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ORIGINAL ARTICLE
The Activities of Daily Living Questionnaire
A Validation Study in Patients with Dementia
N. Johnson,*† A. Barion,*‡ A. Rademaker,*§ G. Rehkemper,k and S. Weintraub*†‡
Abstract: This study describes the development and validation of
the Activities of Daily Living Questionnaire (ADLQ), an informantbased assessment of functional abilities, in patients with probable
Alzheimer disease and other forms of dementia. The ADLQ measures
functioning in six areas: self-care, household care, employment and
recreation, shopping and money, travel, and communication. The
ADLQ was administered to 140 caregivers followed longitudinally in
the Northwestern Alzheimer’s Disease Center. In a subset of 28 participants, the total ADLQ score and each of the subscales were found
to be highly reproducible, with average concordance coefficients of
0.86. Concurrent validity was established by comparing the ADLQ
with the Record of Independent Living, a previously validated measure of level of dependency in daily living activities. The ADLQ was
also compared with other measures of dementia severity on the initial
and annual follow-up visits and was found to be significantly and
negatively correlated with the Mini-Mental State Examination and
positively correlated with the Clinical Dementia Rating Scale. The
ADLQ has high test-retest and concurrent validity and is consistent
with other measures of temporal decline in patients with probable
Alzheimer disease and other forms of dementia.
Key Words: activities of daily living, dementia
(Alzheimer Dis Assoc Disord 2004;18:223–230)
A
s the older population grows, chronic conditions, such as
dementia, have become a focus of medical practice. The
provision of long-term care for individuals with dementia is
emerging as a major public health problem in the foreseeable
future. Independent living skills are necessary for functioning
in the home and in the community. The functional disability
associated with dementia has a major impact on the quality of
life, not only of affected patients living in the community but
also of their caregivers.1 Functional assessment, therefore, is
important in making recommendations about appropriate
Received for publication June 19, 2003; accepted April 30, 2004.
From the *Cognitive Neurology and Alzheimer’s Disease Center, and the
Departments of †Psychiatry and Behavioral Sciences, ‡Neurology, and
§Preventive Medicine, Northwestern University Feinberg School of
Medicine, Chicago, IL; and kWaukesha Memorial Hospital, Waukesha, WI.
Supported by National Institute on Aging, Alzheimer’s Disease Core Center
grant AG 13854 to Northwestern University, Chicago.
Reprints: Nancy Johnson, PhD, Cognitive Neurology and Alzheimer’s Disease
Center, Northwestern University Medical School, 320 E. Superior, Searle
11-499, Chicago, IL 60611 (e-mail: johnson-n@northwestern.edu).
Copyright Ó 2004 by Lippincott Williams & Wilkins
settings of care, measuring disease severity, and determining
caregiver needs. For all of these reasons, the assessment of daily
living activities is increasingly recognized as a valuable outcome measure in clinical trials.2
Two main types of abilities are measured by functional
assessment scales. Basic activities of daily living (ADL) consist of activities that are performed daily, habitually and universally, such as dressing, bathing, and eating. In contrast, instrumental ADL require organization and planning, and include
such tasks as shopping, using transportation, preparing meals,
handling finances, keeping the house, and using a telephone.
Many of the early ADL scales were designed for use in
a rehabilitation setting3–5 and thus emphasize basic physical,
rather than cognitive, abilities. These scales are less applicable
to a dementia population where limitations in ADL are most
often the result of cognitive decline, while physical abilities
remain relatively intact for an extended time. In addition, most
of these scales require clinical observation of the patient and
are time-consuming and impractical in an outpatient clinical
setting. Several scales have been designed to detect early
signs of dementia,6–9 but the utility of these scales in identifying symptoms in later stages of dementia or tracking progression of symptoms after the onset of dementia has not been
established.
Several scales have been developed specifically for use
in the dementia population. The Daily Activities Questionnaire
was developed to assess instrumental and self-care activities of
daily living in patients with Alzheimer disease (AD).10 This
scale is observational and was designed to be completed by
an occupational therapist on an inpatient unit. The original
10-item scale was reduced to 5 items ordered along a continuum of difficulty from ‘‘eating’’ to ‘‘finances.’’ This scale
has been shown to have good construct and internal validity in
assessing clinical progression of AD. However, only a small
range of behaviors are rated, and there is no breakdown of
specific subscales (eg, communications, finances) which limits
its utility in non-Alzheimer’s dementia syndromes. In addition,
although this scale demonstrates good validity in the inpatient
population, it is not applicable for use in an outpatient clinical
setting. The Bristol Activities of Daily Living Scale11 is
a caregiver-rated instrument designed specifically for use in
the community. While this scale has the advantages of ease of
use, test-retest reliability was only fair or moderate on 8 of
22 items. In addition, more than half of the items (13 of 22) on
the scale rate basic ADL (eg, selecting food, eating food,
selecting drink, drinking); therefore, the total score is heavily
weighted by these tasks. Most individuals with dementia
would not experience a decline in these areas until the later
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stages of illness, and this scale is not likely to be sensitive to
early decline in higher level cognitive activities. No provision
is made for the calculation of functional subscales, so changes
in ADL that occur in patients with neuropsychologically focal
dementia syndromes (eg, primary progressive aphasia) would
not be easily detected. The Disability Assessment for Dementia scale is a caregiver interview developed for use in
clinical trials, which includes items to assess both basic and
instrumental ADL.12 The 46-item scale can be broken down
into three subdomains; initiation, planning and organization,
and performance. This scale has been shown to have good
reliability and validity and to be sensitive to decline in
performance over a 12-month period.13 While the usefulness
of this scale has been demonstrated in clinical trials, potential
limitations for use in clinical practice include the interviewbased administration, which may not be feasible in a busy
clinical setting, and the absence of questions to assess the
impact of focal cognitive decline in areas such as language.
This paper describes the validation of the Activities of
Daily Living Questionnaire (ADLQ) Scale, an instrument designed to measure ADL in an outpatient clinical population.
This scale was originally developed on the basis of clinical
experience with dementia patients and awareness of areas of
functional decline that are likely to have an impact on ADL.
The ADLQ scale was used in a study by Locascio et al14 and
has been shown to be consistent with other measures in
detecting temporal decline in individuals with probable AD.
This scale provides informant-based assessment of functional
abilities in dementia patients. In addition to a global impairment score, six subscale scores are calculated to assess decline
in the following areas: self-care, household care, employment
and recreation, shopping and money, travel, and communication. This scale is applicable to a wide range of dementia
syndromes and can be used to track progression of functional
decline over time.
METHODS
The items and categories of activities on the ADLQ scale
are shown in the Appendix. The rater, a primary caregiver, is
instructed to ‘‘score each item according to the patient’s current level of ability relative to his/her customary performance
prior to the onset of dementia symptoms.’’ The primary caregiver was defined as the person identified as having the most
frequent contact with, and responsibility for, assisting the
patient. Even when the ADLQ is completed at follow-up, the
instruction is the same so that the baseline standard for each
individual patient does not change over time.
The scale is divided into six sections addressing
different areas of activity, and each section has from three to
six items. Each of the items is rated on a 4-point scale from
0 (no problem) to 3 (no longer capable of performing the
activity). For each item, there is also a rating (9) provided for
instances in which the patient may never have performed that
activity in the past (‘‘Never did this activity’’), stopped the
activity prior to the onset of dementia (eg, stopped working
before dementia symptoms were apparent), or for which the
rater, for a variety of reasons, may not have information
(‘‘Don’t know’’).
224
Scoring
The total score, which has a range of 0 to 100, is calculated by the formula below:
Functional impairment ¼
Sum of all ratings
3 100
3 3 total number of items rated
The denominator represents the score that would have
been obtained if the most severe level of impairment had been
indicated for all items rated (excluding those rated ‘‘9’’). The
numerator represents the total of the actual ratings for all items
rated (excluding those rated ‘‘9’’). The resultant score represents the level of severity of impairment in ADL. The amount
of functional impairment is then rated as ‘‘none to mild’’ (0–33),
‘‘moderate’’ (34–66%), or ‘‘severe’’ (.66%). Functional
impairment scores are calculated for each subscale individually and for the total of all items.
Participants
Archival data from 140 primary caregivers of patients
with dementia who completed the ADLQ were obtained from
the database of the Northwestern Alzheimer’s Disease Center
Clinical Core registry. Primary caregivers included spouses,
adult children, siblings and close friends. Creation of the
Northwestern Alzheimer’s Disease Center registry was
approved by Northwestern University’s Institutional Review
Board. Additional data were collected from a subset of caregivers for study 2 (test-retest reliability) and study 3 (concurrent validity), and the specific numbers of participants in each
of these studies is described below. The patients had mixed
diagnoses of dementia and consisted of the following groups:
probable/possible AD (N = 65),15 vascular or mixed dementia
(N = 28),16 frontotemporal dementia,17 or primary progressive
aphasia (N = 44),18 and other (N = 3). The dementia group
included a wide range of severity levels as measured by the
Clinical Dementia Rating Scale (CDR)19 (average CDR, 1.0;
range, 0.5–3) and the Mini-Mental State Examination
(MMSE)20 (average MMSE, 21.7; range, 4–30) at the baseline
visit.
RESULTS
Administration and Response Characteristics
None of the caregivers in the study was unable to, or
refused to, complete the ADLQ. The average time of completion was between 5 and 10 minutes, and none of the participants reported difficulties in understanding the instructions or
individual items.
For a subset of 50 participants (25 males and 25 females,
randomly selected from the overall group), responses to individual items of the scale were evaluated to determine the
number of participants who rated the item as ‘‘Never did this
activity’’ or ‘‘Don’t know’’(ND/DK). The item most frequently
rated ND/DK was 3A-Employment (42%), most likely because
the ND/DK response includes the option ‘‘Retired before
illness.’’ The two other items most frequently rated as ND/DK
were 2E-Home Repairs (38%) and 5A-Public Transportation
(36%). This was accounted for by the fact that many of the
patients (females and males) never had responsibility for home
repairs or regularly used public transportation. All other items
were rated as ND/DK by fewer than 25% of the caregivers
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(average, 8%). We did not think that any of the individual
items were rated as ND/DK with sufficient frequency in either
male or female participants to warrant exclusion from the
overall ADLQ scale.
There were some expected gender differences in individual items rated as ND/DK, but only the Household Care
subscale was significantly different between male and female
participants (F1,48 = 4.74, p , 0.05). This difference was due to
that fact that male participants were rated as ND/DK more
frequently than female participants (0%) for the following
items: 2A-Preparing Meals (28%), 2B-Setting the Table
(16%), 2C-Housekeeping (24%), and 2F-Laundry (44%).
Female participants were more frequently rated as ND/DK
on item 2E-Home Repairs (52%, compared with 24% for
male participants). Because the ADLQ scale is based in part on
higher level instrumental ADL, it was expected that differences in the frequency of responses to certain gender-specific
items would be present between male and female participants.
However, because each participant’s score is based only on the
items applicable to that participant, completely eliminating
gender-related questions would restrict the scope of the ADLQ
and result in a loss of functionally useful information.
Study 1. Relationship Between ADLQ Score
and Other Measures of Severity (MMSE, CDR),
and Changes in ADLQ Over Time
Procedure
Data from the ADLQ, CDR,19 and MMSE20 were available for 140 participants at the initial and 1-year follow-up visits.
Results
To determine whether the ADLQ was a valid measure of
disease severity, we examined the correlation between MMSE
score and ADLQ at initial visit using a Pearson correlation,
and these values are presented in Table 1. The ADLQ was found
to be highly and negatively correlated with the MMSE,20 a
general measure of cognitive impairment. The ADLQ was also
compared with the CDR,19 a previously validated measure of
clinical progression and staging using a Spearman’s rank correlation, and these results are also given in Table 1.
A repeated-measures ANOVA was used to examine
change in ADLQ, MMSE, and CDR over time. All measures
showed significantly more impairment at the annual follow-up
visit (ADLQ: F1,139 = 73.1, p , 0.001; MMSE: F1,139 = 49.1,
p , 0.001; CDR: F1,139 = 29.8, p , 0.001) providing further
support that the ADLQ is a valid measure of disease progression. Mean change scores for the total ADLQ, subscales,
and the MMSE are given in Table 2. The average decline per
TABLE 1. Mean Total ADLQ Scores Over Time (N = 140)
Visit
Time
ADLQ
[Mean
(SD)]
CDR
[Mean
(SD)]
Correlation
w/ADLQ*
MMSE
[Mean
(SD)]
Correlation
w/ADLQ*
Initial
1 year
33.6 (20.0)
43.5 (21.0)
1.0 (0.5)
1.3 (0.6)
r = .50
r = .55
21.7 (5.3)
18.9 (6.7)
r = 2.42
r = 2.38
*All p , 0.001.
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Activities of Daily Living Questionnaire
year on the ADLQ (9.8) is consistent with the amount of
decline found on the Disability Assessment for Dementia scale
(11.6) over a 12-month period.13 All of the individual subscales
also showed a significant decline (all p , 0.001), although the
greatest change was noted on measures of instrumental ADL
such as shopping/money, travel, and household care. To determine whether decline on the ADLQ was related to baseline
level of functioning, a regression analysis was conducted using
baseline MMSE to predict change in ADLQ. The results of the
regression indicated no relationship between baseline MMSE
(F1,138 = 2.00, p = not significant) and amount of decline in
ADLQ.
Study 2. Test–Retest Reliability
Procedure
Twenty-eight caregivers of patients with a clinical diagnosis of probable AD based on the NINCDS-ADRDA
criteria15 participated in the study of test-retest reliability. All
28 participants had completed the ADLQ as part of a caregiver
questionnaire packet at the time of the patient’s regularly
scheduled research appointment. A second ADLQ was mailed
to the participants’ home 1 week after the appointment with
written instructions to complete the ADLQ and return it by
mail. The interval between the initial questionnaire and completed return of the second questionnaire varied between
2 weeks to 2 months, with the average time equivalent to
25.6 days (SD = 12.2 days). To determine whether participants
may have declined during the test-retest interval, a correlation
between the test-retest interval and change in ADLQ score was
performed. The results of this analysis showed a nonsignificant
correlation (r = 0.16; p = 0.40), suggesting an absence of
clinically significant decline during the test-retest interval.
The total score and each of the subscale scores at time 1
and time 2 were analyzed for test-retest reliability. The primary
statistical method used to compare the test and retest measures
was Lin’s concordance coefficient.21 This measure has a value
of ‘‘1’’ if the test and retest scores are identical, and a value of
‘‘0’’ if the measures are not reproducible. Confidence intervals
indicate the likely range of the true concordance. Mean test
and retest scores were compared using the paired t test.22 The
Pearson correlation coefficent was also calculated and tested
against zero using the t test. A nonsignificant paired t test and
a significant Pearson correlation coefficient are necessary but
not sufficient conditions for the test and retest scores to be
TABLE 2. Mean ADLQ Change Scores at 12 Months
(N = 140)
ADLQ Scales
Mean
(SD)
Self-care
Household care
Shopping/money
Employment/recreation
Travel
Communication
Total ADLQ change
MMSE
26.6
211.6
213.7
27.8
212.3
28.2
29.8
22.7
(13.5)
(33.2)
(27.2)
(24.0)
(23.9)
(16.5)
(13.8)
(4.6)
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similar. Kappa scores were used to examine test-retest reliability individually for each test question. Similar to the concordance coefficient, the closer the kappa score is to ‘‘1,’’ the
greater the agreement between time 1 and time 2.
Results
Table 3 gives the means, standard errors and ranges for
the test and retest measures for each subscale. The statistics are
also included for the difference between the two measures. The
p value for the paired t test will not be significant (p . 0.05) if
the test and retest measures have equal means. Table 4 gives
the correlation coefficient, the concordance coefficient, and the
95% confidence interval for the concordance coefficient.
These results indicate that the total ADLQ score is
highly reproducible, with a narrow confidence interval of high
values for the concordance coefficient. Except for the Employment and Recreation subscale, all other subscales show excellent reproducibility, with concordance coefficients of 0.86 or
higher, and lower confidence limits exceeding 0.73. Although
still within an acceptable range, the Employment and Recreation subscale showed slightly less reproducibility, with a
concordance coefficient lower than the other subscales. This
discrepancy was due primarily to the fact that four caregivers
rated the Employment question as ‘‘No longer works’’ (score = 3)
at time 1 and then rated it as ‘‘Never worked OR retired before
illness OR don’t know’’ (score = 9) at time 2.
Kappa scores to determine test-retest reliability for
individual items were also calculated and are given in Table 5.
Over half of the test items (54%) would be categorized23 as
having ‘‘good’’ Kappa scores (0.61–0.80), 21% have ‘‘very
good’’ scores (0.81–1.0), and 25% had ‘‘moderate’’ Kappa
scores (0.41–0.60). None of the kappa scores were below the
moderate range.
Study 3. Comparison of ADLQ and RIL Scores
Procedure
Concurrent validity of the ADLQ scale was assessed by
comparing ADLQ scores with those of a previously validated
informant-completed instrument, the Record of Independent
Living (RIL).24 The RIL is divided into three sections (Activities, Communication, Behavior). For the Activities and Communications sections, percent scores represent the degree to
which the patient requires assistance with a variety of ADL.
This is a different way of measuring severity of functional
impairment from the ADLQ. The Behavior section requires
caregivers to rate a list of behavioral features in two ways:
whether or not they were present prior to the onset of dementia
and whether or not they were present after the onset of
dementia. The three RIL subsections were compared with the
ADLQ subscales and total score using Pearson correlation
coefficients. Because the ADLQ does not measure behavioral
changes, we expected a high correlation between the ADLQ
and the Activities and Communication sections of the RIL, and
a low correlation between the behavior section of the RIL and
the ADLQ.
Twenty-nine caregivers of patients with mixed dementia
diagnoses completed the RIL and ADLQ at the same visit. The
diagnostic breakdown of the patients was as follows: 15 probable AD, 1 possible AD, 5 vascular dementia, 5 frontotemporal
dementia FTD, 3 primary progressive aphasia. The order of
completion of the scales was randomized among participants.
Results
The results of the correlation analysis are given in Table
6. As seen in Table 6, the total ADLQ score and Activities
section of the RIL were highly correlated (p , 0.001). All of
the ADLQ subscales were also significantly correlated with the
RIL Activities section. The Communication section of the RIL
was highly correlated with the Communication subscale of the
ADL Scale (p , 0.001). Correlations of the RIL Behavior
subsection with the ADLQ were minimal and ranged between
0.30 and 0.52. This analysis supports the convergent validity
and specificity of the ADLQ by demonstrating that: 1) the total
ADLQ correlates highly with a previously validated questionnaire measuring daily living activities in individuals with
dementia; 2) the Communication subscale correlates highly
with the Communication section of the RIL; 3) there is minimal correlation between the ADLQ subscales and a measure
of behavioral change.
DISCUSSION
This study describes the development and validation of
the ADLQ, a measure of functional capacity in patients with
probable AD and other forms of dementia. This scale has high
test-retest and concurrent validity, and has been shown to
accurately detect temporal decline in individuals with probable
Alzheimer’s Disease both in this and a previous study.14 In
TABLE 3. Test-Retest Reliability Values for Each ADLQ Subscale and Total Score (N = 28)
Test Time 1*
Subscale
Self-care
Household
Employment
Shopping
Travel
Communication
Total
Test Time 2
Difference
Mean (SD)
Range
Mean (SD)
Range
Mean (SD)
17.4
39.9
47.9
47.1
46.5
40.7
38.5
0–67
0–100
0–92
0–100
0–100
0–87
0–81
19.3
44.0
50.2
49.3
45.4
42.6
39.6
0–92
0–100
0–100
0–100
0–100
0–93
0–81
1.9
4.0
2.3
2.4
21.2
1.9
1.1
(19.6)
(33.4)
(28.9)
(39.7)
(32.9)
(22.9)
(23.9)
(20.7)
(33.1)
(28.2)
(34.7)
(31.1)
(23.9)
(22.4)
(06.8)
(13.8)
(23.7)
(18.5)
(16.6)
(10.5)
(06.4)
Range
p
211–25
220–47
234–100
234–50
227–45
213–27
29–17
.16
.13
.61
.50
.71
.35
.37
*Average time between test 1 and 2 was 25.6 days (range, 14–60 days).
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TABLE 4. Correlation and Concordance Coefficients of
Test-Retest Reliability (N = 28)
Subscale
Correlation
Coefficient
Significance
(p)
Self-care
Household
Employment
Shopping
Travel
Communication
Total
0.95
0.92
0.65
0.89
0.87
0.90
0.96
,0.001
,0.001
,0.001
,0.001
,0.001
,0.001
,0.001
95%
Concordance Confidence
Coefficient
Interval
0.94
0.91
0.65
0.88
0.86
0.90
0.96
0.87–0.97
0.81–0.96
0.38–0.82
0.76–0.94
0.73–0.93
0.79–0.95
0.92–0.98
addition, it is an informant-based rating that is easy to administer and well suited for an outpatient clinical setting. The scale
measures functioning in six areas: self-care, household care,
employment and recreation, shopping and money, travel, and
TABLE 5. Kappa Scores for Items On the ADLQ
Item
Self-care
Eating
Dressing
Bathing
Elimination
Taking pills
Personal appearance
Household care
Meal preparation
Setting table
Housekeeping
Home maintenance
Home repairs
Laundry
Employment and recreation
Employment
Recreation
Organizations
Travel
Shopping and money
Food shopping
Handling cash
Managing finances
Travel
Public transportation
Driving
Mobility in neighborhood
Travel outside familiar
Communication
Using telephone
Talking
Understanding
Reading
Writing
Kappa Score
0.91
0.81
0.65
*
0.78
0.42
0.47
0.73
0.77
0.53
0.64
0.78
1.00
0.67
0.86
0.85
0.70
0.66
0.60
0.58
0.92
0.76
0.54
0.71
0.71
0.63
0.42
0.74
*Kappa score for this item = 0 because all but two respondents rated the item as ‘‘0’’
for both time 1 and time 2.
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Activities of Daily Living Questionnaire
TABLE 6. Correlation between ADLQ and RIL Demonstrating
Concurrent Validity (N = 29)
Correlation Coefficients
ADL
Subscales
Activities
RIL Subscales
Communications
Behavior
Self-care
Household
Employment
Shopping
Travel
Communication
Total ADL
0.75†
0.84†
0.80†
0.79†
0.72†
0.69†
0.91†
0.46*
0.67†
0.45*
0.62†
0.39*
0.89†
0.71†
0.32
0.37
0.41*
0.52*
0.30
0.39*
0.46*
*p , 0.05.
†p , 0.001.
communication. The calculation of subscale scores allows for
the detection of impairments and identification of preserved
areas of functioning in focal dementia syndromes (eg, primary
progressive aphasia), where decline may not be consistent
across functional domains or may differ in pattern depending
on the nature of the dementia.18
Unlike the majority of other scales currently available,
the ADLQ measures the patient’s ability to carry out both basic
(eg, self-care) and instrumental (eg, employment) ADL and is
sensitive to detecting mild decline as well as more severe symptoms of disease progression. In addition, because the scale is
rated as a change from the patient’s typical baseline (ie, instructions are to compare with the patient’s level of ability in each
activity prior to the onset of dementia), it allows for flexibility
in scoring so that activities that were never part of the patient’s
behavioral repertoire are not counted in the total score. This
also helps correct for gender differences in customary responsibilities in this older population.
The ADLQ was sensitive to functional changes in individuals with mild to moderate dementia severity as measured
by a dementia screening measure (MMSE) well as by a standardized rating scale (CDR). In addition, the ADLQ was applicable to a wide range of dementia diagnoses. Although we did
not include a sample of individuals with mild cognitive impairment without dementia, it seems that the items may not be
sufficiently sensitive to detect changes in functional capacity
in that population without modifications. Such modifications
are being considered, however, because of the need for ADL
measures sensitive to early functional change in older individuals at a time when standardized neuropsychological measures may not detect abnormalities.
Most ADL scales have been designed to detect functional changes associated with AD since it is the most common
cause of dementia in the elderly. The ADLQ also measures
changes in communication ability and may be useful in detecting functional decline in patients with PPA or other focal
dementia syndromes. Individuals with these deficits may have
difficulties in a variety of activities due to these primary deficits; thus, the total score may show change, but the groups
are unlikely to be distinguished on the basis of subscale score
differences. Further studies are required on larger samples of
patients with different forms of dementia to determine if there
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are distinctive profiles on this measure. In addition, although
the current sample size was not sufficient for a principal components analysis of the ADLQ subscales, additional data are being
collected so that this issue can be addressed in a future study.
One potential limitation of the ADLQ was that it was
developed on the basis of clinical experience and there was no
caregiver involvement in the creation of the specific test items.
Although the scale was developed primarily for use by clinicians and, in that regard, has been shown to have good reliability
and validity, a future study may be warranted to determine the
degree to which ADLQ test questions correspond to areas of
concern raised by caregivers, and whether scores on the ADLQ
can be used in long-term care and treatment planning.
The ADLQ is a useful adjunct to the evaluation of the
individual with dementia. It provides a measure of the extent
of functional decline that can be measured over time. This
provides valuable information that physicians can potentially
use to assess the impact of pharmacological treatment on the
course of the dementia. It also can be used to counsel caregivers about areas of daily living that may require more support or intervention.
APPENDIX. Activities of Daily Living Questionnaire (ADLQ)
Instructions: circle one number for each item
1. Self-care activities
A. Eating
0 = No problem
1 = Independent, but slow or some spills
2 = Needs help to cut or pour; spills often
3 = Must be fed most foods
9 = Don’t know
B. Dressing
0 = No problem
1 = Independent, but slow or clumsy
2 = Wrong sequence, forgets items
3 = Needs help with dressing
9 = Don’t know
C. Bathing
0 = No problem
1 = Bathes self, but needs to be reminded
2 = Bathes self with assistance
3 = Must be bathed by others
9 = Don’t know
D. Elimination
0 = Goes to the bathroom independently
1 = Goes to the bathroom when reminded; some accidents
2 = Needs assistance for elimination
3 = Has no control over either bowel or bladder
9 = Don’t know
E. Taking pills or medicine
0 = Remembers without help
1 = Remembers if dose is kept in a special place
2 = Needs spoken or written reminders
3 = Must be given medicine by others
9 = Does not take regular pills or medicine OR Don’t know
228
APPENDIX. (continued) Activities of Daily Living Questionnaire
(ADLQ) Instructions: circle one number for each item
F. Interest in personal appearance
0 = Same as always
1 = Interested if going out, but not at home
2 = Allows self to be groomed, or does so on request only
3 = Resists efforts of caretaker to clean and groom
9 = Don’t know
2. Household care
A. Preparing meals, cooking
0 = Plans and prepares meals without difficulty
1 = Some cooking, but less than usual, or less variety
2 = Gets food only if it has already been prepared
3 = Does nothing to prepare meals
9 = Never did this activity OR Don’t know
B. Setting the table
0 = No problem
1 = Independent, but slow or clumsy
2 = Forgets items or puts them in the wrong place
3 = No longer does this activity
9 = Never did this activity OR Don’t know
C. Housekeeping
0 = Keeps house as usual
1 = Does at least half of his/her job
2 = Occasional dusting or small jobs
3 = No longer keeps house
9 = Never did this activity OR Don’t know
D. Home maintenance
0 = Does all tasks usual for him/her
1 = Does at least half of usual tasks
2 = Occasionally rakes or some other minor job
3 = No longer does any maintenance
9 = Never did this activity OR Don’t know
E. Home repairs
0 = Does all the usual repairs
1 = Does at least half of usual repairs
2 = Occasionally does minor repairs
3 = No longer does any repairs
9 = Never did this activity OR Don’t know
F. Laundry
0 = Does laundry as usual (same schedule, routine)
1 = Does laundry less frequently
2 = Does laundry only if reminded; leaves out detergent, steps
3 = No longer does laundry
9 = Never did this activity OR Don’t know
3. Employment and recreation
A. Employment
0 = Continues to work as usual
1 = Some mild problems with routine responsibilities
2 = Works at an easier job or part-time; threatened with loss of job
3 = No longer works
9 = Never worked OR retired before illness OR Don’t know
B. Recreation
0 = Same as usual
1 = Engages in recreational activities less frequently
2 = Has lost some skills necessary for recreational activities
(eg, bridge, golfing); needs coaxing to participate
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APPENDIX. (continued) Activities of Daily Living Questionnaire
(ADLQ) Instructions: circle one number for each item
3 = No longer pursues recreational activities
9 = Never engaged in recreational activities OR Don’t know
C. Organizations
0 = Attends meetings, takes responsibilities as usual
1 = Attends less frequently
2 = Attends occasionally; has no major responsibilities
3 = No longer attends
9 = Never participated in organizations OR Don’t know
D. Travel
0 = Same as usual
1 = Gets out if someone else drives
2 = Gets out in wheelchair
3 = Home- or hospital-bound
9 = Don’t know
4. Shopping and money
A. Food shopping
0 = No problem
1 = Forgets items or buys unnecessary items
2 = Needs to be accompanied while shopping
3 = No longer does the shopping
9 = Never had responsibility in this activity OR Don’t know
B. Handling cash
0 = No problem
1 = Has difficulty paying proper amount, counting
2 = Loses or misplaces money
3 = No longer handles money
9 = Never had responsibility for this activity OR Don’t know
C. Managing finances
0 = No problem paying bills, banking
1 = Pays bills late; some trouble writing checks
2 = Forgets to pay bills; has trouble balancing checkbook; needs
help from others
3 = No longer manages finances
9 = Never had responsibility in this activity OR Don’t know
5. Travel
A. Public transportation
0 = Uses public transportation as usual
1 = Uses public transportation less frequently
2 = Has gotten lost using public transportation
3 = No longer uses public transportation
9 = Never used public transportation regularly OR Don’t know
B. Driving
0 = Drives as usual
1 = Drives more cautiously
2 = Drives less carefully; has gotten lost while driving
3 = No longer drives
9 = Never drove OR Don’t know
C. Mobility around the neighborhood
0 = Same as usual
1 = Goes out less frequently
2 = Has gotten lost in the immediate neighborhood
3 = No longer goes out unaccompanied
9 = This activity has been restricted in the past OR
Don’t know
Activities of Daily Living Questionnaire
APPENDIX. (continued) Activities of Daily Living Questionnaire
(ADLQ) Instructions: circle one number for each item
D. Travel outside familiar environment
0 = Same as usual
1 = Occasionally gets disoriented in strange surroundings
2 = Gets very disoriented but is able to manage if accompanied
3 = No longer able to travel
9 = Never did this activity OR Don’t know
6. Communication
A. Using the telephone
0 = Same as usual
1 = Calls a few familiar numbers
2 = Will only answer telephone (won’t make calls)
3 = Does not use the telephone at all
9 = Never had a telephone OR Don’t know
B. Talking
0 = Same as usual
1 = Less talkative; has trouble thinking of words or names
2 = Makes occasional errors in speech
3 = Speech is almost unintelligible
9 = Don’t know
C. Understanding
0 = Understands everything that is said as usual
1 = Asks for repetition
2 = Has trouble understanding conversations or specific words
occasionally
3 = Does not understand what people are saying most of the time
9 = Don’t know
D. Reading
0 = Same as usual
1 = Reads less frequently
2 = Has trouble understanding or remembering what he/she has read
3 = Has given up reading
9 = Never read much OR Don’t know
E. Writing
0 = Same as usual
1 = Writes less often; makes occasional spelling errors
2 = Signs name but no other writing
3 = Never writes
9 = Never wrote much OR Don’t know
Scoring:
For each section (eg, self-care, household care, etc.), count the total
number of questions answered (ie, questions that are NOT rated
as ‘‘9,’’ Don’t know).
Multiply the total number of questions answered by 3. This equals the
total points possible for that section.
Add up the total score (ie, the sum of the responses) for that section
and divide by the total points possible. Multiply by 100 to get the
percent impairment.
EXAMPLE:
If the questions were answered as follows in section 1:
A. 0
B. 2
C. 9
D. 0
E. 1
F. 9
(continued on next page)
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Johnson et al
APPENDIX. (continued) Activities of Daily Living Questionnaire
(ADLQ) Instructions: circle one number for each item
The total number of questions answered would be 4 (A, B, D, and E),
total points possible is 12.
The total score for that section is 3 and the percent impairment is 3/12
or 0.25 times 100 = 25%.
Repeat this procedure for each section and sum up the total to get a
percent impairment score for the whole test.
ACTIVITIES OF DAILY LIVING
No. of
questions
answered
Total
score
Self Care Activities
Household Care
Employment and Recreation
Shopping and Money
Travel
Communication
TOTAL EACH COLUMN 0
TOTAL POINTS (no of questions 3 3) 0
TOTAL % (total score / total points) 0
0–33% = impairment
34–66% = moderate impairment
67+ % = severe impairment.
0–33% = impairment
34–66% = moderate impairment
67+% = severe impairment.
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