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ADCS-ADL Scale, Scoring and Manual - Dementia Outcomes ...

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@]<br />

Alzheimer's Disease<br />

Cooperative Study<br />

Yes<br />

L<br />

Yes<br />

L<br />

No<br />

Don't<br />

Know<br />

0<br />

0<br />

0<br />

0<br />

Don't<br />

Yes No Know<br />

1<br />

0 0<br />

0 0<br />

01 01 0<br />

0<br />

0<br />

0<br />

01 0 0<br />

No<br />

Don't<br />

Know<br />

0<br />

0<br />

0<br />

0<br />

~@)ITlfl)~~@(G@)~@ [pJ@~@[f11[P@[fITlfl)<br />

<strong>ADCS</strong> - Activities of Daily Living Inventory<br />

7. In the past 4 weeks, did {8} use a telephone?<br />

8.<br />

Don't<br />

Yes No Know 9.<br />

0 0<br />

0 0<br />

If yes, which best describes his/her highest level of performance:<br />

Page 3 of 8<br />

;:. 5 D made calls after looking up numbers in white or yellow pages, or by<br />

4<br />

3<br />

2<br />

1<br />

dialing directory assistance<br />

D made calls only to well-known numbers, without referring to a directory<br />

or list<br />

D made calls only to well-known numbers, by using a directory or list<br />

D answered the phone; did not make calls<br />

D did not answer the phone, but spoke when put on the line<br />

In the past 4 weeks, did {8} watch television?<br />

If yes, ask all questions:<br />

Did (8):<br />

a) usually select or ask for different programs or his/her favorite show?<br />

b) usually talk about the content of a program while watching it?<br />

c) talk about the content of a program within a day (24 hours) after watching it?<br />

In the past 4 weeks, did {8} ever appear to pay attention to conversation or small<br />

talk for at least 5 minutes?<br />

Note: {5} did not need to initiate the conversation.<br />

If yes, which best describes his/her usual degree of participation:<br />

3 D usually said things that were related to the topic<br />

2 D usually said things that were not related to the topic<br />

1 D rarely or never spoke<br />

10. Did {8} clear the dishes from the table after a meal or snack?<br />

If yes, which best describes how he/she usually performed:<br />

;:. 3 D without supervision or help<br />

2 D with supervision<br />

1 D with physical help<br />

3<br />

<strong>ADL</strong> 1.0 2/99

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