Editor-in-Chief: Sherry A. Greenberg, PhD, RN, GNP-BC New York University Rory Meyers College of Nursing

WHY: Dementia is a neurodegenerative disease where functional ability in persons living with dementia (PLWD) declines over time. The majority of care costs in PWD are directly attributed to functional disability (Jutkowitz et al, 2017; Vandepitte et al, 2020). Compromised functional ability is unsafe for PLWD, anxiety provoking for families and costly for families, health care organizations and the US federal government (Alzheimer’s Association, 2026).  Valid  clinical information collected using reliable functional status instruments can be used to individualize care and design safe and supportive environments, thereby promoting the highest level of independence for individuals with dementia. Consequently, an effective and efficient method for measuring functional status is important.

BEST TOOL: The Functional Activities Questionnaire (FAQ) measures instrumental activities of daily living (IADLs), such as preparing balanced meals and managing personal finances. Functional changes in IADLs  are noted earlier in the dementia process because IALs require a higher cognitive ability compared to basic activities of daily living (ADLs) (Guo & Sapra, 2020). This instrument is useful in monitoring these functional changes over time. In addition to other measures, the FAQ may be used to differentiate those with normal cognition and mild cognitive impairment (Marshall et al., 2015). To further exemplify the importance and utilization of the FAQ, thousands of research participants across the United States are administered the FAQ annually as part of the National Alzheimer’s Coordinating Center (NACC) longitudinal research study taking place in 38 National Institute on Aging-funded Alzheimer’s Disease Centers.

TARGET POPULATION: Older adults with normal cognition, mild cognitive impairment (MCI), as well as mild, moderate, and severe dementia. The FAQ is appropriate for clinical settings, such as acute and primary care, rehabilitation, assisted living, and home settings, as well as for research.

VALIDITY AND RELIABILITY:  For PWD the FAQ is an accurate instrument with good sensitivity (80-98.0%), specificity (71-91%), and classification accuracy (84.7%). It demonstrates overall good reliability (0.52-0.95). Tests of validity have been performed establishing it as an instrument for the bedside and research because it can discriminate among different functional levels (including normal cognition from MCI), predict neurological exam ratings and mental status scores such as the Folstein Mini-Mental Status Examination (MMSE) and demonstrate sensitivity to change (Assis, 2014; Gonzalez, 2022; Malek-Ahmadi, 2015; Pfeffer, 1982; Teng et al, 2011).

STRENGTHS AND LIMITATIONS: The FAQ is efficient to administer to older adults giving consistent results across different professionals and settings including primary care settings, as well as with different forms of dementia (Mayo, 2013; Tabert et al., 2002). As with other instruments that measure functional activities using indirect approaches, there may be over or under estimation of abilities because of the lack of direct observations.

FOLLOW-UP:  Clinical monitoring of IADLs in PLWD is important to ensure environmental adaptations keeping these individuals safe. The measurement of IADLs is also important for advancing science. Therefore, the FAQ is an important measure for researchers.

MORE ON THE TOPIC:

Alzheimer’s Association. 2026 Alzheimer’s Disease Facts and Figures. Alzheimer's Dementia 2026;22. https://doi.org/10.1002/alz.71345.

Assis, L., de Paula, J., Assis, M. G., de Moraes, E. N., & Malloy-Dinis, L. F. (2014). Frontiers in Aging Neuroscience, 5(255), 1-7. doi: 10.3389/fnagi.2014.00255

González, D. A., Gonzales, M. M., Resch, Z. J., Sullivan, A. C., & Soble, J. R. (2022). Comprehensive Evaluation of the Functional Activities                         Questionnaire (FAQ) and Its Reliability and Validity. Assessment, 29(4), 748–763. https://doi.org/10.1177/1073191121991215

Guo HJ, Sapra A. Instrumental Activity of Daily Living. [Updated 2020 Nov 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553126/

Jutkowitz et al, 2017). Societal and family lifetime cost of dementia: Applications for policy. Journal of the American Geriatric Society, 65(10), 2169-2175. Doi:10.1111/jgs.15043

Malek-Ahmadi, M., Chen, K., Davis, K., Belden, C. M., Powell, J., Jacobson, S. A., & Sabbagh, M. N. (2015). Alzheimer’s Research & Therapy, 7(1), 2-9. doi: 10.1186/s13195-014-0092-z

Marshall, G. A. et al., (2015). Functional Activities Questionnaire that best discriminate and predict progression from clinically normal to mild cognitive impairment. Current Alzheimer’s Research, 12(5), 493-502. 

Mayo, A. M., Wallhagen, M., Cooper, B., Mehta, K., Ross, L., & Miller, B. (2013). Functional and mental status provide insight into judgment and problem solving among patients with dementia. International Journal of Geriatric Psychiatry, 28(5), 514–521.

Teng, E., Becker, B. W., Woo, E, Knopman, D. S., Cummings, J. L. & Lu, P. H. (2010). Utility of the Functional Activities Questionnaire fordistingushing mild cogntivie impairment from very mild Alzheimer’s disease. Alzheimer’s Disease & Related Disorders Association, 24(4): 348–353. doi:10.1097/WAD.0b013e3181e2fc84. 

Pfeffer, R.I., Kurosaki, T.T., Harrah, C.H. Jr., Chance, J.M., & Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37(3), 323-329.

Vandepitte, S. et al  (2020). Factors associated with costs of care in community-dwelling persons with dementia from a third party payor and societal perspective: A cross-sectional study. BMC Geriatrics, Open Access, 20:18 https://doi.org/10.1186/s12877-020-1414-6 

Weintraub, S., Salmon, D., Mercaldo, N., Ferris, S., Graff-Radford, N.R., Chui, H., & et al. (2009). The Alzheimer’s Disease Centers’ Uniform Data Set (UDS): The neuropsychologic test battery. Alzheimer’s Disease and Associated Disorders, 23(2), 91-101.

Functional Activities Questionnaire

Administration

Ask informant to rate patient’s ability using the following scoring system:

• Dependent = 3
• Requires assistance = 2
• Has difficulty but does by self = 1
• Normal = 0
• Never did [the activity] but could do now = 0

• Never did and would have difficulty now = 1

   

1.        Writing checks, paying bills, balancing checkbook

2.        Assembling tax records, business affairs, or papers

3.        Shopping alone for clothes, household necessities, or groceries

4.        Playing a game of skill, working on a hobby

5.        Heating water, making a cup of coffee, turning off stove after use

6.        Preparing a balanced meal

7.        Keeping track of current events

8.        Paying attention to, understanding, discussing TV, book, magazine

9.        Remembering appointments, family occasions, holidays, medications

10.        Traveling out of neighborhood, driving, arranging to take buses

TOTAL SCORE:

Evaluation

Sum scores (range 0-30). Cut-point of 9 (dependent in 3 or more activities) is recommended to indicate impaired function and possible cognitive impairment.

Pfeffer, R.I., Kurosaki, T.T., Harrah, C.H. Jr., Chance, J.M., & Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37(3), 323-329. Reprinted with permission of Oxford University Press.