Memory and Behavior Problem Checklist (MBPC)

Abstract

The Memory and Behavior Problem Checklist (MBPC) is a psychometric instrument designed to assess the frequency of specific behavioral and psychological symptoms experienced by individuals, typically those suffering from Dementia or related cognitive impairments. Developed initially by Zarit and Zarit (1985), the scale was later extensively revised by Teri et al. in 1992 (RMBPC). The MBPC is unique in that it measures not only the occurrence of problematic behaviors but also the subjective emotional burden or reaction experienced by the primary informal caregiver. This dual measurement approach provides crucial data for clinical intervention and research concerning Caregiver Burden in geriatric populations.

The Revised MBPC (RMBPC) comprises 24 items, categorized into distinct subscales relating to Memory, Depression, and Disruption, offering a standardized method for tracking changes in patient behavior over time and evaluating the effectiveness of treatment strategies.

Keywords

Memory and Behavior Problem Checklist, MBPC, Revised MBPC, Dementia, Alzheimer’s disease, Caregiver Burden, Behavioral Assessment, Psychometrics, Geriatric Psychiatry

Authors

Steven H. Zarit, Judy M. Zarit, Linda Teri, P. Truax, R. Logsdon, J. Uomoto, P. Vitaliano

Purpose

The primary purpose of the MBPC and its revised version (RMBPC) is to provide a reliable and comprehensive assessment of the behavioral disturbances exhibited by individuals with cognitive decline, such as those caused by Alzheimer’s disease. The instrument serves a dual function: first, quantifying the frequency of disruptive behaviors; and second, quantifying the degree of stress, annoyance, or negative emotional reaction these behaviors elicit in the primary caregiver.

By assessing both the objective behavioral frequency and the subjective caregiver reaction, clinicians and researchers can better understand the relationship between patient symptoms and caregiver distress, facilitating targeted interventions aimed at reducing the overall burden on family members providing care.

Construct

The MBPC measures two core psychological constructs relevant to geriatric care:

• Behavioral and Psychological Symptoms of Dementia (BPSD): This construct includes a wide range of non-cognitive symptoms common in dementia, such as memory deficits, agitation, aggression, wandering, depression, and psychotic symptoms (e.g., hallucinations).
• Caregiver Reaction/Strain: This construct assesses the subjective emotional and psychological impact of the patient’s behaviors on the caregiver. The reaction score is crucial as it acknowledges that the same behavior may cause widely varying levels of distress depending on the caregiver’s coping mechanisms and resources.

The Revised MBPC (RMBPC) further refines the measurement of BPSD by grouping items into empirically derived subscales: Memory problems, Depression, and Disruption/Aggression.

Validity

The validity of the Revised Memory and Behavior Problem Checklist (RMBPC) has been established through several studies, particularly demonstrating its utility in populations with dementia.

• Content Validity: The items were derived from clinical experience and earlier research on common behavioral problems observed in dementia patients, ensuring comprehensive coverage of relevant symptoms.
• Construct Validity: Factor analysis supports the theoretical structure of the scale, confirming that the items load onto distinct factors (Memory, Depression, and Disruption), which align with established clinical presentations of dementia.
• Criterion Validity: The MBPC scores, particularly the reaction ratings, have consistently shown strong correlations with measures of Caregiver Burden (such as the Zarit Burden Interview) and measures of caregiver depression or distress, confirming its ability to predict relevant clinical outcomes.

Reliability

The MBPC demonstrates strong internal consistency and adequate test-retest reliability, particularly in its revised form.

• Internal Consistency: Studies on the RMBPC (Teri et al., 1992) typically report high internal consistency (Cronbach’s alpha) for the total score and its subscales. For example, the total frequency score often yields an alpha above 0.85, indicating that the items effectively measure a unified construct of behavioral problems. The individual subscales (Memory, Depression, Disruption) also show acceptable to good reliability coefficients.
• Inter-Rater Reliability: Since the MBPC is a caregiver-report measure, reliability depends on the consistency of the caregiver’s observations. The structured rating system is designed to maximize clarity and minimize ambiguity in reporting frequency and reaction.

Factor Analysis

The revision of the MBPC into the 24-item RMBPC by Teri et al. (1992) was based on rigorous Factor Analysis conducted on a sample of dementia patients. This analysis established a stable, multi-dimensional structure for the behavioral problems reported.

The factor structure of the Revised MBPC typically identifies three primary factors or subscales:

1. Memory: Items related to forgetting, losing things, asking repetitive questions, and temporal confusion.
2. Depression: Items related to sadness, hopelessness, tearfulness, and feelings of worthlessness or failure.
3. Disruption/Aggression: Items related to agitation, physical or verbal aggression, property destruction, inappropriate public behavior, and sleep disturbance.

Instrument

Test Type: Self-Report Checklist (Caregiver Report)

Format: Paper-and-pencil checklist requiring the caregiver to rate both the frequency of the patient’s behaviors and their own emotional reaction to those behaviors.

Language Available: Primarily English, though translations may exist for research purposes.

Population Group: Caregivers of individuals suffering from cognitive impairment or Dementia.

Age Group: Adults (Geriatric patients being assessed; adult caregivers providing the report).

Population Details: Widely used in clinical settings and research involving patients with Alzheimer’s disease and other neurocognitive disorders.

Test Methodology: The scale uses distinct Likert-type scales for frequency and reaction ratings, allowing for nuanced quantification of the behavioral impact. The RMBPC uses a 5-point frequency scale (0 to 4, plus 9 for NA) and a 5-point reaction scale (0 to 4, plus 9 for NA).

Keywords

Behavioral Assessment, Geriatric Psychology, Psychometrics, Neurocognitive Disorders, Caregiver Strain, BPSD, Activities of Daily Living (ADLs), Gerontology

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: [email protected] (Likely related to Zarit at Penn State University).

Correspondence Address: Not specified in source content (Historically affiliated with Penn State University Gerontology Center).

Permissions & Fee and Test Year

The original Memory and Behavior Problem Checklist (MBPC) was developed in 1985 by Zarit and Zarit. The revised and more commonly used version (RMBPC) was published by Teri et al. in 1992. The instrument is generally considered to be in the public domain for non-commercial research and clinical use, especially given its inclusion in major sourcebooks for clinical measures.

The original PDF of the instrument, as referenced in the source materials, can be downloaded here: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.832.3797&rep=rep1&type=pdf.

Reference’s

The following key references document the development, revision, and psychometric properties of the MBPC and RMBPC:

• Zarit, S. H., Orr, N. K, & Zarit, J. M. (1985). The hidden victims of Alzheimer’s disease: Families under stress. New York: New York University Press.
• Zarit, S. H., Zarit, J. M. (1990). The Memory and Behavior Problems Checklist and the burden interview. University Park, PA: Penn State University Gerontology Center. (Google Scholar Link)
• Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. H., Vitaliano, P. 1992. Assessment of behavior problems in dementia: The revised Memory and Behavior Problems Checklist. Psychology and Aging, 7, 622-631.
• Zarit, S. H., Zarit, J. M. (1998). Mental disorders in older adults: Principles of assessment and treatment. New York: Guilford Press.
• Zarit, S. H., Zarit, J. M. (1998). Memory and Behavior Problem Checklist (MBPC). In Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page(s): 362-365.

Items of the Memory and Behavior Problem Checklist (MBPC)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Behaviors (Original MBPC)

Frequency Ratings 0= never occurred‚ 1= occurred frequently in past but not in the past three months‚ 2= has occurred recently‚ but not in the past week‚ 3= has occurred 1 or 2 times in the past week‚ 4= has occurred 3 to 6 times in the past week‚ 5= occurs daily or more often‚ 7= this problem would occur‚ if the patient wasn’t supervised

Reaction Rating: 0 = not at all‚ 1= a little‚ 2= moderately‚ 3= very much‚ 4= extremely

1. Asking the same question over and over.
2. Trouble remembering recent events (e.g.‚ items in the newspaper or on TV).
3. Trouble remembering significant past.
4. Mixing up past and present (e.g. thinking a deceased parent alive)
5. Losing or misplacing things.
6. Hiding things.
7. Unable to find way about indoors.
8. Unable to find way about outdoors‚ for example‚ on familiar place.
9. Wandering or getting lost.
10. Not recognize a familiar place.
11. Not recognize a familiar people.
12. Not recognize a familiar object.
13. Forgetting what day it is.
14. Unable to start activities by self (besides ADLS)
15. Unable to keep occupied or busy by self.
16. Follows you around.
17. Being constantly restless or agitated‚
18. Spending long periods of time inactive.
19. Being constantly talkative.
20. Talking little or not at all.
21. Being suspicious or accusative.
22. Doing things in public that embarrass you.
23. Walking you up at night.
24. Appears sad or depressed.
25. Appears anxious or worried.
26. Becoming angry.
27. Strikes out or tries to hit.
28. Destroying property.
29. Engaging in behavior that is potentially dangerous to self or others.
30. Seeing or hearing things that are not there (hallucinations or illusions)
31. Any other problems (specify).
32. Any other problems (specify).

Activity of Daily Living (Original MBPC)

Activity

Frequency Ratings 0= Independent‚ 1= Needs supervision‚ 2= Needs some assistance to complete task‚ 3= Totally independent

Reaction Rating: 0 = not at all‚ 1= a little‚ 2= moderately‚ 3= very much‚ 4= extremely‚ 9= don’t know/not applicable

1. Eating
2. Dressing
3. Sha‎ving or putting on make-up.
4. Talking medications
5. Bathing
6. Going to the bathroom (indicate if incontinent of bowel or bladder; score 2 if occasionally incontinent‚ 3 if incontinent most or all of the time)

Other Activity (Original MBPC)

1. Walking
2. Watching television
3. telephone

Revised Memory and Behavior Problems Checklist (RMBPC)

Teri et al‚ 1992

Frequency Ratings 0= never occurred‚ 1= not in the past week‚ 2= 1 to 2 times in the past week‚ 3= 3 to 6 times in the past week‚ 4= daily or more often‚ 9 = don’t know/not applicable

Reaction Rating: 0 = not at all‚ 1= a little‚ 2= moderately‚ 3= very much‚ 4= extremely‚ 9= don’t know/not applicable

1. Asking the same question over and over.
2. Trouble remembering recent events (e.g.‚ items in the newspaper or on TV).
3. Trouble remembering significant past events.
4. Losing or misplacing things.
5. Forgetting what day it is.
6. Starting‚ but not finishing‚ things.
7. Difficulty concentrating on a task.
8. Destroying property.
9. Doing things that embarrass you.
10. Waking you or other family members up at night.
11. Talking loudly and rapidly.
12. Appears anxious or worried.
13. Engaging in behavior that is potentially dangerous to self or others.
14. Threats to hurt oneself.
15. Threats to hurt others.
16. Aggressive to others verbally.
17. Appears sad or depressed.
18. Expressing feelings of hopelessness or sadness about the future (e.g.‚ “Nothing worthwhile ever happens‚” ” I never do anything right”).
19. Crying and tearfulness.
20. Commenting about death of self or others (e.g.‚ “Life isn’t worth living‚” “I’d be better off dead”).
21. Talking about feeling lonely.
22. Comments about feeling worthless or being a burden to others.
23. Comments about feeling like a failure or about not ha‎ving any worthwhile accomplishments in life.
24. Arguing‚ irritability‚ and/or complaining.

Revised Memory and Behavior Problems Checklist Subscales: Memory (items 1-7)‚ Depression (items 12‚ 14‚ 17-23)‚ Disruption (items 9-11‚ 13‚ 15‚ 16‚ and 24)