Memory and Behavior Problem Checklist (MBPC)

1. Abstract

The Memory and Behavior Problem Checklist (MBPC) is a seminal clinical and psychometric assessment instrument developed to evaluate the frequency of cognitive, behavioral, and functional problems in individuals with dementia and neurocognitive disorders, while concurrently quantifying the subjective distress or appraisal elicited in their informal family caregivers. Conceptualized initially by Steven H. Zarit and colleagues in the 1980s, and later refined into various standardized forms including the 1985 version and the subsequent Revised Memory and Behavior Problems Checklist (RMBPC) by Linda Teri and colleagues in 1992, the MBPC bridges geriatric psychiatry, clinical neuropsychology, and family caregiving dynamics. The standard long-form checklist evaluates 32 behavioral and cognitive items across observable dimensions including memory-related dysfunctions, disruptive and agitated conduct, mood disturbances, depressive symptoms, and functional deficits in activities of daily living (ADLs).

A defining methodological feature of the MBPC is its dual-rating format: for each observable behavioral manifestation, the caregiver provides both an objective frequency rating (ranging across a graded ordinal continuum reflecting weekly occurrence) and a subjective caregiver reaction rating (ranging from 0 = not at all to 4 = extremely upset or distressed). This operational split operationalizes the transactional model of stress, segregating primary objective stressors (the patient’s actual symptomatic manifestations) from subjective appraisal (the caregiver’s emotional vulnerability and psychological burden). Across empirical validation studies, the MBPC and its structural revisions exhibit robust psychometric properties, featuring internal consistency reliabilities ranging from α = .75 to α = .90 for total scores and underlying subscales. Construct, convergent, and discriminant validities are firmly established through strong correlations with independent dementia staging markers, objective neuropsychological tests such as the Mini-Mental State Examination (MMSE), and psychometric inventories of caregiver burden and depression such as the Zarit Burden Interview (ZBI) and the Center for Epidemiologic Studies Depression Scale (CES-D).

2. Keywords

Memory and Behavior Problem Checklist, MBPC, Revised Memory and Behavior Problems Checklist, RMBPC, dementia caregiving, caregiver burden, behavioral and psychological symptoms of dementia, BPSD, Zarit Burden Interview, neuropsychological assessment, functional assessment, Alzheimer’s disease.

3. Authors

The primary architects and key psychometric contributors responsible for the formulation, validation, and programmatic operationalization of the Memory and Behavior Problem Checklist encompass several prominent scholars in gerontology and clinical psychology:

• Steven H. Zarit, Ph.D. — Professor Emeritus of Human Development and Family Studies at The Pennsylvania State University (Penn State University), University Park, PA, USA. Dr. Zarit is an internationally recognized pioneer in geriatric mental health, family caregiving research, and the developer of the Zarit Burden Interview (ZBI). Contact: [email protected].
• Judy M. Zarit, Ph.D. — Clinical psychologist, gerontologist, and clinical researcher specializing in clinical geropsychology, dementia interventions, and caregiver family consultations; co-author of foundational manuals and assessment methodologies for families coping with chronic neurodegenerative conditions.
• Nancy K. Orr, M.S.W. — Clinical social worker, researcher, and clinical specialist focused on family systems under stress, long-term care counseling, and community-based dementia support protocols.
• Linda Teri, Ph.D. — Professor Emerita at the University of Washington School of Nursing and Department of Psychosocial and Community Health, Seattle, WA, USA. Dr. Teri is a preeminent clinical geropsychologist known for advancing behavioral interventions in Alzheimer’s disease and for leading the 1992 psychometric revision and factor-analytic structural validation of the Revised Memory and Behavior Problems Checklist (RMBPC).

4. Purpose

The primary clinical and psychometric objective of the Memory and Behavior Problem Checklist (MBPC) is to provide a comprehensive, standardized, informant-reported inventory that captures the heterogenous array of cognitive, emotional, and behavioral disturbances manifested by community-dwelling or institutionalized older adults with neurocognitive disorders. Chronic neurodegenerative disorders such as Alzheimer’s disease, vascular dementia, frontotemporal lobar degeneration, and Lewy body dementia present not merely as circumscribed memory failures, but as pervasive complexes involving behavioral and psychological symptoms of dementia (BPSD). Clinicians and clinical researchers require tools that register both the objective profile of patient pathology and its interpersonal repercussions.

Crucially, the MBPC serves a dual evaluative purpose: it assesses the patient’s symptomatic phenomenology while simultaneously measuring the primary caregiver’s subjective level of distress or upset elicited by each specific problem. Prior to the development of this instrument, clinical assessments frequently conflated the behavioral severity of the patient with the subjective strain of the caregiver. By structurally disentangling the frequency of patient manifestation from the caregiver’s psychological reaction, the MBPC enables researchers and clinicians to determine whether caregiver distress stems directly from high behavioral frequency, or from heightened cognitive and emotional vulnerability to specific behavioral profiles, such as nocturnal wandering, verbal hostility, or catastrophic emotional reactions.

In clinical practice, the MBPC is utilized as an intake assessment, a psychoeducational framework, and an outcome metric for psychosocial, environmental, and pharmacological interventions. In psychiatric settings, it pinpoints high-distress behavioral targets (e.g., screaming, wandering, suspiciousness) requiring urgent environmental or behavioral stabilization. In clinical trials, it provides sensitive change-score indices tracking treatment efficacy across both behavioral symptom abatement and caregiver coping mitigation.

5. Psychological Construct

The overarching construct captured by the MBPC is the multidimensional landscape of behavioral disturbance in dementia, coupled with the caregiver’s concurrent cognitive-affective appraisal. The scale encompasses several interlinked empirical dimensions:

Memory-Related Impairments

This sub-domain reflects the core cognitive and executive disruptions associated with cortical neurodegeneration. Observable items assess short-term memory failures, such as repetitive questioning (e.g., asking the same question over and over), forgetting recent events, misplacing items, concealing personal belongings, and temporal disorientation (forgetting the date or mixing up past and present, such as believing a deceased relative is alive). The construct is anchored not in abstract psychometric cognitive tasks, but in observable behavioral consequences within daily routines.

Disruptive and Agitated Behaviors

This dimension encompasses externalizing, socially inappropriate, or dangerous behavioral manifestations that challenge the physical safety, home environment, and social functioning of the family system. Specific items measure motor agitation, restlessness, wandering, catastrophic pacing, verbal aggressiveness, physical striking, property destruction, and nocturnal awakening. These behaviors represent major drivers of caregiver institutionalization decisions and psychiatric hospitalizations.

Depressive and Affective Disturbance

Affective dysregulation constitutes an essential facet of BPSD. This construct includes observable manifestations of sadness, crying, persistent anxiety, somatic worry, passive withdrawal, apathy, expressions of worthlessness, hopelessness, verbalization of feeling like a burden, and suicidal ideation or explicit comments regarding death. Because individuals with moderate-to-severe dementia frequently lack introspective insight or verbal fluency to complete self-report depression inventories (such as the Beck Depression Inventory), the MBPC relies on informant-reported behavioral observation.

Functional and ADL Dependence

The full 32-item checklist framework integrates activities of daily living (ADLs) and basic self-care routines (eating, dressing, grooming, bathing, continence, and medication management). Physical dependence interacts dynamically with behavioral resistance, providing a granular picture of care recipient vulnerability.

Subjective Caregiver Appraisal

Complementing the behavioral constructs is the caregiver’s psychological appraisal. Operating on an affective axis of tolerance versus emotional overload, this construct evaluates the subjective burden, irritation, guilt, or helplessness provoked by each individual patient behavior, recognizing that identical behavioral frequencies can evoke dramatically disparate emotional responses depending on family dynamics and caregiver coping mechanisms.

6. Theoretical Framework

The architectural framework of the MBPC is grounded in the Transactional Model of Stress and Coping formulated by Richard Lazarus and Susan Folkman (1984), and specifically adapted to gerontological contexts through the Caregiver Stress Process Model synthesized by Leonard Pearlin and colleagues (1990).

According to the Pearlin Stress Process Model, caregiving outcomes are structured into four interconnected domains: the background/context (socioeconomic status, family history), primary stressors, secondary stressors (role strains, financial conflicts), and psychological outcomes (clinical depression, cardiovascular strain). Within this paradigm, the patient’s cognitive decline, memory impairments, and behavioral outbursts represent primary objective stressors. However, the theoretical model dictates that primary objective stressors do not directly cause psychological breakdown in the caregiver; rather, their impact is mediated and moderated by primary subjective stressors (subjective appraisal of overload and emotional distress) and coping resources (social support, cognitive reappraisal, psychological mastery).

The MBPC embeds this transactional dichotomy directly into its measurement architecture. By demanding two separate responses for every single behavioral item—one tracking objective behavioral occurrence (frequency) and the other capturing cognitive appraisal and emotional reactivity (reaction)—the scale translates Lazarus and Folkman’s primary and secondary appraisal concepts into quantifiable psychometric indicators. A caregiver experiencing high subjective reaction to modest behavioral frequencies may suffer from maladaptive cognitive attributions (e.g., believing the care recipient is deliberately acting disruptive out of spite), whereas low reaction in the context of high frequency indicates emotional resilience, acceptance, or effective behavioral containment strategies.

7. Validity

The validity of the MBPC and its standard revised iterations has been established across extensive gerontological, psychiatric, and epidemiological research programs.

Construct and Factorial Validity

Construct validity is evidenced by the tool’s capacity to discriminate between varying levels of neurocognitive impairment and clinical staging. Factor-analytic investigations (most notably demonstrated in the landmark 1992 structural revision by Teri et al.) validate that the items coalesce reliably into three clinically distinct yet correlated syndromes: Memory Problems, Disruptive Behaviors, and Depressive Behaviors. Factorial validity has been replicated across cross-cultural translations (e.g., Spanish, Chinese, French, and German adaptations), demonstrating invariant structural properties across diverse ethnic cohorts.

Convergent and Criterion-Related Validity

The MBPC subscales demonstrate robust convergent correlations with independent clinical criteria:

• Cognitive Measures: The Memory Problems subscale correlates significantly with standardized neuropsychological tests, including the Mini-Mental State Examination (MMSE; r = -.35 to -.52, p < .001) and the Clinical Dementia Rating (CDR) scale, confirming that caregiver reports accurately mirror objective cognitive deterioration.
• Affective and Caregiver Burden Measures: The MBPC Reaction scales correlate strongly with standardized measures of caregiver burden, notably the Zarit Burden Interview (r = .50 to .68, p < .001), and psychological distress scales such as the Center for Epidemiologic Studies Depression Scale (CES-D; r = .40 to .55, p < .001).
• Depression Convergence: The Depression subscale of the patient behaviors correlates systematically with external clinician-rated depression scales in dementia, such as the Cornell Scale for Depression in Dementia (CSDD; r = .60 to .74).

Discriminant Validity

The instrument demonstrates strong discriminant validity: patient behavioral frequency scores do not significantly correlate with demographic variables such as caregiver income, gender, or unrelated physical health indices, whereas caregiver reaction scores diverge predictably based on social support availability and psychological interventions rather than gross patient cognitive decline alone.

8. Reliability

The MBPC exhibits high internal consistency and test-retest reliability across both research and community clinical environments:

Internal Consistency

Across validation cohorts, internal consistency estimates (Cronbach’s alpha, α) remain consistently elevated across both behavioral frequency and caregiver reaction dimensions:

• Total Scale: Global internal consistency for the behavioral frequency index typically ranges from α = .84 to α = .90, while the overall subjective reaction index ranges from α = .88 to α = .92.
• Memory Subscale: Reported Cronbach’s alphas range between α = .75 and α = .87.
• Depression Subscale: Reported Cronbach’s alphas range between α = .80 and α = .88, indicating high item homogeneity when tracking depressive phenomenology in cognitive decline.
• Disruptive Behaviors Subscale: Cronbach’s alphas typically span from α = .72 to α = .81; the slightly lower alpha reflects the diverse behavioral manifestations included (ranging from nocturnal wandering to verbal outbursts and property destruction).

Test-Retest and Inter-Rater Reliability

Stability across time has been demonstrated with test-retest reliability coefficients exceeding r = .75 to .85 over one- to four-week baseline stabilization periods in non-interventional control cohorts. Inter-informant reliability between primary and secondary family caregivers yields intraclass correlation coefficients (ICC) ranging between .65 and .80, demonstrating moderate-to-high concordance while reflecting authentic differences in caregiver exposure and subjective appraisal.

9. Factor Analysis

The factor structure of the Memory and Behavior Problem Checklist has been evaluated using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). While Zarit and colleagues originally utilized the instrument as a comprehensive clinical inventory of cognitive and functional dilemmas, Teri et al. (1992) conducted a systematic psychometric distillation using principal components analysis with varimax and oblique rotations across a diverse sample of dementia patients and their family caregivers (N = 201).

This structural revision extracted three clean, robust, and clinically meaningful factors accounting for substantial cumulative variance:

1. Factor 1: Memory-Related Problems — Defined by items including repetitive questioning (loading > .70), misplacing belongings, temporal disorientation, forgetting recent and remote events, and concentration failures. Items specifically tap basic cognitive loss manifested within daily living environments.
2. Factor 2: Depressive Behaviors — Defined by items assessing affective disturbance, such as expressing hopelessness, crying, statements of worthlessness, feeling like a burden, commenting on death, and visible anxiety/sadness (loadings spanning .55 to .78).
3. Factor 3: Disruptive Behaviors — Defined by externalizing behaviors including verbal aggression, physical combativeness, night waking, embarrassing public conduct, arguing, and potential danger to self or others (loadings spanning .48 to .72).

Subsequent confirmatory factor analyses using structural equation modeling have corroborated this three-factor structure, reporting favorable model fit statistics across elderly populations: Comparative Fit Index (CFI) > .92, Tucker-Lewis Index (TLI) > .90, and Root Mean Square Error of Approximation (RMSEA) < .06.

10. Instrument / Measurement Tool

The Memory and Behavior Problem Checklist (MBPC) is designed as an informant-rated, standardized questionnaire administered either via structured clinical interview, paper-and-pencil self-administration, or electronic survey platforms. The long-form instrument contains 32 numbered entries (including 30 designated problem behaviors and 2 open-ended entries for idiosyncratic clinical problems), accompanied by functional ADL evaluations.

• Administration Format: Informant-report (completed by the primary informal caregiver, spouse, adult child, or professional care partner).
• Target Population: Community-dwelling or institutionalized individuals diagnosed with, or suspected of having, mild cognitive impairment, Alzheimer’s disease, or related dementias.
• Item Count: 32 behavioral problem items on the classic Zarit instrument (supplemented by ADL self-care items); 24 items on the Revised (RMBPC) version.
• Dual-Response Architecture: For each item, the caregiver provides two separate ratings:
  • Frequency Rating (Zarit 1985 Format): Graded 7-point scale capturing temporal frequency:
    • 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
  • Caregiver Reaction Rating: Graded 5-point Likert scale evaluating subjective distress or upset:
    • 0 = Not at all
    • 1 = A little
    • 2 = Moderately
    • 3 = Very much
    • 4 = Extremely
• Scoring and Quantification:
  • Behavior Frequency Score: Calculated by summing the frequency values across items or calculating mean frequency indices for the overall scale and specific subscales.
  • Caregiver Reaction Score: Calculated by summing the reaction ratings across endorsed items, yielding an index of conditional distress (upset given the occurrence of behaviors) or absolute distress.
  • Diagnostic Utility: High frequency combined with low caregiver distress identifies resilient family systems requiring logistical rather than psychological interventions; conversely, high caregiver distress provoked by low behavioral frequencies indicates caregiver vulnerability, exhaustion, or clinical depression requiring therapeutic support.

11. Permissions & Fee and Test Year

The original Memory and Behavior Problem Checklist was formulated and published between 1980 and 1985 by Steven H. Zarit and Judy M. Zarit, appearing in clinical texts including The Hidden Victims of Alzheimer’s Disease: Families Under Stress (Zarit, Orr, & Zarit, 1985). The Revised Memory and Behavior Problems Checklist (RMBPC) was subsequently standardized by Linda Teri and colleagues in 1992.

The MBPC and RMBPC are widely regarded as open-access instruments available for academic, clinical, and non-commercial research purposes. The authors have historically permitted free utilization by healthcare clinicians and psychological investigators, provided proper bibliographic attribution is maintained. Standard psychometric printings and administration protocols are published in clinical sourcebooks such as Fischer and Corcoran’s Measures for Clinical Practice and Research: A Sourcebook (Oxford University Press). Commercial organizations or pharmaceutical clinical trial developers seeking digitized distribution, proprietary integration, or fee-based licensing should contact Dr. Steven H. Zarit ([email protected]) or the respective copyright holders associated with the American Psychological Association (APA) and Oxford University Press.

12. References

• Fischer, J., & Corcoran, K. J. (2007). Measures for clinical practice and research: A sourcebook (4th ed., Vol. 1, pp. 362–365). Oxford University Press.
• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583
• Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. H., & Vitaliano, P. P. (1992). Assessment of behavior problems in dementia: The revised Memory and Behavior Problems Checklist. Psychology and Aging, 7(4), 622–631. https://doi.org/10.1037/0882-7974.7.4.622
• Zarit, S. H., Orr, N. K., & Zarit, J. M. (1985). The hidden victims of Alzheimer’s disease: Families under stress. New York University Press.
• Zarit, S. H., & Zarit, J. M. (1990). The Memory and Behavior Problems Checklist and the Burden Interview. Pennsylvania State University Gerontology Center.
• Zarit, S. H., & Zarit, J. M. (1998). Mental disorders in older adults: Principles of assessment and treatment. Guilford Press.

13. Items of the Scale