Quality of Life Research

, Volume 28, Issue 1, pp 131–139 | Cite as

Mapping the Alzheimer’s Disease Cooperative Study-Activities of Daily Living Inventory to the Health Utility Index Mark III

  • Yin Bun CheungEmail author
  • Hui Xing Tan
  • Vivian Wei Wang
  • Nagaendran Kandiah
  • Nan Luo
  • Gerald C. H. Koh
  • Hwee Lin Wee



To map the Alzheimer’s Disease Cooperative Study—Activities of Daily Living Inventory (ADCS-ADL) to the Health Utility Index Mark III (HUI3) in people living with dementia (PWD) and to compare the performance of five methods for mapping.


A cross-sectional study of 346 dyads of community-dwelling PWD and family caregiver was carried out in Singapore. ADCS-ADL and HUI3 were rated by the family caregivers. Disease severity ratings and Mini Mental State Examination (MMSE) results were retrieved from medical records. A recently proposed mapping method called the Mean Rank Method (MRM) was described and applied, and the results were compared with regression-based mapping, including ordinary least squares, censored least absolute deviation (CLAD), Tobit and response mapping.


The MRM produced a mapped utility distribution that closely resembled the observed utility distribution. The standard deviations (SDs) of the observed and MRM-mapped utility were both 0.340, whereas the SDs of the other mapped utilities ranged from 0.243 (response mapping) to 0.283 (CLAD). Regressing the MRM- and CLAD-mapped and observed utility values upon disease severity and MMSE gave similar regression lines (each P > 0.05). Regressing the other mapped utility values upon the covariates under- (over-) estimated the utility of good (poor) clinical states. However, regression-based mapping methods gave a better fit at the individual level, as measured by root mean square error, mean absolute error and R2. K fold cross-validation gave similar results.


The MRM is accurate at the group level. The regression-based mapping methods are more accurate for making individual-level prediction. In addition, CLAD also performed reasonably well at the group level.


Activities of daily living Dementia Health utility Health Utility Index Mark III Mapping 


Author contributions

VWW, NK and HLW designed and conducted the cross-sectional study of dementia patients and caregivers. YBC and HLW conceived this specific aim for mapping ADL inventory to health utilities. YBC, HLW, NL and GCHK contributed to the development of the analysis strategy. YBC and HXT implemented the statistical analysis. YBC wrote the first draft of the article. All the authors critically reviewed the article and agreed with the submission.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2018_1991_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 KB)
11136_2018_1991_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 21 KB)
11136_2018_1991_MOESM3_ESM.xls (50 kb)
Supplementary material 3 (XLS 49 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Center for Quantitative MedicineDuke-NUS Medical SchoolSingaporeSingapore
  2. 2.Center for Child Health ResearchUniversity of Tampere and Tampere University HospitalTampereFinland
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  4. 4.Department of Hospital ManagementFudan UniversityShanghaiChina
  5. 5.Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
  6. 6.Department of PharmacyNational University of SingaporeSingaporeSingapore

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