Objective measures of IADl in clinical practice

[neuropsychstudent2021]

What are your guys thoughts on measures like the Texas Functional Living Scale in the assessment of dementia? Is there a certain level of impairment on the objective test that meet the criterion for adl as in the dsm-v, or again is that based on the data as a whole?

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[WisNeuro]

What are your guys thoughts on measures like the Texas Functional Living Scale in the assessment of dementia? Is there a certain level of impairment on the objective test that meet the criterion for adl as in the dsm-v, or again is that based on the data as a whole?

You have to map impairment onto the patient's actual circumstances. Take for instance a patient who has recently been widowed. They fail the financial section of the TFLS. Their recently passed spouse was also the one in the dyad who managed all of the household finances. Do they hqve an actual impairment, or did they never learn those skills in the first place. Also, these measures are losing their ecological validity. I have very few patients, even among the elderly, who write actual checks anymore. I have fewer still who have looked something up in a paper phonebook in the last few decades. I prefer some other measures, like Health and Safety from the ILS or the TOP-J if I want a number or don't have great information from records or collateral.

 

[PsyDr]

This is one of those psychometric vs practical things. You can support functional impairment that way. But the DSM5 parameters for neuropsych testing in neurocognitive disorders almost guarantees the functional impairment will be obvious based upon where they have to fall on the normal curve.


But I like the TFLS for some things. IMO, it's better than the NAB.

 

[neuropsychstudent2021]

You have to map impairment onto the patient's actual circumstances. Take for instance a patient who has recently been widowed. They fail the financial section of the TFLS. Their recently passed spouse was also the one in the dyad who managed all of the household finances. Do they hqve an actual impairment, or did they never learn those skills in the first place. Also, these measures are losing their ecological validity. I have very few patients, even among the elderly, who write actual checks anymore. I have fewer still who have looked something up in a paper phonebook in the last few decades. I prefer some other measures, like Health and Safety from the ILS or the TOP-J if I want a number or don't have great information from records or collateral.

So basically the measures are there in the case of when we cant make a correct judgment based of collateral,interview etc?

 

[WisNeuro]

So basically the measures are there in the case of when we cant make a correct judgment based of collateral,interview etc?

They are more there for if you need some confirmatory information, or you're trying to gild your assessment for legal reasons.

 

[neuropsychstudent2021]

They are more there for if you need some confirmatory information, or you're trying to gild your assessment for legal reasons.

Right, but what I mean is from your comment I understood it works in the same way that objective cognitive testing does in that its more for hypothesis testing or adding validity but ultimately the judgment is on the clinician based on all data.

 

[WisNeuro]

Right, but what I mean is from your comment I understood it works in the same way that objective cognitive testing does in that its more for hypothesis testing or adding validity but ultimately the judgment is on the clinician based on all data.

Yes, it's merely a tool in the box, and by far one of the less useful tools you should have in that box.

 

[AbnormalPsych]

Second all the opinions about interview, collateral, and subjective mapping onto patient's context/life. I've used and like the ILS if there is a need for some sort of objective data (usually based in the referral question / source).