors.lastname: Giebel
authors.affiliation: 3 Personal Social Services Research Unit, The University of Manchester, Manchester, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sutcliffe
authors.affiliation: 3 Personal Social Services Research Unit, The University of Manchester, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Challis
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000150:complications*; D003704:Dementia / Q000453:epidemiology / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis
keywords: activities of daily living; carers; dementia