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Related Concept Videos

Dementia l: Introduction01:22

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Dementia is an acquired, progressive syndrome characterized by a decline in multiple cognitive domains severe enough to impair daily functioning and reduce independence. Although memory loss is a central feature, the diagnosis requires additional deficits involving language, executive function, visuospatial skills, judgment, calculation, or abstract reasoning. These cognitive impairments reflect underlying neurodegenerative or vascular processes that gradually disrupt neuronal networks...
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Drawing a line: Differentiating mild from moderate dementia using the functional activities questionnaire.

Ersin Ersözlü1, Lukas Preis2, Aykut Aktuz3

  • 1Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Neurosciences, Hindenburgdamm 30, 12203, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Berlin, Germany.

The Journal of Prevention of Alzheimer'S Disease
|June 29, 2026
PubMed
Summary

The Functional Activities Questionnaire (FAQ) effectively distinguishes mild from moderate dementia. A score of 18 or higher is recommended for high sensitivity, while 23 or higher prioritizes specificity in dementia staging.

Keywords:
Alzheimer's diseaseDementia stagingFunctional activities questionnaireInstrumental activities of daily living

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Area of Science:

  • Neurology
  • Geriatrics
  • Neuroscience

Background:

  • Accurate differentiation between mild and moderate dementia is crucial for early intervention, especially with emerging amyloid-targeting therapies.
  • Functional impairment in instrumental activities of daily living is a key indicator of dementia progression.
  • The informant-based Functional Activities Questionnaire (FAQ) is widely used but lacks empirically validated cut-offs for distinguishing dementia severity.

Purpose of the Study:

  • To establish empirically validated cut-off scores for the Functional Activities Questionnaire (FAQ) to differentiate mild from moderate dementia.
  • To validate these cut-offs in independent, diverse patient cohorts.

Main Methods:

  • Utilized a large discovery cohort (NACC, n=34,513) to derive optimal FAQ thresholds using receiver operating characteristic analyses.
  • Validated the derived thresholds in two independent multicentric cohorts (ADNI, n=381; FTLDNI, n=74).
  • Dementia staging was based on the Clinical Dementia Rating (CDR) global score; functional impairment assessed via the 10-item FAQ.

Main Results:

  • The FAQ demonstrated excellent discrimination of moderate dementia in the NACC cohort (AUC=0.947).
  • A cut-off of ≥18 provided high sensitivity (96%) and specificity (87%), while ≥23 improved specificity (92%) with maintained sensitivity (83%).
  • Validation cohorts showed high sensitivity for the ≥18 threshold (ADNI: 92%, FTLDNI: 94%); older age and lower cognition were linked to misclassification.

Conclusions:

  • The FAQ reliably differentiates mild from moderate dementia across different cohorts.
  • A threshold of ≥18 maximizes sensitivity, while ≥23 maximizes specificity, allowing for context-dependent staging.
  • Individuals with FAQ scores of 18-22 may require further detailed clinical evaluation for precise staging.