The Revised Memory and Behavior Problems Checklist

Description of Measure

The Revised Memory and Behavior Checklist (RMBC) (PDF, 130.42KB) is a 24-item caregiver-report measure revised from the original 64-item MBPC of observable behavioral problems in the loved one with dementia (Teri et al., 1992). It provides a total score plus scores for three subscale memory-related problems, affective distress and disruptive behaviors. Scores are computed for the presence or absence of each problem first, and then for caregiver “reaction” or the extent to which caregivers were “bothered” or “distressed” by each behavior. The questions derived from two sources: (a) 30 items from Zarit and Zarit (1983; Zarit et al., 1986, and Zarit et al., 1987) and (b) 34 items developed by the authors to include specific behaviors not assessed on the MBPC and thought to be easily observable and representative of memory-related problems (e.g., asking repeated questions), depression (e.g., crying) and disruptive behaviors (e.g., verbal aggression) in patients with dementia. The caregivers’ reaction to each behavior, or the extent of distress experienced, were scored as follows: Reactions are assessed by asking how ”upsetting” the behavior was on a Likert scale of 0 to 4 (0 = Not at all, 1= a little, 2 = moderately, 3 = very much, and 4 =extremely). Frequency of behaviors are assessed based on a Likert-scale of 0 to4 (0 = never occurs, 1 = occurs infrequently and not in the last week, 2 = occurred 1-2 times in the last week, 3 = occurred 3-6 times in the last week, and 4 = occurs daily or more often).

Validity and Reliability

Internal consistency for frequency and reaction was established by Cronbach’s alpha (.75 and .76, respectively), for memory-related problems, .82 and .77 for depression, and .62 and .70 for disruptive behaviors. Factor analysis confirmed 3 first-order factors, consistent with the subscales just named and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89.

Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment and caregiver burden. For example, the frequency sub-scale was correlated with the Hamilton Rating Scale for Depression (r=.44, p<.01), and Mini Mental State Examination score for the person with dementia was correlated with the Memory Problems sub-scale (r=-.48, p<.01). The validity of Reaction was found through correlations with measures of caregiver depression (CES-D) and burden (the Caregiver Stress Scale) with all subscales significantly correlated with caregivers’ depression or burden (rs=.29, .31, and .26; ps<.01).

Use with Ethnically Diverse Caregivers

RMBPC has been validated for use with ethnically diverse caregivers in several studies.

Roth et al in 2003 administered this scale to two ethnic groups (African-American and Hispanic) of family caregivers and found it to be reliable and valid for them, using the 3-factor model. Correlations with other caregiver and care-recipient measures such as the Leisure Time Satisfaction (LTS; Cronbach’s alpha = .80) and Positive Aspects of Caregiving (PAC; Cronbach’s alpha = .88) were examined, as well as the occurrence and reaction scores on the GFI (.92 and .92), AGFI (Adjusted Goodness of Fit Index: .91 and .91), NFI (.80 and .83), and RMSEA (.07 and .07), respectively, supporting the convergent and discriminant validity of the RMBPC (GFI and AGFI exceeded .90, suggesting relatively good overall fit for this model).

Other studies published in 2003 (Gitlin et al; Gallagher-Thompson et al., 2003) from REACH I, and then in 2006 from REACH II (Belle et al., 2006) were developed to identify and test interventions that were specially targeted to African-American, Caucasian and Hispanic/Latino caregivers. Both frequency and “bother” ratings were used to assess change in caregiver distress as a result of being in the various interventions.

Pinguart and Sorensen (2005) compared White, African-American, and Hispanic caregivers using this scale and found that for all three ethnic groups, being female, being a spouse and caring for a care recipient with greater memory and behavior problems were related to higher levels of caregiver depression. The Goodness of Fit Index (GFI) score was =0.99, the Normed Fit Index (NFI) =0.99 (scores between .90 and .95 are considered acceptable, while scores higher than .95 are considered good) and the Root Mean Square Error of Approximation (RMSEA = 0.00; lower values indicate better fit, with 0 being the limit that is achieved with perfect fit) suggest that these general models apply to caregivers of color equally because more similarities than differences were found across racial/ethnic groups in predictors of caregiver depression. Cronbach’s alphas for each group were 0.76 (Whites 0.74, African-Americans 0.77, Hispanics 0.78).  Finally, in a study examining Chinese dementia family caregivers, Gallagher-Thompson et al (2007) reported adequate internal consistency for the three subs-scales: Cronbach’s alpha = .866 for memory problems sub-scale; , 0.82 for disruptive behavior and 0.876 for depressive symptoms. Taken together, these studies support the validity and reliability of this measure across diverse ethnic and racial groups.

Conclusion

The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of both the presence of behavior problems in dementia patients, and the extent of caregiver “subjective burden” or “distress” associated with those problems. It has been translated into Spanish, Mandarin and German. Other translations exist as well (e.g., Chinese and Japanese) which can be obtained from the Stanford Geriatric Education Center. English and Chinese copies are available through this website.

References

Belle, S.H., Burgio, L., Burns, R., Coon, D., Czaja, S., Gallagher-Thompson, D., Gitlin, L., Klinger, J., Koepke, K. M., Lee, C. C., Martindale-Adams, J., Nichols, L., Schulz, R., Stahl, S., Stevens, A., Winter, L. & Zhang, S.)  (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, 145, 727-738.

Gallagher-Thompson, D., Coon, D., Solano, N., Ambler, C., Rabinowitz, Y. and Thompson, L. (2003). Change in Indices of Distress Among Latino and Anglo Female Caregivers of Elderly Relatives with Dementia: Site-Specific Results From the REACH National Collaborative Study. The Gerontologist. 43,4 580-591.

Gallagher-Thompson, D., Gray, H., Tang, P.C.Y., Yu Pu, C., Leung, L.Y.L., Wang, P.C., Tse, C., Hsu, S., Kwo, E., Tong, H.Q., Long, J., Thompson, L.W. (May 2007). Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese Caregivers: Results of a pilot study. American Journal of Geriatric Psychiatry. 15,5 425-434.

Gitlin, L., Belle S. H., Burgio, L., Czaja, S., Mahoney, D., Gallagher-Thompson, D. et al. (2003). Effects of multicomponent intervention on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up. Psychological Aging^©. 18, 361–374.

Pinquart, M., and Sorensen, S. (2005). Ethnic Differences in Stressors, Resources, and psychological Outcomes of Family Caregiving: A Meta-Analysis. The Gerontologist. 45,1 90-106.

Teri, L., Truax P., Logsdon R., Uomoto, J., Zarit, S., & Vitaliano, P.P. (1992). Assessment of Behavioral Problems in Dementia: The Revised Memory and Behavior Problems Checklist (RMBPC). Psychology and Aging, 7,4, 622-31.

Zarit, S. H., Anthony, C. R., Boutselis, M. (1987). Interventions with care givers of dementia patients: Comparison of two approaches. Psychology and Aging, 2, 225-232.

Zarit, S. H., Todd, P. A., Zarit, J. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. Gerontologist. 26, 260-266.

Zarit, S. H., & Zarit, J. M. (1983). Cognitive impairment. In P. M. Lewinsohn & L. Teri (Eds.). Clinical geropsychology. Elmsford, NY: Pergamon Press. pp. 38-81.