Cognition · 16 items · 1.00–5.00 · Jorm AF (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24(1), 145–153.
Short IQCODE: Scoring, Cutoffs & Interpretation
A 16-item informant questionnaire rating an older person's cognitive change over the past 10 years, used to screen for possible dementia.
Think of how your friend or relative was 10 years ago, and compare it with how they are now. For each situation, indicate whether their performance has improved, stayed the same or got worse over those 10 years.
Much improved1
A bit improved2
Not much change3
A bit worse4
Much worse5
Score
01Compared with 10 years ago, how is this person at: remembering things about family and friends e.g. occupations, birthdays, addresses
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02Compared with 10 years ago, how is this person at: remembering things that have happened recently
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03Compared with 10 years ago, how is this person at: recalling conversations a few days later
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04Compared with 10 years ago, how is this person at: remembering his/her address and telephone number
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05Compared with 10 years ago, how is this person at: remembering what day and month it is
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06Compared with 10 years ago, how is this person at: remembering where things are usually kept
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07Compared with 10 years ago, how is this person at: remembering where to find things which have been put in a different place from usual
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08Compared with 10 years ago, how is this person at: knowing how to work familiar machines around the house
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09Compared with 10 years ago, how is this person at: learning to use a new gadget or machine around the house
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10Compared with 10 years ago, how is this person at: learning new things in general
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11Compared with 10 years ago, how is this person at: following a story in a book or on TV
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12Compared with 10 years ago, how is this person at: making decisions on everyday matters
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13Compared with 10 years ago, how is this person at: handling money for shopping
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14Compared with 10 years ago, how is this person at: handling financial matters e.g. the pension, dealing with the bank
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15Compared with 10 years ago, how is this person at: handling other everyday arithmetic problems e.g. knowing how much food to buy, knowing how long between visits from family or friends
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16Compared with 10 years ago, how is this person at: using his/her intelligence to understand what's going on and to reason things through
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Think of how your friend or relative was 10 years ago, and compare it with how they are now. For each situation, indicate whether their performance has improved, stayed the same or got worse over those 10 years.
Scored locally - nothing leaves this page
01Compared with 10 years ago, how is this person at: remembering things about family and friends e.g. occupations, birthdays, addresses
02Compared with 10 years ago, how is this person at: remembering things that have happened recently
03Compared with 10 years ago, how is this person at: recalling conversations a few days later
04Compared with 10 years ago, how is this person at: remembering his/her address and telephone number
05Compared with 10 years ago, how is this person at: remembering what day and month it is
06Compared with 10 years ago, how is this person at: remembering where things are usually kept
07Compared with 10 years ago, how is this person at: remembering where to find things which have been put in a different place from usual
08Compared with 10 years ago, how is this person at: knowing how to work familiar machines around the house
09Compared with 10 years ago, how is this person at: learning to use a new gadget or machine around the house
10Compared with 10 years ago, how is this person at: learning new things in general
11Compared with 10 years ago, how is this person at: following a story in a book or on TV
12Compared with 10 years ago, how is this person at: making decisions on everyday matters
13Compared with 10 years ago, how is this person at: handling money for shopping
14Compared with 10 years ago, how is this person at: handling financial matters e.g. the pension, dealing with the bank
15Compared with 10 years ago, how is this person at: handling other everyday arithmetic problems e.g. knowing how much food to buy, knowing how long between visits from family or friends
16Compared with 10 years ago, how is this person at: using his/her intelligence to understand what's going on and to reason things through
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) measures change in a person's everyday cognitive performance over the previous ten years, as judged by someone who knows them well. The short form in use here asks an informant - usually a spouse, adult child or close friend - to rate 16 everyday situations, from remembering recent conversations to handling money and learning to use new gadgets, on a five-point scale from "much improved" to "much worse". A rating of 3 means no change.
Because every item is anchored to the person's own earlier performance, the IQCODE measures decline from an individual baseline rather than current ability against a population norm. This is its defining property: a person with limited schooling and a university professor are both compared with their former selves, which makes the instrument far less confounded by education and premorbid ability than performance tests such as the MMSE. It captures cognition as it operates in daily life, and it can be completed when the patient themselves cannot be tested - in acute illness, when direct testing would be unreliable, or remotely.
02 - Origin & purpose
Where it comes from.
The IQCODE was developed by Anthony Jorm and Patricia Jacomb at the Australian National University, published in 1989 as a 26-item informant questionnaire 1. In the validation sample of 613 general-population informants it showed very high internal consistency (alpha 0.95) and, in 309 informants of dementing patients re-tested after a year, test-retest reliability of r 0.75. It was designed from the outset to assess decline independently of premorbid ability, addressing the long-standing complaint that brief cognitive tests penalise people with little education and flatter those with a lot.
In 1994 Jorm published the 16-item short form, derived from item analyses across four datasets and cross-validated against clinical dementia diagnosis 2. The short form correlates 0.98 with the full 26-item version and performs just as well against diagnosis, so it has become the recommended default in both research and clinical use. The IQCODE has since been translated into many languages and is one of the most widely studied informant instruments in dementia screening, with a dedicated suite of Cochrane diagnostic accuracy reviews 56.
03 - Scoring & cutoffs
How scoring works.
The 16 ratings are averaged, giving a score from 1 to 5. A mean of 3.0 means the informant reports no change over ten years; above 3 indicates decline, below 3 improvement. Unlike sum-scored questionnaires, missing items are handled naturally, because the score is a mean of the items completed. Screening cutoffs in the literature range from about 3.3 to 3.6: lower cutoffs favour sensitivity (fewer missed cases), higher cutoffs favour specificity (fewer false alarms). A cutoff of 3.44 is a widely used clinical compromise - in Harwood and colleagues' 1997 validation it identified every case of dementia (sensitivity 100%) while correctly reassuring 86% of those without 3. The Cochrane reviews note that studies rarely use identical cutoffs, so the threshold should be chosen for the setting, and the score should always prompt fuller assessment rather than act as a diagnosis 5.
Score
Severity
Interpretation
1.00–2.99
Improvement or no decline reported
The informant reports the person is the same as or better than 10 years ago. No screening concern from this instrument.
3.00–3.00
No change compared with 10 years ago
An average of exactly 3.00 means the informant reports no overall change over the past 10 years.
3.01–3.43
Some decline reported, below the usual screening threshold
Some decline is reported but the average falls below the usual screening threshold. Consider repeating over time and correlating with cognitive testing.
3.44–5.00
Positive screen - further assessment warranted
Cognitive decline at a level where further assessment for dementia is warranted. Common cutoffs range 3.3-3.6; 3.44 is the widely used clinical threshold.
The Short IQCODE is completed by an informant - a relative, friend or carer who has known the person well for at least 10 years - and not by the patient. It is a screening aid only and does not diagnose dementia; interpret it alongside clinical assessment, cognitive testing and history.
04 - Validation evidence
How well it performs.
The Short IQCODE was cross-validated at development: Jorm's 1994 analysis showed the 16-item form correlating 0.98 with the parent instrument and discriminating dementia as well as the full version 2. Internal consistency is consistently excellent - Jorm's 2004 review reports Cronbach's alpha between 0.93 and 0.97 across studies 4. In a meta-analysis of seven studies, the IQCODE separated dementia cases from non-cases with a weighted effect size of 1.75, slightly larger than the MMSE's 1.48 in the same analysis 4.
The most rigorous accuracy synthesis is the 2021 Cochrane review of secondary-care studies: pooled sensitivity 0.90 (95% CI 0.83-0.94) and specificity 0.54 (95% CI 0.44-0.64) for dementia in hospital settings 5. The high sensitivity supports its use for case-finding; the modest specificity in hospital populations means positive results over-call and must be followed by clinical assessment. Crucially for its intended purpose, IQCODE scores correlate only minimally with the patient's education and premorbid ability - the confounders that most trouble performance-based screens.
0.98
Correlation with 26-item IQCODE
Short 16-item form vs the original (Jorm 1994)
alpha 0.93-0.97
Internal consistency
Across studies (Jorm 2004 review)
100% / 86%
Sensitivity / specificity at 3.44
Medical inpatients (Harwood et al. 1997)
0.90 / 0.54
Pooled sensitivity / specificity
Dementia in secondary care (Cochrane 2021)
05 - How it compares
How it compares to the alternatives.
Instrument
Items
Time
When to reach for it
IQCODE
16, informant-rated
~5 min
You need baseline-relative change, the patient cannot be tested, or education/language make performance tests unfair
You want a free MMSE alternative with better sensitivity for mild neurocognitive disorder
06 - When to use it
Right tool, wrong tool.
The IQCODE is a screening aid for suspected dementia where an informant's perspective on decline is available and valuable. It complements, rather than replaces, direct cognitive testing and full clinical assessment.
Reach for it when
-A reliable informant who has known the patient for years is available
-You need decline from the person's own baseline, not a norm-referenced snapshot
-Education, language or literacy would bias a performance test
-Remote or telephone assessment, or triage before a memory-clinic referral
-Pairing with a performance test - informant report plus direct testing outperforms either alone
Reach for something else when
-No informant, or the informant has infrequent contact with the patient
-Detecting mild cognitive impairment - the evidence base is for dementia, not MCI
-Differentiating dementia subtypes - it grades decline, not aetiology
-Tracking short-term change or treatment response
-As a diagnostic instrument - a positive screen always needs full assessment
07 - Confidence & precision
Reading the score with care.
No standard error of measurement or minimal clinically important difference has been established for the IQCODE, and its score depends on the informant as much as the patient, so small differences around the cutoff should carry little weight. The sensible reading is categorical: clearly below ~3.3 is reassuring, clearly above ~3.6 warrants assessment, and the zone between is where informant quality, clinical context and a paired performance test should decide. Repeat measurement with a different informant is not comparable measurement.
08 - Limitations
What it cannot tell you.
The IQCODE inherits the biases of its informant: ratings are influenced by the informant's own mood (depression and anxiety inflate reported decline), by the quality of the relationship, and by how much contact they have with the patient. Specificity is modest in hospital settings (0.54 pooled), so it over-identifies in acutely unwell populations 5. The ten-year window is awkward when the informant has known the patient for less than a decade. Evidence for detecting MCI, as opposed to dementia, is limited. And like every screen on this site, it does not diagnose: it selects people for proper assessment.
[3]Harwood DMJ, Hope T, Jacoby R. Cognitive impairment in medical inpatients: screening for dementia - is history better than mental state? Age and Ageing 26(1):31-35. (1997) ↩
[4]Jorm AF. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): a review. International Psychogeriatrics 16(3):275-293. (2004) ↩
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