Skip to main content Accessibility help

The newly revised interview for deteriorations in daily living activities in dementia (R-IDDD2): distinguishing initiative from performance at assessment

  • Clarissa M. Giebel (a1) (a2), David Challis (a3) and Daniela Montaldi (a2)



Minimal evidence exists on the detailed deficits in complex instrumental activities of daily living (IADLs) in mild dementia. The aim of this study was twofold, to validate a revised questionnaire focusing measuring the initiative and performance of IADLs in mild dementia and to explore the relationship between individual IADLs and patient and carer well-being.


A total of 183 carers of people with mild dementia completed a further modified Revised Interview for Deterioration in Daily Living Activities 2 (R-IDDD2), which comprised new activities such as computer use, as well as sub-activities on the performance scale. Carers also completed questionnaires assessing patient quality of life (QoL-AD), carer quality of life (AC-QoL), and burden (GHQ-12).


Persons with dementia were significantly poorer initiating than performing cleaning, doing repair work, and preparing a hot or cold meal, whereas being poorer at performing dressing and following current affairs. Using the computer, preparing a hot meal, finance, and medication management were most impaired, whereas more basic activities of dressing, washing oneself, brushing hair or teeth, and preparing a hot drink were most preserved. Poor initiative and performance on nearly all activities were significantly related to reduced carer and patient well-being.


The R-IDDD2 offers a platform to comprehensively assess everyday functioning. Deteriorations in initiative and performance need to be targeted separately in interventions, as the former requires effective triggering and the latter structured training and support. Most activities were significantly associated with well-being, particularly patient quality of life so that improving any activity should improve well-being.


Corresponding author

Correspondence should be addressed to: Clarissa Giebel, School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK. Phone: +44-1603-593259. Email:


Hide All
Afram, B. et al. (2014). Reasons for institutionalization of people with dementia: informal caregiver reports from 8 European countries. Journal of the American Medical Directors Association, 15, 108116.
Alzheimer Nederland (2012). DeltaPlan Dementie. Alzheimer Nederland.
Alzheimers New Zealand (2010). National Dementia Strategy 2010-2015. Wellington.
Ballard, C., Burns, A., Corbett, A., Livingston, G. and Rasmussen, J. (2013). Helping you to Assess Cognition: A Practical Toolkit for Clinicians. London: Alzheimer's Society.
Beerens, H. C. et al. (2015). Change in quality of life of people with dementia recently admitted to long-term care facilities. Journal of Advanced Nursing, 71, 14351447.
Brown, P. J., Devanand, D. P., Liu, X. and Caccappolo, E. (2011). Functional impairment in elderly patients with mild cognitive impairment and mild Alzheimer disease. Archives of General Psychiatry, 68, 617626.
Camic, P., Williams, C. M. and Meeten, F. (2013). Does a ‘singing together group’ improve the quality of life of people with dementia and their carers? A pilot evaluation study. Dementia, 12, 157176.
Chiong, W., Hsu, M., Wudka, D., Miller, B. L. and Rosen, H. J. (2014). Financial errors in dementia: testing a neuroeconomic conceptual framework. Neurocase, 20, 389396.
Clare, L. et al. (2000). Intervening with everyday memory problems in dementia of Alzheimer type: an errorless learning approach. Journal of Clinical and Experimental Neuropsychology, 22, 132146.
Clarke, D. E. et al. (2008). Apathy in dementia: clinical and sociodemographic correlates. Journal of Neuropsychiatry and Clinical Neuroscience, 20, 337347.
Department of Health (2009). Living Well with Dementia: A National Dementia Strategy. Accessible Summary. London: Department of Health.
Earnst, K. S. et al. (2001). Loss of financial capacity in Alzheimer's disease: the role of working memory. Aging, Neuropsychology, and Cognition, 8, 109119.
Elwick, H., Joseph, S., Becker, S. and Becker, F. (2010). Manual for the Adult Carer Quality of Life Questionnaire (AC-QoL). London: The Princess Royal Trust for Carers.
Fauth, E. B., Schwartz, S., Tschanz, J. T., Ostbye, T., Corcoran, C. and Norton, M. C. (2013). Baseline disability in activities of daily living predicts dementia risk even after controlling for baseline global cognitive ability and depressive symptoms. International Journal of Geriatric Psychiatry, 28, 597606.
Fieo, R., Manly, J. J., Schupf, N. and Stern, Y. (2014). Functional status in the young-old: establishing a working prototype of an extended-instrumental activities of daily living scale. Journal of Gerontology Medical Sciences, 69, 766772.
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Gelinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471481.
Gibson, G., Dickinson, C., Brittain, K. and Robinson, L. (2015). The everyday use of assistive technology by people with dementia and their family carers: a qualitative study. BMC Geriatrics, 15, 89.
Giebel, C. M., Challis, D. and Montaldi, D. (2016). A revised interview for deterioration in daily activities in dementia (R-IDDD) reveals the relationship between social activities and wellbeing. Dementia, 15, 10681081.
Giebel, C. M., Sutcliffe, C. and Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: a UK Study. Aging and Mental Health, 19, 6371.
Giebel, C. and Challis, D. (2015). Translating cognitive and everyday activity deficits into cognitive interventions in mild dementia and mild cognitive impairment. International Journal of Geriatric Psychiatry, 30, 6371.
Goldberg, D. and Williams, P. (1998). A User's Guide to the General Health Questionnaire. Windsor, UK: NFER-Nelson.
Griffith, H. R. et al. (2003). Impaired financial abilities in mild cognitive impairment. Neurology, 60, 449457.
Hoe, J., Katona, C., Roch, B. and Livingston, G. (2005). Use of the QoL-AD for measuring quality of life in people with severe dementia - the LASER-AD study. Age and Ageing, 34, 130135.
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E. and Hodges, J. R. (2013). Validation of the Addenbrooke's cognitive examination III in frontotemporal dementia and Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 36, 242250.
Jones, R. W. et al. (2015). Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: the DADE study. Alzheimer's & Dementia, 11, 280290.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914919.
Kurz, A., Pohl, C., Ramsenthaler, M. and Sorg, C. (2009). Cognitive rehabilitation in patients with mild cognitive impairment. International Journal of Geriatric Psychiatry, 24, 163168.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontolology, 9, 179186.
Liu-Seiffert, H. et al. (2015). Cognitive and functional decline and their relationship in patients with mild Alzheimer's dementia. Journal of Alzheimer Disease, 43, 949955.
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 2132.
Marson, D. C. et al. (2000). Assessing financial capacity in patients with Alzheimer's disease: a conceptual model and prototype instrument. Archives of Neurology, 57, 877884.
Martin, R. C. et al. (2013). Impaired financial abilities in Parkinson's disease patients with mild cognitive impairment and dementia. Parkinsonism and Related Disorders, 19, 986990.
Martyr, A. et al. (2012). Verbal fluency and awareness of functional deficits in early-stage dementia. Clinical Neuropsychologist, 26, 501519.
Martyr, A., Nelis, S. M. and Clare, L (2014). Predictors of perceived functional ability in early-stage dementia: self-ratings, informant ratings and discrepancy scores. International Journal of Geriatric Psychiatry, 29, 852862.
Mioshi, E., Bristow, M., Cook, R. and Hodges, J. R. (2009). Factors underlying caregiver stress in frontotemporal dementia and Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 27, 7681.
Mioshi, E., Kipps, C. M., Dawson, K., Mitchell, J., Graham, A. and Hodges, J. R. (2007). Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology, 68, 20772084.
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.
Norwegian Ministry of Health and Care Services (2007). Dementia Plan 2015. Norway: Norwegian Ministry of Health and Care Services.
Peres, K. et al. (2008). Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. Journal of the American Geriatrics Society, 56, 3744.
Razani, J. et al. (2014). The effects of declining functional abilities in dementia patients and increases in psychological distress on caregiver burden over a one-year period. Clinical Gerontology, 37, 235252.
Reisberg, B. et al. (1984). Functional staging of dementia of the Alzheimer's type. Annals of the New York Academy of Sciences, 435, 481483.
Sikkes, S. A. M. et al. (2012). A new informant-based questionnaire for instrumental activities of daily living in dementia. Alzheimer's and Dementia, 8, 536543.
Sutcliffe, C. L., Giebel, C. M., Jolley, D., Challis, D (2016). Experience of burden in carers of people with dementia at the margins of long-term care. International Journal of Geriatric Psychiatry, 31, 101108.
Teunisse, S., Derix, M. M. A. and van Crevel, H. (1991). Assessing the severity of dementia. Archives of Neurology, 48, 274277.
Teunisse, S. and Derix, M. M. (1997). The interview for deterioration in daily living activities in dementia: agreement between primary and secondary caregivers. International Psychogeriatrics, 9, 155162.
van der Vleuten, M., Visser, A. and Meeuwesen, L. (2012). The contribution of intimate live music performances to the quality of life for persons with dementia. Patient Education and Counselling, 89, 484488.
Verlinden, V. J. A., van der Geest, J. N., de Bruijn, R. F. A. G., Hofman, A., Koudstaal, P. J. and Arfan Ikram, M. (2015). Trajectories of decline in cognition and daily functioning in preclinical dementia. Alzheimer's and Dementia, doi: 10.1016/j.jalz.2015.08.001.
Vermeersch, S., Gorus, E., Cornelis, S. and De Vriendt, P. (2015). An explorative study of the relationship between functional and cognitive decline in older persons with mild cognitive impairment and Alzheimer's disease. British Journal of Occupational Therapy, 78, 166174.
Voigt-Radloff, S. et al. (2012). Interview for deterioration in daily living activities in dementia: construct and concurrent validity in patients with mild to moderate dementia. International Psychogeriatrics, 24, 382390.
Wübker, A. et al. (2015). Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries. European Journal of Health Economics, 16, 689707.


The newly revised interview for deteriorations in daily living activities in dementia (R-IDDD2): distinguishing initiative from performance at assessment

  • Clarissa M. Giebel (a1) (a2), David Challis (a3) and Daniela Montaldi (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed