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Background: The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly due to difficulties in
assessing function, an essential step in diagnosis.
Objectives: 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.
Design: 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 IDEAIADL
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.
Keywords: instrumental activities of daily living; validation; screening; dementia; Africa; Tanzania |
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