Close menu


Sunderland Repository records the research produced by the University of Sunderland including practice-based research and theses.

Instrumental activities of daily living scales to detect cognitive impairment and dementia in low- and middle income countries: a systematic review

Yemm, Heather, Robinson, Louise, Paddick, Stella-Maria, Dotchin, Catherine, Goodson, Michaela, Narytnyk, Alla, Poole, Marie and McArdle, Riona (2021) Instrumental activities of daily living scales to detect cognitive impairment and dementia in low- and middle income countries: a systematic review. Journal of Alzheimers Disease. ISSN 1387-2877

Item Type: Article


Background: The largest proportion of people with dementia worldwide live in lowand middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated or adapted for use in LMICs to guide selection of such tools.
Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies.
Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n=6), translated and adapted for cultural differences (n=6), or newly developed for target LMIC populations (n=7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good.
Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

IADL tools in LMICs JAD wellcome (1).pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (760kB) | Preview

More Information

Depositing User: Yitka Graham


Item ID: 13627
Identification Number:
ISSN: 1387-2877
Official URL:

Users with ORCIDS

ORCID for Heather Yemm: ORCID iD

Catalogue record

Date Deposited: 25 Jun 2021 10:56
Last Modified: 09 Aug 2021 09:15


Author: Heather Yemm ORCID iD
Author: Louise Robinson
Author: Stella-Maria Paddick
Author: Catherine Dotchin
Author: Michaela Goodson
Author: Alla Narytnyk
Author: Marie Poole
Author: Riona McArdle

University Divisions

Faculty of Health Sciences and Wellbeing > School of Nursing and Health Sciences


Sciences > Nursing

Actions (login required)

View Item (Repository Staff Only) View Item (Repository Staff Only)