Informant Questionnaire on Cognitive Decline in the Elderly
Encyclopedia
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is a questionnaire
Questionnaire
A questionnaire is a research instrument consisting of a series of questions and other prompts for the purpose of gathering information from respondents. Although they are often designed for statistical analysis of the responses, this is not always the case...

 that can be filled out by a relative or other supporter of an older person to determine whether that person has declined in cognitive functioning. The IQCODE is used as a screening test for dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

. If the person is found to have significant cognitive decline, then this needs to be followed up with a medical examination to determine whether dementia is present.

Rationale behind the IQCODE

Most screening tests for dementia involve a brief list of questions to directly assess cognitive functioning. Probably the best-known dementia screening test of this kind is the Mini-Mental State Examination
Mini-mental state examination
The mini–mental state examination or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia...

. A disadvantage of such tests is that they are affected by the person’s level of education
Education
Education in its broadest, general sense is the means through which the aims and habits of a group of people lives on from one generation to the next. Generally, it occurs through any experience that has a formative effect on the way one thinks, feels, or acts...

, familiarity with the dominant language
Language
Language may refer either to the specifically human capacity for acquiring and using complex systems of communication, or to a specific instance of such a system of complex communication...

 and culture in their country, and level of intelligence before the onset of dementia.

Because of this, cognitive screening tests can falsely indicate dementia in people with lower education, culturally and linguistically diverse backgrounds, and lower intelligence. Cognitive screening tests may also have the opposite problem, falsely indicating that a person does not have dementia, especially if that person had a higher level of education or intelligence originally. The IQCODE attempts to overcome this problem by assessing change from earlier in life, rather than the person’s current level of functioning. It does this by making use of the informant’s knowledge of both the person’s earlier and current cognitive functioning.

Content

The IQCODE lists 26 everyday situations where a person has to use their memory
Memory
In psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....

 or intelligence
Intelligence
Intelligence has been defined in different ways, including the abilities for abstract thought, understanding, communication, reasoning, learning, planning, emotional intelligence and problem solving....

. Examples of such situations include: “Remembering where to find things which have been put in a different place from usual” and “Handling money for shopping”. Each situation is rated by the informant for amount of change over the previous 10 years, using the following scale: 1. Much improved, 2. A bit improved, 3. Not much change, 4. A bit worse, 5. Much worse.

Scoring

The IQCODE is generally scored by averaging the ratings across the 26 situations. A person who has no cognitive decline will have an average score of 3, while scores of greater than 3 indicate that some decline has occurred. However, some users of the IQCODE have scored it by summing the scores to give a range from 26 to 130.

Various cutoff scores have been used to distinguish dementia from normality. In community samples, cutoff scores for likely dementia have ranged from 3.3 and above to 3.6 and above, while in patient samples the cutoff scores have ranged from 3.4 and above to 4.0 and above.

To improve the detection of dementia, the IQCODE can be used in combination with the Mini-Mental State Examination. A graphical method of combining the two tests has been developed and is known as the Demegraph.

Validity of the IQCODE

The IQCODE has been found to distinguish people who have or do not have dementia. A low score on the IQCODE in a person who does not currently have dementia has also been found to predict that they will develop dementia in the future.

The IQCODE has found to correlate highly with conventional dementia screening tests, such as the Mini-Mental State Examination, and to have moderate correlations with a range of neuropsychological tests. It has also been found to correlate with change in cognitive test scores over time.

The IQCODE has near-zero correlations with a person’s level of education or with their intelligence earlier in life. This is in contrast to conventional dementia screening tests like the Mini-Mental State Examination, which are affected by education and intelligence as well as the presence of dementia.

Other versions of the IQCODE

The original IQCODE has 26 items. A Short IQCODE has been developed, consisting of the 16 items, and has been found to be as valid as the full version. Because it is briefer and of equal validity, the Short IQCODE can generally be used in preference to the original version.

Because the IQCODE does not require the involvement of the person being assessed, it can be used to assess probable dementia in someone who is unable to be assessed because they have had a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

, developed delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

 or have died. A Retrospective IQCODE has been developed for this purpose.

The IQCODE has been translated into many languages, including Chinese, Danish, Dutch, Finnish, French, Canadian French, German, Italian, Japanese, Korean, Norwegian, Polish, Portuguese, Spanish and Thai.

See also

  • Abbreviated mental test score
    Abbreviated mental test score
    The abbreviated mental test score was introduced by Hodkinson in 1972 to rapidly assess elderly patients for the possibility of dementia. Its uses in medicine have become somewhat wider, e.g. to assess for confusion and other cognitive impairment, although it has mainly been validated in the...

     A shorter, 10 question screen for impaired cognition.
  • General Practitioner Assessment Of Cognition
    General Practitioner Assessment Of Cognition
    The General Practitioner Assessment of Cognition is a brief screening test for cognitive impairment introduced by Brodaty et al. in 2002. It was specifically developed for the use in the primary care setting.- The test :...

     A brief screening tool designed for General Practitioners and Primary Care Physicians
  • Mental status examination
    Mental status examination
    The mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice...

  • Montreal Cognitive Assessment
    Montreal Cognitive Assessment
    The Montreal Cognitive Assessment, MoCA, was created in 1996 in Montreal, Canada. It was validated in the setting of mild cognitive impairment, and has subsequently been adopted in numerous other settings clinically....


External links

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