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Factor Analysis of the Dysfunctional

Behavior Rating Instrument:Preliminary Results

D. William Molloy, MB MRCPI FRCPC

David L. Lewis, PhD

Martin J. ODonnell, MB MRCPITimothy I. M. Standish, MA

David Jewell, MHAMcMaster University, Hamilton, Ontario

Regional Geriatric Program central, Hamilton ON

Presented at the meetings of the Canadian Associationon Gerontology, Toronto, November 1, 2003

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Background

Behavioral and psychological symptoms of

dementia (BPSD) are common. (1) Natural history of BPSD has been poorly

described (2).

Especially for community-dwelling persons

Many instruments measure the frequency/

severity of BPSD.(3, 4, 5, 6, 7)

One of these is the Dysfunctional BehaviourRating Index (DBRI).

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ObjectiveTo examine BPSD in community

dwelling patients.To classify behaviors into distinct,

clinically meaningful domains.To determine the frequency of

common behaviors amongcommunity-dwelling older adults withcognitive impairment/ dementia.

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Method

Descriptive study

Community-dwelling elderly withcaregivers

Presented at a memory clinic in

Hamilton, 1989 - 2000

Referral from primary care or

internal medicineData collection by electronic charting

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Data used in this study:

Patient

Agegender

duration of condition

Standardized Mini-Mental Status Exam,MMSE

DysfunctionalBehaviour RatingInstrument, DBRI

Caregiver:

agegender

relationship topatient

hours spent

caregiving

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Analysis

Data were collected by nursing and medicalstaff at first visit and entered directly into anelectronic relational database (GeriatricAssessment Tool)

Then exported into SPSS 11.0 for analysis

Analysis was by Principle Components (factor)analysis with Varimax rotation and Kaisernormalization

Validated by correlations with Zarit BurdenIndex (not shown)

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The DBRI

25 close-ended questions

(+ 3 open-ended, not included) Completed by caregiver

Asks about frequency (never greater

than 5 times a day) Asks about problem (not a problem

great deal of a problem)

21 behaviours reviewed: repeats stories,repeats questions, angry, withdrawn,tearful, aggressive, etc.

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Results (I)Table 1: Patient Demographics at Presentation

No Caregiver 71.7

Caregiver 73.4

No Caregiver 68.2

Caregiver 70.1

No Caregiver 42.5

Caregiver 44.6

No Caregiver 21.4

Caregiver 20.3

No Caregiver 3.2

Caregiver 3.2

No Caregiver --

Caregiver 65.9

No Caregiver N= 464; Caregiver N=921

Mean Duration of

Disease

% Secondary

Education Diploma

Mean Age

Mean Age at Onset

% Male

Mean SMMSE

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Results (II)

Mean Age 60.4% Male 34.3

Pt Lives With CG (%) 65.2

% Spouse of Pt 56.3

Mean Weekly Hours Caregiving 85.1

Table 2: Caregiver Demographics at Presentation

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Results (III)

Factor analysis yielded 5 components

AngerAgitation

Delusional behaviorsSuspicion

Repetitive behaviors

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%Angry 65

Demanding 39

Aggressive 32Temper Outbursts 47

Embarrassing Behaviour 24

Refused to Cooperate 35

Withdrawn 46

Agitated 43

Crying 39

Frustrated 75

Wandering 28Up at Night 54A

gitation

An

ger

Prevalence of Behaviors (I)Prevalence of Behaviors (I)

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Prevalence of Behaviors (II)Prevalence of Behaviors (II)Repeats Questions 82

Repeats Stories 70

Spouse not Spouse 11Home not Home 15

People in House 21

Sees Things not There 19Hears Things not There 19

People Stealing Things 23

Hides Things 33

Suspicious 44

Wants to Leave 26

Keeps Changing Mind 42

Afraid to be Left Alone 35Misce

ll-

aneous

Susp

ic-

ions

Delu

sions

Repe

tition

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Goodness of FitGoodness of Fit

Anger 15.5

Agitation 12.7Repetition 11.9

Delusions 11.3

Suspicions 7.2

Total 58.6

Table 4: Eigenvalues of Factors

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Reliability and ValidityReliability and Validity

Intraclass correlation coefficient: 0.75

Zarit scores (not shown)Correlate strongly with anger and

agitation

Correlate moderately withrepetition.

Patient traits (age, gender,education) not useful explanatoryvariables.

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Discussion:

BPSD clusters into distinct domains,

allowing treatment focus. The elements of BPSD most strongly

associated with caregiver burden are

anger and agitation BPSD as indicated by the DBRI is the best

predictor of burden.