Is there an association between help-seeking for early detection of Alzheimer's disease and illness representations of this disease among the lay public?

Medical help-seeking intentions among patients with early Alzheimer's disease

Background

Limited information is available on the active process of seeking medical help in patients with Alzheimer's disease (AD) at early stages. The aim of this study was to assess the phenomenon of medical help-seeking in early AD and to identify associated factors.

Methods

A multicenter, non-interventional study was conducted including patients of 50-90 years of age with prodromal or mild AD (National Institute on Aging/Alzheimer's Association criteria), a Mini-Mental State Examination (MMSE) score ≥ 22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5-1.0. A multivariate logistic regression analysis was conducted.

Results

A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years, 50.3% were female, and 87.2% had a CDR-GS score of 0.5. Mean disease duration was 1.4 (1.8) years. Ninety-four (63.1%) patients sought medical help, mostly from neurologists. Patients with help-seeking intentions were mostly female (60.6%) with a CDR-GS score of 0.5 (91.5%) and had a greater awareness of diagnosis, poorer quality of life, more depressive symptoms, and a more severe perception of their condition than their counterparts. Lack of help-seeking intentions was associated with male sex (p = 0.003), fewer years of education (p = 0.005), a low awareness of diagnosis (p = 0.005), and a low emotional consequence of the condition (p = 0.016).

Conclusion

Understanding the phenomenon of active medical help-seeking may facilitate the design of specific strategies to improve the detection of cognitive impairment, especially in patients with a lower level of educational attainment and poor awareness of their condition.

Race and Personal Exposure to AD Influence Projected Memory Failure Attributions and Help-Seeking Behaviors

OBJECTIVES

Examine race and personal exposure to Alzheimer's Disease (AD) on projected memory failure attributions and medical help-seeking thresholds of pre-morbid adults. The goal is to better understand race discrepancies in help-seeking for those potentially at risk for early-onset AD.

METHODS

498 adults aged 40 to 65 (M = 52.27), screened for current memory failure, completed an online questionnaire exploring their help-seeking intentions and threshold, attributions of hypothetical memory failures, and level of AD concern.

RESULTS

Non-Hispanic Whites (n = 248) were significantly more concerned about AD than African Americans (n = 250) (p =.027). Personal exposure to AD moderated the impact of race on memory failure attributions (p =.036), so that personal exposure was more influential for African Americans. Those who were more likely to attribute hypothetical memory failures to AD had lower projected thresholds for seeking a medical evaluation (p =.010). Memory failure attribution emerged as a potential mediator of the impact of race on projected help-seeking behaviors (p =.057).

CONCLUSIONS

African Americans were more influenced by personal experience when considering the causes of hypothetical memory failures.

CLINICAL IMPLICATIONS

Healthcare providers should emphasize to African American families the value of early AD detection and treatment in terms of quality of life for both patient and caregiver.

Trajectories of socio-emotional functioning in early-stage dementia: implications for the individual with dementia and their family carer

BACKGROUND AND OBJECTIVES

Changes in socio-emotional functioning in people living with dementia (PLWD) are common; however, little is known about the broader effects these may have on wellbeing. This study examined socio-emotional functioning over time and associations with the wellbeing of PLWD and their family carers.

METHOD

One hundred and one individuals with a diagnosis of dementia and their respective carers completed the Social Emotional Questionnaire (assessing emotion recognition, empathy, social relationships and social behaviour) alongside measures of dementia severity, cognition, mood, stress, and relationship quality. Sixty-six dyads were reassessed on the same measures at 12 months post-baseline, and 51 dyads again at 20 months post-baseline.

RESULTS

When rated by the PLWD, there was no change in socio-emotional functioning over time; however, carers reported a significant decline over time. For both carers and the PLWD, poorer wellbeing measures were indicative of worse socio-emotional functioning at Time 1, though only dementia type, quality of life and relationship quality impacted upon the trajectory of socio-emotional decline over time.

CONCLUSIONS

Changes in social and emotional functioning are evident early in the course of dementia and worsen within 20 months. Both carer characteristics and those of the PWLD affected reporting of social and emotional functioning. These data are useful for guiding the provision of appropriate education and care.

Risk, worry and motivation: How is public knowledge of dementia shaped?

BACKGROUND AND OBJECTIVES

Due to the concern over global rising rates of dementia, increased emphasis has been placed on understanding and moulding the public's knowledge and awareness of the condition. There has been limited previous research into predictors of dementia knowledge; overall knowledge amongst the public is low, and it has been widely agreed that more needs to be done to raise awareness of this condition. This study seeks to solidify understanding of public dementia knowledge and introduces dementia worry, motivation to seek information and risk perception as novel concomitants of this knowledge.

RESEARCH DESIGN AND METHODS

A convenience sample of 311 UK adults completed a survey on dementia knowledge including Alzheimer's disease-specific questions, worry about developing dementia, motivation to seek information and perceived personal risk of getting the disease. Surveys were completed face-to-face and included both closed and open-ended questions.

RESULTS

Overall dementia knowledge scores were low, achieving an average of 33% of the total possible score, with 88% of the sample scoring below 50%. Bivariate correlations were performed between dementia knowledge and key variables, revealing significant positive relationships with risk perception (r = 0.179, p = .002), worry (r = 0.140, p = .016) and motivation to seek information (r = 0.139, p = .016). When knowledge was dichotomised into high and low, worry about (p = .28) and perceived risk (p = .19) of dementia was significantly lower for people with low knowledge scores than for people with higher dementia knowledge scores. Motivation to seek information was not significantly different between the high and low knowledge groups (p = .071).

DISCUSSION AND IMPLICATIONS

Despite the relatively low knowledge scores, findings show a positive relationship between modifiable factors and dementia knowledge, suggesting areas to consider for both further research and publication campaigns. Further implications and limitations of this study are discussed.

The Barts Explanatory Model Inventory for Dementia: An item reduction approach based on responses from South Asian communities

BACKGROUND

Cultural differences in how the symptoms, causes, consequences, and treatments of dementia are understood and interpreted by South Asian people are a commonly expressed reason for late- or nonuse of mental health and care services. However, systematic collection of information on South Asian perceptions of dementia is hindered by a lack of appropriate instrumentation.

OBJECTIVES

To produce a shortened version of the Barts Explanatory Model Inventory for Dementia (BEMI-D) schedule.

METHODS

A two stage item reduction approach was employed first using multidimensional scaling categorizing items as core, intermediate, or outlier. Then, item review was undertaken using three criteria: literature importance, clinical face validity, and sub-group prevalence. The analysis followed a nonmetric multidimensional scaling method based on a two-way proximity matrix.

RESULTS

The original BEMI-D had 197 items allocated to four checklists: symptoms, causes, consequences, and treatments. The two stage item reduction approach resulted in the removal of 75 items. These reductions were achieved across all four checklists in relatively equal proportions. There was no evidence of substantive content loss in the revised schedule. The reduced version of the schedule comprises 122 items.

CONCLUSIONS

A condensed version of the BEMI-D is more efficient as an assessment schedule that captures the culturally diverse perceptions of memory problems for South Asians offering a balanced trade-off between feasibility of use and content validity.

Illness representations of dementia: a scoping review

As the number of persons with dementia grows, an increasing number of families, professionals, and laypersons will come into contact with persons with cognitive deterioration. Assessing dementia illness representations (IRs) among these groups may have great importance for understanding their responses to dementia. The purpose of this study was to summarize and critically review the literature on dementia IRs. A total of 25 articles that satisfied the inclusion criteria were identified. The review revealed that conceptually, research attention on dementia IRs has increased over the past several years as a result of changes in the notion of IRs and in the dementia discourse. Regardless of the population examined, dementia was mostly described as a chronic condition, presenting more cognitive than behavioral symptoms, and as being caused mainly by age, heredity, and abnormal brain changes. Methodologically, the area of dementia IRs is characterized by design, sample, and data collection weaknesses. Findings suggest that although the literature in the area of dementia and IRs is increasing, several conceptual and methodological limitations still have to be resolved in order to advance knowledge in the area. The research and clinical implications of these findings stress the importance of IRs in the area of dementia.

Beliefs About Dementia: Development and Validation of the Representations and Adjustment to Dementia Index (RADIX)

OBJECTIVES

The Self-Regulation Model (SRM) identifies that the beliefs people hold about an illness can influence their responses to that illness. Although there are generic measures of illness representations, there is a need for a brief tailored measure to use with people with dementia. The aim of this study was to develop and validate a brief measure called the Representations and Adjustment to Dementia Index (RADIX). The RADIX contains questions on the SRM elements: Identity, Cause, Timeline, Control, and Consequences.

METHODS

The RADIX validation was conducted with a sample of 385 community-dwelling people with mild to moderate dementia who were taking part in the IDEAL cohort study. Test-retest reliability was conducted over a 4-week period with a separate sample of 20 people with dementia.

RESULTS

The validation process resulted in a reduction in the number of items in the Timeline, Control, and Consequences items. The resulting RADIX demonstrated good acceptability, internal reliability, and test-retest reliability. All the RADIX items had low missing data, indicating good acceptability. The factor analysis confirmed that the Consequences items formed two subscales (practical and emotional consequences) that had Cronbach's α of 8 and 0.91 respectively. Test-retest reliability indicated that the Identity, Timeline, and Control items had moderate reliability and the practical and emotional consequences scales had good reliability.

CONCLUSIONS

The RADIX demonstrates acceptable psychometric properties, proves to be a useful measure for exploring people's beliefs about dementia, and could aid the provision of tailored information and support to people with dementia.

What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys

Objectives

To synthesise results of population surveys assessing knowledge and attitudes about prevention and treatment of dementia.

Methods

MEDLINE, EMBASE, PsycINFO, and grey literature were searched for English language entries published between 2012 and May 2017. Survey questions were grouped using an inductive approach and responses were pooled.

Results

Thirty-four eligible studies and four grey literature items were identified. Surveys were conducted in Europe, the US, Eastern Asia, Israel, and Australia. Nearly half of respondents agreed that dementia is a normal and non-preventable part of ageing, but belief in the potential for prevention may be improving over time. The role of cardiovascular risk factors was poorly understood overall. Less than half of respondents reported belief in the availability of a cure for dementia. The value of seeking treatment was highly endorsed.

Conclusions

Results suggest that knowledge about the potential for dementia prevention and treatment remains poor but may be improving over time. Knowledge among those living in low- and middle-income countries are largely unknown, presenting challenges for the development of National action plans consistent with World Health Organization directives.

Building Eminence through Evidence

With modern-day medicine going the way it is - new developments, great science, the advent of personalised medicine and more - there's little doubt that healthcare can move in the right direction if everything is put in place to allow it to do so. But in many areas progress is being halted. Or at the very least slowed. Like it or not, many front-line healthcare professionals still do things the way they did things three decades ago, and are reluctant to adapt to new methods (assuming they are aware of them). Evidence exists that today's rapidly developing new medicines and treatments can positively influence healthcare in modern-day Europe, but a gap in education (also applying to patients and politicians), often exacerbated by “fake news” on the internet, is hampering uptake of new and often better methods, while even causing doubts about vaccines. More understanding at every level will inevitably lead to swifter integration of innovation into the healthcare systems of Europe. The time to look, listen and learn has come.