From Mild Behavioral Impairment-Checklist (MBI-C) to MBI-Distress (MBI-D): A Paired Assessment and Clinical Correlates of Domain-Specific Caregiver Distress in MCI due to AD

Efthalia Angelopoulou^1*Niki Tsinia^1,2Maria Hatzopoulou²Akylina Despoti²Vasiliki Kamtsadeli²Marina Papadogiani²Evangelia Stanitsa¹Vasilis Kyriakidis²Sokratis G Papageorgiou¹John Dimitrios Papatriantafyllou²

• ¹Eginition Hospital, Athens, Greece
• ²Third Age Day Care Center IASIS, 16562 Athens, Greece, Athens, Greece

Background: Mild behavioral impairment (MBI) captures later-life onset neuropsychiatric symptoms (NPS) that may herald neurodegeneration. The emotional impact of these early behavioral changes on caregivers is under-measured in pre-dementia care. Objective: To develop a brief, domain-aligned caregiver distress scale for MBI (MBI-D) and examine clinical correlates of MBI-related caregiver distress in mild cognitive impairment due to AD (MCI-AD). Methods: 104 participant–informant dyads with MCI-AD at a Greek memory clinic were included. Caregivers completed the Greek MBI-C and the new five-item MBI-D (one item per ISTAART-AA MBI domain). Internal consistency (Cronbach's α), non-parametric tests, and Spearman correlations assessed bivariate associations. Multiple linear regression identified independent correlates of MBI-D total. Prespecified covariates were age, education, sex, global cognition (MMSE or ACE-R), disease duration, and MBI-C (total or domains). Results: Internal consistency of the MBI-D was moderate (α=0.617; standardized α=0.627; mean inter-item r=0.25). MBI-D total correlated strongly with MBI-C total (ρ=0.789, p<0.001), and each MBI-D domain correlated with its corresponding MBI-C domain (ρ=0.478–0.850, all p<0.001). Disease duration was associated with MBI-D total and with apathy-related distress (ρ=0.302, p=0.002 and ρ=0.392, p<0.001, respectively). In multivariable regression, MBI-C total and education were independent predictors of MBI caregiver distress (β=0.804, p<0.001, and β=0.135, p=0.017, respectively). In the MBI-C domains model, impulse dyscontrol, apathy and emotional dysregulation independently related to higher distress (B=0.513, β=0.482, p<0.001, B=0.315, β=0.278, p<0.001, and B=0.289, β=0.227, p=0.001 respectively), while cognitive performance (MMSE and ACE-R) did not have a significant impact. Conclusions: The MBI-D, strongly coupled with MBI-C, is a concise, clinically practical and scalable measure of MBI-related caregiver distress in MCI-AD, capturing both symptom burden and domain-specific distress in a single administration. Impulsivity, apathy, and affective dysregulation are highlighted as priority targets for early, caregiver-focused interventions advancing innovative, prevention-oriented dementia care delivery.