title: Factors associated with caregiver burden: comparative study between Brazilian and Spanish caregivers of patients with Alzheimer's disease (AD).
abstract: Transcultural studies regarding the comparison of levels of burden in caregivers of patients with Alzheimer's disease (AD) from Europe and Latin America are rare. We designed this study to investigate the differentiating factors associated with burden in Brazilian and Spanish caregivers of patients with AD.
  
  
  
  This is a cross-sectional study composed by samples of outpatients with AD and their caregivers from Brazil (n = 128) and Spain (n = 146). Caregivers answered the Zarit Burden Interview (ZBI) and a Sociodemographic Questionnaire. Patients were assessed with the Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR) Scale.
  
  
  
  In the multivariate regression analysis, high burden levels were reported in Brazil, when caregivers were female (p = 0.025) and when patients did not attend Day Care Center (p = 0.025). In Spain, high burden levels were associated with living with the patient (p = 0.014), younger caregivers (p = 0.003), and participation of patients at Day Care Center (p = 0.046). Also, different neuropsychiatric symptoms explained high burden levels: in Brazil, depression (p < 0.001) and anxiety (p = 0.024) and, in Spain, apathy/indifference (p < 0.001), agitation/aggression (p = 0.019) and irritability/lability (p = 0.027).
  
  
  
  Caregivers' gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.
authors.affiliation: Center for Alzheimer's Disease,Institute of Psychiatry,Universidade Federal do Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Maria Fernanda B
authors.initials: MF
authors.lastname: Sousa
authors.affiliation: Center for Alzheimer's Disease,Institute of Psychiatry,Universidade Federal do Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Raquel L
authors.initials: RL
authors.lastname: Santos
authors.affiliation: Research Unit,Santa Caterina Hospital,Institut d'Assistència Sanitària,Salt,Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Turró-Garriga
authors.affiliation: Center for Alzheimer's Disease,Institute of Psychiatry,Universidade Federal do Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dias
authors.affiliation: Center for Alzheimer's Disease,Institute of Psychiatry,Universidade Federal do Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Marcia C N
authors.initials: MC
authors.lastname: Dourado
authors.affiliation: Faculty of Psychology,University of Barcelona,Barcelona,Spain.
authors.forename: Josep L
authors.initials: JL
authors.lastname: Conde-Sala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012720:Severity of Illness Index; D013030:Spain
keywords: Alzheimer's disease; Day Care Center; burden; family caregivers; neuropsychiatric symptoms; transcultural studies