Open Access Highly Accessed Research article

Activities of daily living in dementia: revalidation of the E-ADL test and suggestions for further development

Katharina Luttenberger*, Anke Schmiedeberg and Elmar Gräßel

Author affiliations

Medical Psychology and Medical Sociology, Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany

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Citation and License

BMC Psychiatry 2012, 12:208  doi:10.1186/1471-244X-12-208

Published: 23 November 2012



The everyday practical capabilities of dementia patients have a direct influence on a patient’s independence and thus on the person’s quality of life and on the amount of care needed. These capabilities are therefore important as therapeutic goals and are also important from a health-economic point of view. To date, no economical and valid performance test is available. The E-ADL-Test developed by Gräβel et al. in 2009 is a short performance test that has, however, only been validated on a small sample thus far. The objective of the present study is to re-validate the E-ADL-Test and explore possibilities for further development.


The data were obtained from an RCT with a sample of 139 dementia patients in 5 nursing homes in Bavaria (Germany). The internal consistency was calculated as a measure of reliability. An item analysis was performed for the sample and subgroups with various degrees of dementia. Criterion and construct validity were tested based on five hypotheses. For validation, the residents’ capabilities were examined using the Barthel-Index (BI), the Nurses’ Observation Scale for Geriatric Patients (NOSGER), the Alzheimer’s Disease Assessment Scale (ADAS), and the Mini-Mental Status Examination (MMSE).


The internal consistency was .68 for the sample and .73 for the subgroup with severe dementia. The item analysis yielded good difficulty indices and discrimination power for moderate and severe dementia. The tasks were found to be too easy for mild dementia. The predictive criterion-related validity was confirmed by a correlation of r = .54 with the care level after 22 months and significant mean differences in the E-ADL-Test between persons with and without an increase in the care level. A differentiated correlation profile supported the three hypotheses on construct validity.


The E-ADL-Test in its current form is a valid and reliable instrument for assessing the ADL capabilities of patients with moderate and severe dementia. More difficult items should be developed for use with mild dementia.

Trial registration webcite Identifier: ISRCTN87391496

Activities of daily living; Dementia; Performance test; Reliability; Validity