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Alzheimer’s disease ⴢ Activities of daily living ⴢ Functional compared to the SV-ADLQ. Results: The T-ADLQ showed sig-
assessment ⴢ Activities of Daily Living Questionnaire ⴢ nificant correlations with the Mini-Mental State Examination
Validity ⴢ Technology assessment (MMSE), the Frontal Assessment Battery (FAB) as well as other
measures of functional impairment and dementia sever-
ity (MMSE: r = –0.70; FAB: r = –0.65; Functional Assessment
Abstract Questionnaire: r = 0.77; Instrumental Activities of Daily Living
Background: Information and communication technology Scale: r = –0.75; Clinical Dementia Rating Scale: r = 0.72; p <
(ICT) has become an increasingly important part of daily life. 0.001). The T-ADLQ showed a good reliability with a relatively
The ability to use technology is becoming essential for au- high Cronbach’s α-coefficient (Cronbach’s α = 0.861). When
tonomous functioning in society. Current functional scales considering a functional impairment cut-off point greater
for patients with cognitive impairment do not evaluate the than 29.25%, the sensitivity and specificity of the T-ADLQ
use of technology. The objective of this study was to devel- were 82 and 90%, respectively. The area under the receiver-
op and validate a new version of the Activities of Daily Living operating characteristic curve was 0.937 for the T-ADLQ and
Questionnaire (ADLQ) that incorporates an ICT subscale. 0.932 for the original version of the test. Conclusions: The
Method: A new technology-based subscale was incorporat- T-ADLQ revealed adequate indicators of validity and reliabil-
ed into the Spanish version of the ADLQ (SV-ADLQ), entitled ity for the functional assessment of activities of daily living
the Technology version of the ADLQ (T-ADLQ). The T-ADLQ in dementia patients. However, the inclusion of technology
was administered to 63 caregivers of dementia patients, 21 items in the T-ADLQ did not improve the performance of the
proxies of mild cognitive impairment patients and 44 prox- scale, which may reflect the lack of widespread use of tech-
ies of normal elderly subjects (mean age of the sample ± nology by elderly individuals. Thus, although it appeared
SD: 73.5 ± 8.30 years). We analysed the convergent validity, reasonable to add technology use questions to the ADLQ,
internal consistency, reliability cut-off point, sensitivity and our experience suggested that this has to be done cautious-
specificity of the T-ADLQ. The results of the T-ADLQ were ly, since the sensitivity of these additional items could vary
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Universidad de Valparaiso
Results are expressed as the mean ± SD; figures in parentheses indicate numbers. * p > 0.05: not significantly
different; ** p < 0.05: significantly different. Post-hoc analysis was carried out with the Games-Howell test.
Demographic and Clinical Data (79.7% of the answers), ’7D – Internet access’ (75.8%)
The total sample included 128 subjects (60 men and 68 and ’7A – Computer access’ (70.3%). The percentage of
women). The control group included 44 subjects (21 men ND/DK responses on items included in the original SV-
and 23 women), the MCI group included 21 subjects (10 ADLQ was 9.1 ± 7.42% and ranged from 51.6% (item ’5B
men and 11 women) and the dementia group included – Driving’) to less than 2% (items ’5A – Taking pills or
63 subjects (29 men and 34 women). Table 1 summarises medicine’, ’4E – Travel outside familiar environment’, ’2F
the demographic characteristics and clinical profiles of – Talking’, ’3F – Understanding’ and ’3D – Travel’). Items
the three groups. No significant differences (p > 0.05) that did not have any ND/DK answers were ’1A – Eating’,
were found between the three groups with respect to the ’1C – Bathing’, ’1D – Elimination’, ’1F – Interest in per-
age (F2, 127 = 0.892; p = 0.413), years of education (F2, 123 sonal appearance’, ’4B – Handling cash’ and ’6A – Using
2
= 3.08; p = 0.5) or sex (χ128, 2 = 0.910; p = 0.635). The the telephone’ (table 2).
three groups differed significantly in the global cognitive
efficiency (MMSE; F2, 127 = 73.367; p < 0.001), executive Answer Characteristics of the Technology Subscale
function (FAB; F2, 121 = 54.861; p < 0.001), functional as- To determine the effects of previous exposure to tech-
sessment (PFAQ; F2, 124 = 65.973; p < 0.001), IADL (F2, 116 nology, a multiple regression analysis (Enter Method)
= 50.87; p < 0.001) and total CDR scores (F2, 123 = 48.421; was performed with the percentage of ND/DK responses
p < 0.001). A post-hoc analysis revealed that dementia in the technology subscale as dependent variables and the
and MCI patients, as well as dementia patients and con- subject-based variables as independent variables (gender,
trols, were significantly different in all these measures (p years of education and age). The resulting regression
< 0.05). MCI patients and controls differed significantly model excluded gender as a factor. Age and education
only in the CDR scale (table 1). explained 32.4% of the total variance of the percent-
age of ND/DK (r2 = 0.324, F3, 120 = 19.17, p < 0.001).
Answer Characteristics There was a strong negative effect of years of education
For the set of 128 participants, the average number of (β-coefficient = –0.47, p < 0.001) and a positive effect of
ND/DK responses on items included in the Technology age (β-coefficient = 0.245, p = 0.002). In summary, the
subscale was 65.62 ± 36.79% (mean ± SD). The items percentage of ND/DK responses was lower in less edu-
most frequently rated as ND/DK were ’7E – E-mail access’ cated and older subjects. The mean percentage of ND/
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Universidad de Valparaiso
Results are expressed as the mean ± SD. * p > 0.05: not significantly different; ** p < 0.05: significantly differ-
ent. Post-hoc analysis was carried out with the Bonferroni test.
1.0
SV-ADLQ
T-ADLQ
Reference line
0.8
0.6
Sensitivity
0.4
Fig. 1. SV-ADLQ and T-ADLQ ROC for
the discrimination of patients with demen-
tia and normal controls. ROC curve for 0.2
each percentage of functional impairment
in the SV-ADLQ and the T-ADLQ for
discriminating between patients with de- 0.0
mentia and normal controls. An ROC sen- 0.0 0.2 0.4 0.6 0.8 1.0
sitivity curve was plotted against 1 minus 1 – specificity
the specificity. The most discriminative Comparison Instruments AuC Cut-off point Sensitivity Specificity (95%) CI
cut-off point was set nearest to the upper
Dementia vs. SV-ADLQ 0.932 29.25 0.810 0.909 0.888–0.976
left corner of the graph. CI = Confidence Control T-ADLQ 0.937 29.25 0.825 0.909 0.895–0.978
interval.
tionality at lower scores. The Technology subscale of the ity). Finally, the total T-ADLQ score showed a significant
T-ADLQ was significantly correlated with the PFAQ total negative correlation with the MMSE score (r = –0.70; p
score (r = 0.257; p = 0.004), the IADL (r = –0.21; p = 0.030) < 0.001) and the FAB (r = –0.65; p < 0.001; MMSE and
and the SV-ADLQ (r = 0.755; p < 0.001). The T-ADLQ FAB low scores indicate greater cognitive deterioration).
total score was also significantly correlated with measures In summary, the results showed that greater severity of de-
of dementia severity, such as the CDR score (r = 0.72; p < mentia correlated with greater functional impairment, and
0.001; higher CDR scores indicate greater dementia sever- lower global cognitive efficiency correlated with greater
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Universidad de Valparaiso
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