The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in 8 countries

TL;DR

This study validates the Amsterdam IADL Questionnaire across eight countries, showing minimal bias from demographic and cultural diversity, thus supporting its use in international dementia research.

Contribution

It provides an international validation of the Amsterdam IADL Questionnaire, assessing and confirming its robustness across diverse populations with minimal bias.

Findings

Some activity endorsement differences observed

A few items showed statistically significant DIF

Minimal impact on total scores from demographic factors

Abstract

INTRODUCTION: To understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences. METHODS: 3,571 individuals (67.1 {\pm} 9.5 years old, 44.7% female) from the Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia and Finland were included. Functional impairment was measured using the Amsterdam IADL Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis. RESULTS: There were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: effect sizes were low ({\Delta}R2 range 0-0.03). Impact on total scores was minimal. DISCUSSION: The results imply a limited bias for age, gender, education and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia research.