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Bayer Activities of Daily Living Scale

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Purpose

The purpose of the B-ADL is to assess deficits in functional performance of routine activities of daily living (ADL) for elderly individuals that have been diagnosed with mild cognitive impairments or mild to moderate dementia. It was originally designed by Hindmarch et al1 as cost effective way  for physicians to screen for the early signs of mild to moderate dementia as well as evaluate changes in ADL as it pertains to pharmacotherapeutic treatment.

Link to Instrument

Acronym B-ADL

Cost

Free

Populations

Alzheimer's Disease and Progressive Dementia
Mixed Populations

Key Descriptions

  • B–ADL scale was developed for assessing functional disability in the cognitively impaired elderly.
  • The B-ADL is a 25 item questionnaire that is to be filled out by the individual’s caregiver or another member of the individual’s life that is familiar with the individual’s everyday activities both prior to and following the first signs of cognitive impairment.
  • The informant rates a person’s ability to perform an activity on a scale of 1 to 10 for each of the 25 items, where 1 indicates ‘never’ and 10 indicates ‘always’ have difficulty.
  • In instances where an activity is not appropriate, not relevant, or unknown, the rater rates ‘not applicable’ or ‘unknown.’
  • The 25 items evaluate three separate domains of daily function:1
    - Items 1-2: Evaluate the individual’s ability to manage ADL’s and take care of themselves independently
    - Items 3 – 20: Evaluate the individual’s difficulty with specific ADL’s with specific emphasis on short and long term memory as well as functioning in familiar and unfamiliar surroundings
    - Items 21-25: Evaluate cognitive functions that are required for the management of everyday activities

  • Individual item scores are summed up. Items rated ‘not applicable’ and ‘unknown’ are not used for the computation of this sum score. The total is then divided by the number of items rated between ‘1’ and ‘10.’ Thus, the scale’s sum score is corrected for the number of irrelevant items and missing scores.
  • Total scores of the B-ADL range between values 1.00 and 10.00.
  • Higher score predicts an increased severity of dementia.

Number of Items

25

Equipment Required

  • Score sheet
  • Pen

Time to Administer

5-15 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Murtaza Khumri, PT, MHS-PT on 12/5/2014.

 

Revised by Eric Schneider, PT, MPT, OCS on 4/23/2017.

ICF Domain

Activity
Participation

Considerations

  • Intercultural differences require a reference or a gold standard, which can serve as a reliable and valid measure to match patient group across countries, which is lacking. Applicability of the B-ADL in different languages other than the ones researched needs to be assessed. Caregiver rating bias should be considered when implementing this scale. A study by Pfeifer et al, 2013, dementia, studied caregiver burden and depression as predictors of bias for mild cognitive impairment and mild alzheimer’s disease. Results showed negative 23.35 discrepancy between patient self-rating and caregiver rating of the patient for B-ADL suggesting a caregiver bias while assessing for dementia.
  • Due to the effects of cognitive decline, the B-ADL is routinely filled out by the patient’s primary caregiver or family member as the patient is unable to accurately answer each item.  The individual filling the measure must have a sufficient understanding of the patient’s current level of function as well as their level of function prior to the cognitive decline.
  • The reliability and validity of the B-ADL in various languages including, Spanish, Korean, German, Portuguese, and English have been assessed.  Furthermore, the reliability and validity of the B-ADL has remained consistent with the various cultural differences in the UK, Spain, Germany, Korea, and Brazil.2-5 If any activity listed within an item on the B-ADL is not common in a particular culture, the individual can mark, “Not Applicable” and the specific item is not taken into consideration for the scoring.  For example, Folquitto et al4 noted that 84.6% of the male samples chose, “Not Applicable” on item 13 as it is not customary for men to cook in Brazilian culture.

Nagaratnam et al6 suggests the use of the B-ADL in conjunction with the CDR scale as well as the MMSE in order to most accurately diagnose the level of cognitive decline in the elderly population. 

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Alzheimer's Disease and Progressive Dementia

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Cut-Off Scores

Mild to Moderate Dementia: (Folquitto et al, 2007; n = 33, mean age = 73.82 (5.88); CDR Mild = 15, CDR Moderate = 13; MMSE = 19.72 (6.06))

  • Cut-Off Score of 3.12 to differentiate between mild  to moderate dementia on the CDR scale (Sensitivity = 0.879, Specificity = 0.966)

Test/Retest Reliability

Alzheimer’s Dementia: Choi S et al, 2003, Alzheimer’s Dementia; n= 129; age 60 – 87 years; 54 patients with Alzheimer’s dementia (AD), 31 vascular dementia (VaD), 44 non-demented patients; Severity of dementia as per Global Deterioration Scale (GDS) Stages 1 to 5 evaluated by MMSE; Korean

  • Excellent test-retest reliability (ICC = 0.95)

Alzheimer’s Disease: (Choi et al, 2003)

  • Excellent test-retest reliability (ICC = 0.95)

Interrater/Intrarater Reliability

Dementia: Nagaratnam et al, 2013, Dementia; n = 66; (mild dementia n=33; moderated dementia n=33)

  • Excellent: Cronbach’s alpha > 0.8 (.94)

Internal Consistency

Dementia: Erzigkeit H et al, 2001, Dementia; n = 1433; minimum age 60 years; Severity of dementia as per Global Deterioration Scale (GDS) Stages 1 to 5 evaluated by MMSE; English, German, Spanish and French

    • Excellent internal consistency (Cronbach’s Alpha > 0.98 for all three samples; UK Sample = 0.987, Germany Sample = 0.987, Spain = 0.984)

Mild to Moderate Dementia: (Folquitto J et al, 2007)

  • Excellent: Cronbach’s alpha > 0.8 (.98)

Vascular Dementia: (Choi et al, 2003)

  • Excellent internal consistency (Cronbach’s Alpha = 0.982)

Alzheimer’s Disease: (Choi et al, 2003)

  • Excellent internal consistency (Cronbach’s Alpha = 0.982)

Mild to Moderate Dementia of the Alzheimer’s Type: (Nagaratnam et al, 2013; n = 66; mean age not reported; CDR Mild = 35, CDR Moderate = 31)

  • Excellent  internal consistency (Cronbach’s Alpha = 0.937)

Criterion Validity (Predictive/Concurrent)

Mild to Moderate Dementia of the Alzheimer’s Type: (Nagaratnam et al, 2013)

  • Adequate correlation with CDR scale (Spearman’s coefficient = 0.384, p = 0.001, 99% CI)
  • Adequate correlation with MMSE score (Spearman’s coefficient = -0.335, p = 0.006, 99% CI)

Vascular Dementia: (Choi et al, 2003)

  • Excellent correlation with MMSE (r = -0.77, p < 0.001)
  • Excellent correlation with Syndrome Kurz test (SKT) (r = 0.77, p < 0.001)

Alzheimer’s Disease: (Choi et al, 2003)

  • Excellent correlation with MMSE (r = -0.77, p < 0.001)
  • Excellent correlation with Syndrome Kurz test (SKT) (r = 0.77, p < 0.001)

Construct Validity

Mild to Moderate Dementia of the Alzheimer’s Type: (Nagaratnam et al, 2013)

  • Adequate discrimination between CDR scale (ROC = 0.722)

Mild to Moderate Dementia: (Folquitto et al, 2007)

  • Excellent discrimination between controls (CDR absent) and those with mild to moderate dementia (CDR mild & CDR moderate) (ROC = 0.97, p > 0.0001, 95% CI)

Vascular Dementia: (Choi et al, 2003)

  • Excellent to identify individuals with dementia using GDS stages 1-5 (ROC = 0.906, 95% CI)

Alzheimer’s Disease: (Choi et al, 2003)

  • Excellent to identify individuals with dementia using GDS stages 1-5 (ROC = 0.906, 95% CI)

Mixed Populations

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Cut-Off Scores

Mild Cognitive Impairments or Mild Alzheimer’s Disease: (Sanchez-Benavides et al, 2009; n = 277; mean age = 77.12 (2.94); GDS stage 1 & 2 = 0, GDS stage 3 = 78, GDS stage 4 = 130, GDS stage 5 = 43, GDS stage 6 = 26; *Non English speaking sample)

  • Cut-Off Score of 3.3 to differentiate between mild cognitive impairments and the transition to early Alzheimer’s Disease/GDS stage 4 (Sensitivity = 0.808, Specificity = 0.718)

Criterion Validity (Predictive/Concurrent)

Mild Cognitive Impairments or Mild to Moderate Dementia: (Sanchez-Benavides et al, 2009)

  • Excellent correlation with Blessed Dementia Rating Scale (BDRS) (Spearman correlation = 0.691, p < 0.01)
  • Excellent correlation with the Interview for Deterioration of Daily Living in Dementia (IDDD) (Spearman correlation = 0.793, p < 0.01)
  • Adequate correlation with MMSE ( Spearman correlation = -0.472, p <0.01)

Construct Validity

Mild Cognitive Impairments or Mild Alzheimer’s Disease: (Sanchez-Benavides et al, 2009)

  • Excellent discrimination between individuals with mild cognitive impairments and mild Alzheimer’s disease (GDS stage 4) (AUC = 0.838, p <0.05, 95% CI)

Mild Cognitive Impairments or Mild to Moderate Dementia: (Erzigkeit et al, 2001)

  • Excellent ability to identify individuals with manifestations of cognitive decline by discriminating between GDS stages 1-3 and GDS stages 4-5 (UK Sample ROC = 0.902, Germany Sample ROC = 0.928, Spain Sample ROC = 0.941, 95% CI for all ROC)

Bibliography

The Bayer activities of daily living scale (B-ADL). Available at: Accessed on October 10th, 2014.

Choi S, Na D, Erzigkeit H, et al. Validation of the Korean version of the Bayer activities of daily living scale. Human Psychopharmacology. August 2003;18(6):469-475.

Erzigkeit H, Lehfeld H, Hindmarch I, et al. The Bayer-Activities of Daily Living Scale (B-ADL): Results from a validation study in three European countries. Dementia And Geriatric Cognitive Disorders. September 2001;12(5):348-358.

Folquitto J, Bustamante S, Bottino C, et al. The Bayer - Activities of Daily Living Scale (B-ADL) in the differentiation between mild to moderate dementia and normal aging.Revista Brasileira De Psiquiatria. December 2007;29(4):350-353. 

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.

Hindmarch I, Lehfeld H, de Jongh P, Erzigkeit H. The Bayer Activities of Daily Living Scale (B-ADL). Dementia And Geriatric Cognitive Disorders . July 1998;9(Suppl 2):20-26.

Hughes CP, Berg L, Daneringer WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Brit J Psychiatry. 1982;140:566-572.

Nagaratnam N, Nagaratnam K, O’Mara D. Bayer-Activities of Daily Living scale in mild and moderate dementia of the Alzheimer type. American Journal Of Alzheimer's Disease And Other Dementias. December 2013;28(8): 784-789.

Pfeifer L, Drobetz R, Fankhauser S, Mortby M, Maercker A, Forstmeier S. Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: Impact of caregiver burden and depression on dyadic rating discrepancy across domains. International Psychogeriatrics. August 2013;25(8):1345-1355.

Sánchez-Benavides G, Manero R, Qui?ones-Ubeda S, de Sola S, Quintana M, Pe?a-Casanova J. Spanish version of the Bayer Activities of Daily Living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity. Dementia And Geriatric Cognitive Disorders. 2009;27(6):572-578.

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