title: Cross-cultural study of caregiver burden for Alzheimer's disease in Japan and Taiwan: result from Dementia Research in Kumamoto and Tainan (DeReKaT).
abstract: Caregiver burden (CB) of Alzheimer's disease (AD) in Taiwan is becoming an urgent social issue as well as that in Japan. The comparison of CB may explain how caregiver feels burden in each country.
  
  
  
  The participants were 343 outpatients with AD and their caregivers of Japan (n = 230) and Taiwan (n = 113). We assessed the CB using the Japanese and Chinese version of Zarit Caregiver Burden Interview (ZBI). The initial analysis was an exploratory factor analysis for each group to confirm the factor structure of ZBI. Then, the multiple-group structural equation modeling (MG-SEM) was used to assess the measurement invariance of ZBI such as configural, metric, and scalar invariances. Lastly, we compared the latent factor means of the ZBI between Japan and Taiwan.
  
  
  
  In both groups, the confirmatory factor analysis extracted 3 factors which were labeled "Impact on caregiver's life", "Embarrassed/anger", and "Dependency". The MG-SEM indicated an acceptable model fit, and established the partial scalar measurement invariance (comparative fit index (CFI) = 0.901, root mean square error of approximation (RMSEA) = 0.066). When we compared the latent factor means, the score of "Impact on caregiver's life" in Taiwanese caregivers was significantly higher than that in Japanese (p = 0.001). However, "Dependency" in Taiwanese caregivers was lower than that in Japanese (p < 0.001).
  
  
  
  Partial measurement invariance allowed comparing the latent factor mean across two countries. The results of comparisons suggested that there may be differences in the way of feeling CB between Japan and Taiwan.
authors.affiliation: Center for Medical Education and Research,Faculty of Life Sciences,Kumamoto University,Kumamoto,Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Division of Behavioral Neurology,Department of Neurology,National Cheng Kung University Hospital,College of Medicine,National Cheng Kung University,Tainan,Taiwan.
authors.forename: Ming-Chyi
authors.initials: MC
authors.lastname: Pai
authors.affiliation: Alzheimer's Disease Research Center,National Cheng Kung University Hospital,Tainan,Taiwan.
authors.forename: Cai-Ying
authors.initials: CY
authors.lastname: Jhou
authors.affiliation: Department of Neuropsychiatry,Faculty of Life Sciences,Kumamoto University,Kumamoto,Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Koyama
authors.affiliation: Department of Neuropsychiatry,Faculty of Life Sciences,Kumamoto University,Kumamoto,Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ikeda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D000068376:Compassion Fatigue / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D017281:Cost of Illness; D003431:Cross-Cultural Comparison; D003858:Dependency, Psychological; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D013624:Taiwan / Q000453:epidemiology
keywords: Alzheimer's disease; caregiver burden; international