Academic journal article Iranian Journal of Public Health

Evaluation of Psychometric Aspects of Cleveland Scale of Activity Daily Living in the Diagnosis of Dementia in Iran

Academic journal article Iranian Journal of Public Health

Evaluation of Psychometric Aspects of Cleveland Scale of Activity Daily Living in the Diagnosis of Dementia in Iran

Article excerpt


Background: The purpose of this study was to design a valid questionnaire to the Iranian culture for dementia diagnosis and more specifically in its early stage.

Methods: A cross-sectional study was conducted in 2012 in Memory Clinic of Roozbeh Hospital and Iranian Alzheimer Association in Tehran in 2012. Among 235 subjects, there were 72 patients with Alzheimer's disease (AD), 137 patients with other types of dementia, and 26 subjects with Mild Cognitive Impairment (MCI), which 107 of them were male. Moreover, 42 healthy subjects were selected as control group. We considered psychometric properties of the Cleveland Scale of Activity Daily Living (CSADL) questionnaire and used standard making operations according to exploratory factor analysis.

Results: Three factors were extracted: self-care (21 items), language skills (14 items), and planning (7 items). Convergent validity was 0.86 and cut offpoint for total, basic and instrumental scores respectively was 20, 3 and 20.

Conclusion: It can be claimed that Persian Version of CSADL psychometric questionnaire has appropriate indicators and can serve as a useful tool for research in dementia and in its early stage. It can also enable the implementation of scientific research in academic and medical centers on dementia in general and Alzheimer's disease specifically in Iran.

Keywords: Psychometric characteristics, Dementia, Alzheimer's disease, Iran


According to WHO, all people aged more than 65 years are defined as old (1). The average annual growth rate of aged population over 65 is annually 2.5%. In Iran, the growth rate of 4.3% in 1995 has increased to 5.2% in 2005, and it is estimated to reach more than 7.2%. According to the report of WHO, by 2050, the number of elderly population in Iran will reach 26,393,000 people and at that time, elderly population will form 26% of population. Therefore, Iran society will change to aged population and we will face common aging disorders (2). Dementia mainly affects people over 65 years (3). Thus, memory impairment and amnesia is the most common disease in the old age. According to the statistics reported by the Iranian Alzheimer Association, about 450,000 patients suffer from this disease and the costs of medical treatments and care for them is very high. Hence, this trend in the coming years will cause a high financial cost and emotional burden on the health care system in Iran. Approximately 80% of patients with dementia receive care from family members. The amount of time spent providing care to these patients is significantly associated with the level of cognitive impairment and the patient's dysfunction. Psychological stress which caregivers incur, including the time spent away from community to care patient (an average of 11 hours a day), illness stigma, behavioral and Psychological Symptoms of Dementia (BPSD), insomnia, memory impairment and cognitive dysfunction(4).

Early diagnosis and treatment of the disease at early stages of the disease before can stop the course of destruction and consequently improve the quality of these patients' lives and reduce the burden of future maintenance costs. Dementia has not been considered as a major problem in Iran health system so diagnosis of dementia and create tools which are free of educational level and culture is very crucial in improving the national health care system. Most of available neuropsychological tests to recognize dementia are highly dependent to culture and education (years of schooling). Due to high rates of dementia in developing countries, illiteracy and low literacy levels in the countries such as Iran, there is an unmet need to develop appropriate scales, which are independent to education and culture (5).

This research was done to provide the psychometric properties of the Persian version of CSADL questionnaire for the patients with dementia and AD in Iran.

Materials and Methods

Used method in the present research was cross-sectional, descriptive and correlation one. …

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