Dubbelman, Mark AntonVerrijp, MerikeFacal Mayo, DavidSánchez Benavides, Gonzalo AndrésBrown, Laura J. E.Flier, Wiesje Maria van derJokinen, HannaLee, AtheneLeroi, IracemaLojo Seoane, CristinaMilošević, VukMolinuevo Guix, José LuísPereiro Rozas, Arturo X.Ritchie, Craig WilliamSalloway, StephenStringer, GemmaZygouris, SteliosDubois, BrunoEpelbaum, StéphaneScheltens, PhilipSikkes, Sietske A.M.2022-01-072022-01-072020Dubbelman, M. A., Verrijp, M., Facal, D., Sánchez-Benavides, G., Brown, L. J. E., Flier, W. M., Jokinen, H., Lee, A., Leroi, I., Lojo-Seoane, C., Milošević, V., Molinuevo, J. L., Pereiro Rozas, A. X., Ritchie, C., Salloway, S., Stringer, G., Zygouris, S., Dubois, B., Epelbaum, S., . . . Sikkes, S. A. M. (2020). The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in eight countries. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 12(1), e12021. https://doi.org/10.1002/dad2.12021http://hdl.handle.net/10347/27327Introduction: To understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences. Methods: A total of 3571 individuals (67.1 ± 9.5 years old, 44.7% female) from The Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia, and Finland were included. Functional impairment was measured using the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis. Results: There were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: Effect sizes were low (ΔR2 range 0-0.03). Impact on total scores was minimal. Discussion: The results imply a limited bias for age, gender, education, and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia researcheng© 2020 The Authors. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, Inc. on behalf of Alzheimer’s Association. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are madeAlzheimer’s diseaseCross-cultural validationDementiaDifferential item functioningDiversityFunctional declineInstrumental activities of daily livingItem response theoryjournal article10.1002/dad2.120212352-8729open access