Standard activities of daily living (ADL) scales developed in the 1960s and 1970s do not capture the subtle impairments seen in individuals with progressive mild cognitive impairment (MCI), which in many cases is due to prodromal Alzheimer's disease (AD). Given the promise of treatments now in development to modify the underlying AD process, early detection of MCI may become very important in future. De Vriendt and colleagues, whose paper has been chosen by the editorial team of International Psychogeriatrics, to be paper of the month in this issue, are to be congratulated for developing and validating the advanced ADL tool with the aim of providing a useful ADL measure to distinguish normal from pathological cognitive aging. They have assessed a large sample (150 people with AD, MCI and healthy controls) and report acceptable parameters for discrimination of these three groups using the instrument they have developed. The next step will be to try it out in a variety of clinical populations, settings, and cultures and perhaps to see how well it stacks up against other methods of detecting preclinical and prodromal AD (e.g. amyloid PET scans or lumbar punctures). The publication of this very good paper will allow other teams around the world to start using this user-friendly instrument and I await the outcome of further work on it with great interest.
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