Amsterdam IADL Questionnaire

Which version(s) of the Amsterdam IADL Questionnaire would you like to request?
- 30-items version
- 70-items version

If you are interested in the 70-items version, please contact us at AmsterdamIADL@amsterdamumc.nl.

My purpose for using the Amsterdam IADL Questionnaire is not-for-profit use (research and clinical).*
- Yes, i agree

For what purpose do you intend to use the tool(s)?*
- Academic research (funded)
- Academic research (unfunded)
- Clinical use (not-for-profit)

Could you briefly describe the project /research below?
Study aim*
Study population*
Sample size*
Study type*
Study start date*
MM slash DD slash JJJJ
Expected study end date*
MM slash DD slash JJJJ
Other measurement tools used*
Purpose of use*
Patient population*
Number of patients a week*
Other measurement tools used*

Which assessment method are you planning to use?*
- Online/Digital
- Paper-Pencil
Please note that the Amsterdam IADL Questionnaire was developed and validated using a digital administration.

Please complete your contact information.
Principal Investigator name / contact person*
Title First (given) name Family name
Name of organization*
Type of organization*
- University/College
- (University) Hospital
- Primary Care Group
- NHS Hospital Trust
- Other
Please specify*
Department*
Address*
Town State / province
Country*
Email address (if possible, please use your professional email address)*

For purposes of standardization and content, scoring and labeling, we wish to assure users of the questionnaire and interpreters of its results that the designation ‘Amsterdam IADL Questionnaire’ refers to the identical instrument and scoring in all cases. This allows comparison of scores across projects and applications. Please see all our terms and conditions below.
Terms and conditions*
- - It is not permitted to create a language version or culturally-modified version of the Amsterdam IADL Questionnaire without explicit prior permission. Please contact us at AmsterdamIADL@amsterdamumc.nl to discuss a collaboration to create a new translation.
- - The Amsterdam IADL questionnaire will not be handed over to third parties. We request you to inform us when the principal investigator signing this user agreement and/or the contact person of the clinic/project will change.
- - We request you to inform us when your study is accepted for publication.
- - All papers using the Amsterdam IADL Questionnaire should cite the original IADL paper(s) (70-items version: Sikkes et al., Alzheimers Dement (2012), 30-items version: Jutten et al., Alzheimers Dement (2017)).
- - All papers using the Amsterdam IADL Questionnaire should include the following copyrights in the acknowledgements: The Amsterdam IADL Questionnaire ©, 2010, Amsterdam Medical Center, Alzheimer Center Amsterdam; All rights reserved.
- - The study data should not to be used to develop another questionnaire with the same purpose as the Amsterdam IADL Questionnaire.
- - If you add questions to or delete questions from the A-IADL-Q, embed it into a larger questionnaire or modify its layout or order of questions; please contact us to discuss further details.
- - For free access to the Amsterdam IADL Questionnaire, we request up-to-date contact information. We may use your contact details to perform a yearly check of current A-IADL-Q use, and/or to request the non-identifiable data from your study for further development and validation of the questionnaire (notably, we will offer co-authorship according to the ICMJE guidelines in case this leads to publication).
- I agree to all terms and conditions

Professionals

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