Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-22T18:25:13.643Z Has data issue: false hasContentIssue false
  • English
  • Français

Multidimensionality of the Zarit Burden Interview across the severity spectrum of cognitive impairment: an Asian perspective

Published online by Cambridge University Press:  03 July 2012

Wee Kooi Cheah ,
Huey Charn Han ,
Mei Sian Chong ,
Philomena Vasantha Anthony  and
Wee Shiong Lim
Wee Kooi Cheah*
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Huey Charn Han
Affiliation:
Nursing Service, Tan Tock Seng Hospital, Singapore
Mei Sian Chong
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Philomena Vasantha Anthony
Affiliation:
Nursing Service, Tan Tock Seng Hospital, Singapore
Wee Shiong Lim
Affiliation:
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
*
Correspondence should be addressed to: Dr. Wee Kooi Cheah, Department of Geriatric Medicine, Tan Tock Seng Hospital, TTSH Annex, Level 2, 11 Jalan Tan Tock Seng, Singapore308433. Phone: +65-6357-7859; Fax: +65-6357-7837. Email: [email protected].
Get access

Abstract

Background: We aimed to examine the multidimensionality of the Zarit Burden Interview (ZBI) beyond the conventional dual-factor structure among caregivers of persons with cognitive impairment in a predominantly Chinese multiethnic Asian population, and ascertain how these dimensions vary across the spectrum of disease severity.

Methods: We studied 130 consecutive dyads of primary caregivers and patients attending a memory clinic over a six-month period. Caregiver burden was measured by the 22-item ZBI, and disease severity was staged via the Clinical Dementia Rating (CDR) scale. We performed principal component analysis (PCA) with varimax rotation to determine the factor structure of the ZBI. The magnitude of burden in each factor was expressed as the item to total ratio (ITR) and plotted against the stages of cognitive impairment. Descriptive and inferential statistics were applied to study the relationships between dimensions with disease and caregiver characteristics.

Results: We identified four factors: demands of care and social impact, control over the situation, psychological impact, and worry about caregiving performance. ITRs of the first three factors increased with severity of disease and were related to recipients’ functional status and disease characteristics. ITR in the dimension of worry about performance was endorsed highest across the spectrum of disease severity, starting as early as the stage of mild cognitive impairment and peaking at CDR 1.

Conclusion: Multidimensionality of ZBI was confirmed in our local setting. Each dimension of burden was unique and expressed differentially across disease severity. The dimension of worry about performance merits further study.

Keywords

caregiverscognitive impairmentdimensionsfactor analysisZarit Burden Interview
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1846 - 1854
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ankri, J., Andrieu, S., Beaufils, B., Grand, A. and Henrard, J. C. (2005). Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. International Journal of Geriatric Psychiatry, 20, 254–260, doi: 10.1002/gps.1275.CrossRefGoogle ScholarPubMed
Asia Pacific Members of Alzheimer's Disease International (2006). Dementia in the Asia Pacific Region: the epidemic is here. Access Economics Pty Ltd. Available at: http://www.alz.co.uk/research/files/apreport.pdf; last accessed 1 Feb 2011.Google Scholar
Bedard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A. and O'Donnell, M. (2001). The Zarit Burden Interview: a new short version and screening version. The Gerontologist, 41, 652–657.CrossRefGoogle ScholarPubMed
Chan, M., Tay, L. and Chong, M. S. (2011). Amnestic mild cognitive impairment and early Alzheimer's disease in an Asian memory clinic – evidence for a clinical spectrum. Dementia and Geriatric Cognitive Disorders, 1, 113–123.CrossRefGoogle Scholar
Chan, T. S. F., Lam, L. C. W. and Chiu, H. F. K. (2005). Validation of the Zarit Burden Interview. Hong Kong Journal of Psychiatry, 15, 9–13.Google Scholar
Choo, W. Y., Low, W. Y., Karina, R., Poi, P. J. H., Ebenezer, E. and Prince, M. J. (2003). Social support and burden among caregivers of patients with dementia in Malaysia. Asia Pacific Journal of Public Health, 15 (1), 23–29, doi:10.1177/101053950301500105.CrossRefGoogle ScholarPubMed
Chui, H. C., Victoroff, J. I., Margolin, D., Jagust, W., Shankle, R. and Katzman, R. (1992). Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology, 42, 473–480.CrossRefGoogle ScholarPubMed
Cohen, J. W. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn (pp. 79–81). Hillsdale, NJ: Laurance Erlbaum Associates.Google Scholar
Collin, C., Wade, D. T., Davies, S. and Horne, V. (1988). The Barthel ADL index: a reliability study. International Disability Studies, 10, 61–63.CrossRefGoogle ScholarPubMed
Garand, L., Dew, M. A., Eazor, L. R., DeKosky, S. T. and Reynolds, C. F. (2005). Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. International Journal of Geriatric Psychiatry, 20, 512–522, doi:10.1002/gps.1318.CrossRefGoogle ScholarPubMed
Hayton, J. C., Allen, G. D. and Scarpello, V. (2004). Factor retention decisions in exploratory factor analysis: a tutorial on parallel analysis. Organizational Research Methods, 7, 191–205, doi:10.1177/1094428104263675.CrossRefGoogle Scholar
Herbert, R., Bravo, G. and Preville, M. (2000). Reliability, validity and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging, 19, 494–507.CrossRefGoogle Scholar
Ko, K. T., Yip, P. K., Liu, S. I. and Huang, C. R. (2008). Chinese version of the Zarit Caregiver Burden Interview: a validation study. American Journal of Geriatric Psychiatry, 16, 513–518.CrossRefGoogle ScholarPubMed
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief form of the neuropsychiatric inventroy. The Journal of Psychiatry and Clinical Neurosciences, 58, 606–610.Google Scholar
Knight, B. G., Fox, L. S. and Chou, C. P. (2000). Factor structure of the Burden Interview. Journal of Clinical Geropsychology, 6, 249–258.CrossRefGoogle Scholar
Kumamoto, K. and Arai, Y. (2004). Validation of ‘personal strain’ and ‘role strain’: subscales of the short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8). The Journal of Psychiatry and Clinical Neurosciences, 58, 606–610.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Leggett, A. N., Zarit, S., Taylor, A. and Galvin, J. E. (2010). Stress and burden among caregivers of patients with Lewy Body Dementia. The Gerontologist, 51, 76–85, doi:10.1093/geront/gnq055.CrossRefGoogle ScholarPubMed
Lim, W. S., Chin, J. J., Lam, C. K., Lim, P. P. and Sahadevan, S. (2005). Clinical dementia rating: experience of a multi-racial Asian population. Alzheimer Disease & Associated Disorder, 19, 135–142.CrossRefGoogle ScholarPubMed
Losada, A. (2010). Development and validation of the caregiver guilt questionnaire. International Psychogeriatrics, 22, 650–660.CrossRefGoogle ScholarPubMed
Lu, L., Wang, L., Yang, X. and Feng, Q. (2009). Zarit Caregiver Burden Interview: development, reliability and validity of the Chinese version. The Journal of Psychiatry and Clinical Neurosciences, 63, 730–734, doi:10.111/j.1440-1819.2009.02019.x.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Sahadevan, S., Lim, J. P., Tan, N. J. and Chan, S. P. (2000). Diagnostic performance of two mental status tests in older Chinese: influence of education and age on cut-off values. International Journal of Geriatric Psychiatry, 15, 234–241.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Sahadevan, S., Lim, J. P., Tan, N. J. and Chan, S. P. (2002). Psychometric identification of early Alzheimer disease in an elderly Chinese population with differing educational levels. Alzheimer Disease & Associated Disorder, 16, 65–72.CrossRefGoogle Scholar
Seng, B. K. et al. (2010). Validity and reliability of the Zarit Burden Interview in assessing caregiving burden. Annals of the Academy of Medicine Singapore, 39, 758–763.CrossRefGoogle ScholarPubMed
Whitlatch, C. J., Zarit, S. H. and von Eye, A. (1991). Efficacy of interventions with caregivers: a reanalysis. The Gerontologist, 31, 9–14.CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E. and Bach-Perterson, J. (1980). Relatives of the impaired elderly, correlates of feelings of burden. The Gerontologist, 20, 649–655.CrossRefGoogle ScholarPubMed
Zarit, S. H. and Zarit, J. M. (1987). The memory and behavior problems checklist 1987R and the burden interview (technical report). Pennsylvania State University, USA.Google Scholar