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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: wkcheah@hotmail.com.
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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

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