Conceptualization, measurement and correlates of dementia worry: A scoping review

Who's Worried? Memory, Worries About Dementia, and Marital Strain in Midlife Same- and Different-Sex Marriages: A Dyadic Perspective

OBJECTIVES

Prior scholarship has highlighted the importance of marriage for cognition. However, little research has considered how cognition-related concerns may impact marriage. In this study, researchers examine how aging couples view each other's memory and worry about their potential development of dementia in the future. Additionally, researchers investigate whether these cognition-related concerns may strain marriage, and how these dynamics differ for men and women in same- and different-sex marriages.

METHODS

Researchers used 2 waves of dyadic data from the Health and Relationships Project (HARP; 2015-2022), including 594 respondents from 297 same- and different-sex married couples (aged 41-71 at Time 2). Researchers employed the Actor-Partner Interdependence Model (APIM) to explore associations between actor and partner reports of memory and dementia worry with marital strain.

RESULTS

Men and women in same- and different-sex marriages were equally likely to report worries about their own potential development of dementia. However, women reported more concerns about their spouse developing dementia in the future than men did, regardless of whether they were married to a man or a woman. Both partners' reports of memory and dementia worry played a complex role in influencing marital strain, with variations observed across couple types.

DISCUSSION

Concerns about cognitive decline and dementia are common in older populations, and for married couples, spouses have concerns about their own memory as well as that of their partner. Researchers finding identified the significance of concerns about a spouse's memory on marital dynamics among aging couples.

Perceived Cognitive Function and Glycemic Variability: Baseline Results From a Cognitive Rehabilitation Intervention

PURPOSE

The purpose of this study was to examine the association between glucose variability, diabetes self-management, and cognitive function in participants enrolled in a cognitive rehabilitation intervention for people with type 2 diabetes.

METHODS

Baseline data from the Memory, Attention, and Problem-Solving Skills for Diabetes randomized controlled trial (n = 95; mean age 65.6 years, SD 5.99; 59.3% female; 59% non-Hispanic White) were analyzed and included scores from the PROMIS Cognitive Function version 2, a measure of perceived cognitive function; glucose variability measurements from continuous glucose monitors; and scores on the Summary of Diabetes Self-Care Activities Survey.

RESULTS

Participants had higher levels of perceived cognitive dysfunction than the US average. Lower PROMIS scores were associated with higher levels of glucose variability. Better perceived cognitive health was related to better diabetes self-management. Glucose variability, measured by the coefficient of variation, was a significant predictor of perceived cognitive function.

CONCLUSIONS

Perceived cognitive function was associated with diabetes self-management and glucose variability. Understanding this association can support the development of interventions to mitigate effects associated with glucose variability and changes in cognitive function. Including measurements of perceived cognitive function in assessments has the potential to alert health care providers about the need for additional support in diabetes management and the possibility of cognitive impairment that may need further objective assessment.

Age moderates associations between dementia worry and subjective cognition

The present study assessed whether dementia worry is associated with adults' subjective cognitive difficulties, and whether any associations are moderated by age. Participants were 477 adults aged 18-90 years. They completed standard, subjective measures of dementia worry and everyday cognitive difficulties (i.e. attention, language, verbal and visual-spatial memory, and visual-perceptual ability). Moderated regression analyses included dementia worry as a predictor of specific cognitive difficulties, and age as a moderator. Covariates included gender, trait cognitive and somatic anxiety, general aging-related anxiety, depression, stress, mental health treatment status, and health status. Greater overall dementia worry, and specifically more frequent dementia worry, were both associated with greater attentional difficulty in middle-aged and older adults, but not in young adults. Cognitions about developing dementia in reaction to memory lapses were also associated with greater cognitive difficulties across the adult lifespan for multiple cognitive domains. Results highlight a robust relationship between dementia worry and subjective attentional difficulties, especially in middle-aged and older adults. Worry frequency is also more influential with adult aging. A cognitive or meta-cognitive mechanism may underlie subjective cognitive concerns across the adult lifespan.

Perceived Threat of Alzheimer's Disease and Related Dementias Among Chinese Family Caregivers of Older Adults with Cognitive Impairment

Perceived threat of Alzheimer's disease and related dementias (ADRD) has been found a widespread phenomenon in developed countries, but has not yet been fully explored in developing countries. Analyzing data from 300 family caregivers of older adults with cognitive impairment in China, this study found caregiver burden was positively associated with the perceived threat of ADRD, and this association was buffered by higher family income and longer caregiving time. To alleviate undue ADRD concerns, it suggests expanding respite care and community elder care beds, and initiating education programs on reducing unnecessary worries about developing ADRD.

Validating the Hebrew Version of the Modified Dementia Worry Scale (H-MDWS)

The body of knowledge regarding dementia worry - people's sense of threat about developing dementia - is still limited. Additional studies are essential to better understand levels of dementia worry and its correlates, especially in cross-cultural contexts. To reach this goal, it is critical to use structured and valid measures to assess dementia worry and to verify these measures in different languages. Therefore, the aim of the current study was to evaluate the psychometric properties of the Hebrew version of the Modified Dementia Worry Scale (the H-MDWS). A cross-sectional study using an online survey was conducted with 368 Israeli laypeople who were 18 years of age or older (53% women, 76% Jewish, mean age = 40, average years of education = 14). In addition to the H-MDWS, participants were asked to report their fear of Alzheimer's disease (using a dichotomous single item), stigma, health anxiety, and demographic characteristics. Reliability analyses showed that the Cronbach's alpha for the H-MDWS was excellent (α = 0.95). The results of the factor analysis demonstrated that the scale has a unidimensional structure, explaining over 66% of the variance. In addition, we found significant correlations between fear of developing Alzheimer's disease, stigma, and health anxiety, on the one hand, and the H-MDWS on the other. The H-MDWS is a reliable and valid tool for assessing dementia worry. The validation of the tool not only allows expanding the body of knowledge related to dementia worry, but will also allow professionals and caregivers to identify people who are at risk of reporting dementia worry and develop interventions accordingly.

Unexpected cognitive similarities between older adults and young people: Scores variability and cognitive performances

BACKGROUND

Increased interindividual variability in cognitive performance during aging has been proposed as an indicator of cognitive reserve.

OBJECTIVE

To determine if interindividual variability performance in episodic memory (PAL), working memory (SWM), reaction time (RTI), and sustained attention (RVP) could differentiate clusters of differential cognitive performance in healthy young and older adults and search for cognitive tests that most contribute to these differential performances.

METHODS

We employed hierarchical cluster and canonical discriminant function analyses of cognitive scores using the Cambridge Neuropsychological Test Automated Battery (CANTAB) to identify cognitive variability in older and young adults using the coefficient of variability of cognitive performances between and within groups. We also analyzed potential influences of age, education, and physical activity.

RESULTS

Cluster analysis distinguished groups with differential cognitive performance and correlation analysis revealed coefficient of variability and cognitive performance associations. The greater the coefficient of variability the poorer was cognitive performance in RTI but not in PAL and SWM. Older adults showed diverse trajectories of cognitive decline, and better education or higher percentage of physically active individuals exhibited better cognitive performance in both older and young adults.

CONCLUSION

PAL and SWM are the most sensitive tests to investigate the wide age range encompassing older and young adults. In older adults' intragroup analysis PAL showed greater discriminatory capacity, indicating its potential for clinical applications late in life. Our data underscore the importance of studying variability as a tool for early detection of subtle cognitive declines and for interpreting results that deviate from normality.

Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial

BACKGROUND

Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life.

METHODS

Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up).

RESULTS

Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed.

CONCLUSIONS

Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT04821960 .

Sense of Purpose in Life and Beliefs and Knowledge of Alzheimer's Disease

OBJECTIVE

A sense of purpose in life is associated with healthier cognitive outcomes, including lower risk of Alzheimer's Disease (ad). The present research examines whether purpose is also associated with beliefs and knowledge of ad.

METHOD

A random subsample (N = 1,187) of community-dwelling participants from the Health and Retirement Study completed a module on self-reported beliefs and knowledge of ad.

RESULTS

Purpose in life was associated with lower perceived threat of ad and greater belief that modifiable factors (e.g., physical activity) decrease risk. Associations were not moderated by experience with ad or depressive symptoms. Purpose was unrelated to beliefs that genetics or stress increase risk or knowledge of ad.

CONCLUSIONS

Individuals with a sense of purpose are less concerned about risk of developing ad and believe modifiable factors reduce risk. These beliefs may support engagement in behaviors that reduce risk and be one psychological pathway through which purpose protects against ad.

Dementia is the second most feared condition among Australian health service consumers: results of a cross-sectional survey

Fear of disease may act as a barrier to screening or early diagnosis. This cross-sectional survey of 355 people attending outpatient clinics at one Australian hospital found that cancer (34%) and dementia (29%) were the most feared diseases. Participants aged 65 years and over feared dementia the most.

Anticipated suicidal and death ideation in response to an imagined dementia diagnosis: A qualitative study

Alzheimer's disease and related dementias are prevalent, highly impactful, and feared diagnoses. A mixed methods study using semi-structured interviews was conducted to clarify causes of dementia-related anxiety. Fifty community-dwelling adults aged 58 to 89 (M = 70.92, SD = 6.08) were recruited from a university participant registry and Memory Clinic; none had dementia diagnoses. Analyses revealed that 42% (n = 21) of participants anticipated suicidal or death ideation if diagnosed with dementia. Among participants endorsing anticipated suicidal or death ideation, responses ranged from active, specific plans, including interest in physician-assisted suicide, to more passive wishes to hasten death rather than continue to live with dementia. Within reports of both anticipated suicidal and death ideation, three subthemes emerged. Participants reported concerns about becoming a burden to others, the devaluation of life/loss of self with dementia, and the desire for (and anticipated thwarting of) personal control as factors contributing to their anticipated responses to a dementia diagnosis. Statements of anticipated suicidal and death ideation were contingent on a dementia diagnosis and may reflect errors in affective forecasting. Nevertheless, given the prevalence of dementias and older adults' elevated rates of suicide, the intersection of these two public health issues warrants greater attention.

Dementia literacy and worry among older Chinese Americans in Arizona: a comparison between 2013 and 2017

OBJECTIVES

This study examined the change in dementia literacy and dementia worry over a 5-year span among older Chinese Americans living in Arizona.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENT

This study used survey data collected among a purposive sample of 703 community-dwelling Chinese Americans aged 55 years or older living in the metropolitan areas of Phoenix, Arizona, from 2013 to 2017. The average age of participants was 73.1 (SD = 8.7) and 64.2% were female. Dementia literacy was measured by dementia knowledge (knowledge about Alzheimer's disease and related dementia) and dementia beliefs (biased attitude toward dementia). Dementia worry was measured by assessing participants' fear toward and concerns of developing dementia.

RESULTS

Regression analyses found dementia knowledge decreased (p < 0.05) and dementia beliefs remained unchanged (p > 0.05) from 2013 to 2017 among participants. Dementia worry only increased among those who lived alone. Significant correlates of dementia worry included low formal education level, depressive symptoms, and family conflict.

CONCLUSIONS

Public health education targeting older Chinese Americans should aim to enhance dementia knowledge and to rectify their biased attitudes toward dementia. Psychosocial education or counseling should be available to older Chinese Americans who present dementia worry, particularly for those who live alone. More studies using diverse study designs, such as a longitudinal design, are needed to examine change in dementia literacy and worry among this population.

Profiles in Dementia-Related Anxiety: A Latent Profile Analysis

OBJECTIVES

Dementia-related anxiety (DRA) is the concern about current or future cognitive decline and potential diagnosis of Alzheimer's disease or related dementias (ADRD). Existing research suggests that DRA likely develops due to diverse reasons (e.g., family ADRD history, self-perceived risk, and health-related anxiety), and approaches to managing DRA likely differ as well (e.g., future planning). This study aimed to identify profiles in DRA.

METHOD

In a cross-sectional study, a convenience sample of U.S. adults ranging in age from 18 to 82 (N = 492, Mage = 49.25, standard deviation [SDage] = 15.43) completed online assessments of characteristics associated with DRA. Latent profile analysis was used to uncover distinct DRA profiles and promote understanding of individual characteristics associated with varying levels of DRA; multinomial regression assessed if the profiles are further distinguished by covariates.

RESULTS

The resulting four-profile model reveals profile differences are largely due to DRA, self-perceived ADRD risk, and preparedness for future care needs; health-related anxiety, age, ADRD exposure, and anticipated ADRD stigma contribute to profile differences as well. Profiles of the youngest and oldest groups reported the lowest and highest levels of preparedness for future care, along with the lowest DRA and self-perceived risk. Several covariates, particularly those assessing general psychological functioning, were also related to profile membership.

DISCUSSION

The resulting profiles point to several factors associated with elevated anxiety about ADRD, which do not fully match the risk factors for ADRD.

A health promoting-lifestyle prediction model for dementia prevention among chinese adults: based on the health belief model

BACKGROUND

People's health belief is an important factor affecting health behavior. However, there has been little use of the health belief model (HBM) in determining the pathway effect of patients' beliefs on health behavior in dementia prevention in China. The aim of our study was to evaluate the impact of dementia prevention beliefs on health promoting lifestyle among Chinese adults.

METHODS

A cross-sectional study was conducted on line by convenience sampling from January to March 2020. A survey about dementia prevention knowledge, health belief of dementia prevention and health-promoting lifestyle was completed by 1201 adults in China. Data was analyzed using a structural equation model with the analysis of moment program.

RESULTS

The participants were aged 40.50 ± 12.72 years. About 70.3% of participants were female. The purposed model fit the data from the study well. Perceived barriers (total effect-0.322, P < 0.01) and perceived susceptibility (total effect -0.242, P < 0.01) had negative effects on lifestyle. Self-efficacy had promoting effects on lifestyle (total effect 0.207, P < 0.01). Perceived severity had positive effects both on perceived benefits (total effect 0.137, P < 0.01) and perceived barriers (total effect 0.202, P < 0.01), which had a contradictory effect in the formation of health belief. Perceived benefits, cues to action and self-efficacy played a partial mediating role between knowledge and health behavior. The belief of changing lifestyle to reduce the risk of dementia could explain 24.5% of health behavior (P < 0.05).

CONCLUSIONS

The findings indicate that in dementia prevention, dementia prevention health belief has important influences on health behavior. Community medical staff can develop targeted dementia prevention interventions based on the health belief model in the future.

Health beliefs, lifestyle, and cognitive aging among Chinese community residents: A structural equation model analysis

Background

Lifestyle factors may could help maintain cognitive function and reduce the risk of dementia. The application of the Health Belief Model (HBM) has been verified by incorporating lifestyle changes for dementia risk reduction; however, the influence of health beliefs on cognitive aging through lifestyle remains unknown. To facilitate research-based interventions to promote successful cognitive aging, we explored the relationship between health beliefs, lifestyle, and cognitive aging based on the HBM using path analysis.

Methods

This cross-sectional study recruited middle-aged and older community residents from a community health service center in Chongqing, China, through convenience sampling. Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Lifestyle for Dementia Risk Reduction (LDRR), and the Montreal Cognitive Assessment (MoCA) were employed to measure participants' beliefs, lifestyle, and cognitive function, respectively. The associations between the beliefs, lifestyle, and cognitive function were analyzed, and a structural equation model was constructed.

Results

A total of 202 participants completed the questionnaires, of whom only 17 (8.4%) were classified as having successful cognitive aging. The model demonstrated the data to have an acceptable fit and elucidated 39.3 and 18.2% of the variance in lifestyle and the grade of cognitive aging, respectively. Positive and negative beliefs had opposite effects on the grade of cognitive aging through lifestyle. Cues to action had opposite effects on the grades of cognitive aging through positive and negative beliefs; however, the total effects canceled each other out.

Conclusions

Positive beliefs have a positive effect on lifestyle, thereby promoting successful cognitive aging, whereas negative beliefs have a negative effect on lifestyle, thereby hindering successful cognitive aging. Health education and media publicity, as specific aspects of cues to action, can have a meaningful impact on healthy behavior and successful cognitive aging by promoting positive beliefs and controlling negative beliefs. The model suggests the strengthening and weakening of the positive and negative beliefs, respectively, of middle-aged and older community residents in the formulation of relevant public health strategies in the future, thereby enabling them to adapt to a healthy lifestyle promoting successful cognitive aging.

How Are Sociodemographic, Health, Psychological, and Cognitive Factors Associated with Dementia Worry? An Online Survey Study among Israeli and Australian Laypeople

BACKGROUND

Dementia worry is a widespread phenomenon and the most common emotional reaction elicited by the threat of developing dementia in the future. The cultural factors of dementia worry have not been examined widely, although dementia can be perceived differently between cultures and lead to varying levels of dementia worry. The purpose of this study was to examine the level of dementia worry and factors associated with it cross-nationally in Israel and Australia.

METHODS

A cross-sectional, online survey was conducted with two age-matched adult samples (447 participants in Israel and 290 in Australia). The primary outcome measure was the 12-item Dementia Worry Scale.

RESULTS

Israeli participants (mean age = 42.5 years; 50.1% female) reported statistically significantly (p < 0.05) higher levels of concern about developing dementia in comparison to Australian participants (mean age = 43.7 years; 49.8% female). Increased ageism and increased perceptions about the likelihood of developing dementia were the most important factors associated with increased worry.

CONCLUSIONS

Our findings suggest that country may not be the best criterion to assess cultural differences and should be accompanied by the participants' assessment of their cultural tendencies. Our study also stresses the importance of conceptualizing and assessing affective and cognitive aspects of dementia worry, as people from different cultures might perceive dementia worry cognitively differently but affectively similar and vice-versa.

A cross-sectional survey of a public, evidence-based multimodal program for cognitive health in older adults

BACKGROUND

In recent decades, the proportion of older adults in the population has continued to rise, and with it, the need for intervention programs to maintain cognitive functions into old age. Multiple lifestyle factors, including physical, cognitive, and social activities, are crucial to forestalling a decline in cognitive functions. However, Covid-19 curtailed most activities, and therefore, strategies are needed to support older adults in remaining cognitively healthy. This study describes a newly developed and publicly available multimodal program, called "brain coach", to support and stimulate cognitive activity in older adults. The autonomy supportive program integrates into daily life recommendations for evidence-based physical, cognitive, social, mindful, and creative activation exercises.

METHODS

The study design corresponds to a correlational, analytical, and cross-sectional study with 660 older adults, who participated in the program for at least 3 months and completed an online survey.

RESULTS

The survey results demonstrate that the average age of the participants was 71 years and 75 % were female. Participants experienced benefits in memory, well-being, attitudes towards the brain, and lifestyle habits. Importantly, time invested in the intervention and participant's positive attitude toward brain health and neuroplasticity, show positive relationships with the experienced benefits.

CONCLUSIONS

The results reveal the potential of a public program with a multimodal approach to increase cognitive health and promote an active lifestyle. Further research will explore the effects of such a multimodal intervention in a longitudinal randomized controlled trial study.

Discordance Between Subjective and Objective Cognitive Function in Older Korean Americans

Objectives: To examine predictors of membership in discordant groups identified by subjective and objective measures of cognitive function. Methods: Participants in the Study of Older Korean Americans (N = 2046) were classified according to their subjective cognitive ratings (excellent/very good/good vs. fair/poor) and Mini-Mental State Examination scores (normal cognition vs. cognitive impairment), yielding two discordant groups: (1) positive ratings but cognitive impairment and (2) negative ratings but normal cognition. Logistic regression models examined how the discordant group membership was associated with personal resources. Results: Among those with positive cognitive ratings, the odds of belonging to the discordant group were associated with low personal resources (advanced age and lower levels of education, acculturation, and knowledge about Alzheimer's disease). However, an opposite pattern was observed among those with negative ratings. Discussion: The pattern of discordance suggests ways to promote early detection of cognitive impairment and close the gap in cognitive health care.

Assessing Knowledge and Perceptions of Alzheimer's Disease Among Employees of a Pharmaceutical Company in Spain: A Comparison Between Caregivers and Non-Caregivers

BACKGROUND

Raising knowledge about Alzheimer's disease (AD) may help in identifying the disorder, seeking earlier appropriate healthcare, and decreasing its stigma. The aim of this study was to determine the knowledge and perceptions towards people with AD among employees of a pharmaceutical company in Spain.

METHODS

A non-interventional, cross-sectional study was conducted among 447 employees. Participants answered demographic questions and completed the Alzheimer's Disease Knowledge Scale (ADKS). Caregivers also answered questions related to their personal experience with patients with AD and completed the Satisfaction with Life Scale (SWLS), the Revised Memory and Behavior Problems Checklist (RMBPC), and the Beck Depression Inventory-Fast Screen (BDI-FS).

RESULTS

Participants were mostly between 30 and 50 years old (63%), female (65.3%), and had bachelor or master degrees (82.7%). Forty-two (9.4%) of participants were caregivers, mainly of moderate to severe dementia subjects. Overall knowledge about AD was moderate (mean ADKS score = 21.2 ± 2.8 [70.6% of correct answers]). Risk factors and caregiving were the domains with lowest scores (correct answers: 58.58% and 63%, respectively). Mean total ADKS score was significantly higher in participants caring for people with AD compared with non-caregivers (22.1 ± 2.9 and 21.0 ± 2.8; p=0.02, respectively). There was no statistically significant association between total ADKS score and age, sex, educational level, or relative's AD severity. Most caregivers were satisfied with life (mean SWLS score = 26.8 ± 5.6) showing a low impact from behavioral problems (mean RMBPC reaction score = 26.81 ± 20.2). Six of them (14.3%) were scored as depressed.

CONCLUSION

There is a continuing need to improve understanding of AD to fill the gaps in knowledge of the disease, even in a population working in healthcare sector with a high educational level.