Duration of residence and dementia literacy among Chinese Americans

Association between loneliness and dementia risk: A systematic review and meta-analysis of cohort studies

Loneliness has been reported to be associated with an increased risk of dementia; however, the extent of this relationship remains controversial. This study aimed to assess the strength of the relationship between loneliness and dementia using a meta-analysis approach. PubMed, EMBASE, and China National Knowledge Internet databases were systematically searched for potentially included studies from inception up to 17 February 2022. A meta-analysis was performed using a random-effects model to assess pooled relative risks (RRs) and 95% confidence intervals (CIs). A literature search identified 16 cohort studies (published in 15 articles), among which 4,625 dementia cases and 62,345 individuals were selected for further meta-analysis. Loneliness was associated with an increased risk of Alzheimer's disease (AD) (RR: 1.72, 95% CI: 1.32-2.23; P < 0.001) and dementia (RR: 1.23, 95% CI: 1.16-1.31; P < 0.00001). However, no significant association between loneliness and risk of mild cognitive impairment (MCI) (RR: 1.34, 95% CI: 0.97-1.87; P = 0.080) or vascular dementia (VaD) (RR: 1.01, 95% CI: 0.51-1.99; P = 0.973) was observed. Results revealed that loneliness might increase the risk of Alzheimer's disease and dementia. Early interventions that limit loneliness may reduce risk of dementia and Alzheimer's disease.

What do young Australian adults know about modifiable risk factors for dementia?

BACKGROUND

There are well established modifiable risk factors for late-life dementia. These risk factors account for over 30% of population attributable dementia risk and accrue over the lifespan. Young adults have the greatest potential to reduce their own risk for dementia. This study aimed to investigate what young Australian adults know about dementia and its risk factors, and further, how they estimated these risks.

METHODS

An online survey promoted through various social media platforms was completed by 604 young Australian adults aged 18-44 years of age.

RESULTS

Seventy percent of participants had a limited understanding of dementia (identifying cognitive or functional impairment), 25% had a good understanding, with 5% having no understanding. Twenty percent of respondents thought there were no modifiable risk factors for dementia. Less the half of participants agreed with two of the nine established dementia risk factors (hearing loss in midlife and education in early life), with over half of participants agreeing to the remaining seven risk factors. Females consistently judged the risks conferred by the nine established dementia risk factors to be higher than males. Those who were lonely judged the dementia risk conferred by loneliness to be higher than those who were not lonely; and smokers judged the dementia risk conferred by smoking to be less than non-smokers.

CONCLUSION

Young adults have the greatest potential to change their dementia risk, and these findings show that there are important gaps in knowledge of dementia and its risk factors in this group.

Dementia knowledge and associated factors among older Chinese adults: a cross-national comparison between Melbourne and Beijing

OBJECTIVES

This study compared dementia knowledge between older Chinese adults in Melbourne, Australia, and Beijing, China, and explored factors associated with dementia knowledge between these two groups. Ultimately, this study aimed to inform the development of tailored dementia education programs for older Chinese adults.

DESIGN

A cross-sectional design was employed in this study.

SETTING

Participants were recruited from 5 Chinese community senior groups in Melbourne and 10 community health centers in Beijing from March to May 2019.

PARTICIPANTS

A total of 379 older Chinese adults aged 50 and over completed the questionnaire, including 153 from Melbourne and 226 from Beijing.

MEASUREMENTS

Dementia knowledge was assessed using the Alzheimer's Disease Knowledge Scale (ADKS). Demographic characteristics, dementia-related experience, and the mental health status of participants were collected. Stepwise linear regression was used to analyze the factors associated with dementia knowledge.

RESULTS

In general, older Chinese adults in Melbourne and Beijing reported similar levels of dementia knowledge for both the overall ADKS scale (mean ± SD: 17.2 ± 2.9 in Melbourne vs. 17.5 ± 2.9 in Beijing, p > 0.05) and the seven subdomains. Of the subdomains, the highest correct response rates were observed in the life impact of the dementia subdomain, and the lowest rates were observed in the caregiving subdomain. Stepwise linear regression analysis revealed that younger age and self-reported dementia worry were significantly associated with higher levels of dementia knowledge in the Melbourne group, whereas a positive family history of dementia was significantly associated with higher levels of dementia knowledge in the Beijing group.

CONCLUSIONS

Older Chinese adults living in Melbourne and Beijing share similar levels of dementia knowledge, but factors associated with their knowledge are different. These findings will inform the development of culturally and socially appropriate dementia education programs for older Chinese populations in different countries.

Stigmatising beliefs about Alzheimer's disease: Findings from the Asian American Quality of Life Survey

Responding to the public health significance of Alzheimer's Disease (AD) and lack of information on AD-related issues in Asian Americans, the present study examined the prevalence and predictors of three stigmatising beliefs about AD (beliefs that associate AD with a normal process of ageing, family embarrassment and social avoidance) using a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino and other Asians) and a broad age range (18-98). Guided by the Sociocultural Health Belief Model, multivariate regression models of stigmatising beliefs about AD examined the effect of demographic characteristics (age, gender, marital status, education and ethnicity) and immigration and culture-related variables (proportion of life in the U.S., English proficiency and acculturation). Data came from the 2015 Asian American Quality of Life survey (N = 2,609). Results indicate that the prevalence of stigmatising beliefs about AD varied across ethnicities. More than 63% of Vietnamese associated AD with a normal process of ageing, and about 10% of Chinese reported that they would feel embarrassed if their family member had AD. Logistic regression analyses demonstrated that advanced age, male gender, low education and limited English proficiency increased the odds of reporting one or more stigmatising beliefs about AD. The findings suggest varying degrees of AD-related misconceptions and stigmatisation and call attention to the need for culturally sensitive AD education in Asian communities.

What do the public really know about dementia and its risk factors?

Dementia has become a major public health concern globally. With no cure available and strong evidence for modifiable risk factors, it is imperative that the public are knowledgeable about dementia and to reduce their risk. The aim of this study was to measure the knowledge of dementia and its risk factors in the Australian public, as well as the number and type of information sources used. An online survey promoted through various social media platforms was completed by 596 Australian adults aged 18-78 years (59% aged 18-44 years; 78% female). Eighty-eight percent of respondents were able to recognise dementia from a vignette, more so from a moderate than from a mild symptom vignette. Only 19% of respondents had a good understanding of dementia, that is describing impairment in both cognition and function. Ninety-five percent of respondents recognised that genetics and old age contributed to a person getting dementia. However, respondents had poor knowledge of empirically supported modifiable risk factors, with most viewed as likely contributors to dementia at chance levels (50%) or below. Respondents reported using informal information sources more often than formal information sources to learn about dementia. The public appear to be able to recognise the symptoms of dementia but lack understanding of how dementia impacts both a person's cognitive functioning and ability to perform everyday tasks. Furthermore, the public remain largely unaware of empirically supported modifiable risk factors that contribute to the development of dementia. It is imperative that the public are educated on how to access and evaluate dementia-related information sources in order to increase their knowledge and understanding of dementia.

Measuring consumer access, appraisal and application of services and information for dementia (CAAASI-Dem): a key component of dementia literacy

BACKGROUND

The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool.

METHODS

Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach's alpha coefficients.

RESULTS

From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident - Extremely confident; or Strongly agree - Strongly disagree) or a binary scale (Yes - No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure: Evaluation and engagement; Readiness; Social supports; Specific dementia services; and Practical aspects.

CONCLUSIONS

The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.

Positioning ethnicity in dementia awareness research: does the use of senility risk ascribing racialised knowledge deficits to minority groups?

Over recent decades, the importance of increasing dementia awareness has been promoted by charities, researchers and governments. In response, a large body of research has emerged that evaluates the awareness of different populations. One such population are minority ethnic communities. Associated studies typically conclude that minority ethnic groups have a poor awareness of dementia and that interventions should be developed to better educate them. Operationalisations of awareness almost always reference senility - the traditional notion that dementia is a natural outcome of ageing - a widely held belief among many populations. Senility is considered incorrect knowledge in the research literature, and those participants who identify with it are deemed to have poor awareness. Despite the researchers' claims that senility is false, the scientific evidence is inconclusive, and the concept is contested. As such, a large body of research repeatedly positions minority ethnic communities as inferior and in need of re-education based on researchers' questionable assumptions. This issue is bound up with a racialised deficit-model of science communication and wider critiques of psychiatric colonialism. In response, researchers of dementia and ethnicity should reflect on their own awareness and the ways in which they position others in relation to it.

YouTube as a New Medium for Dementia Education Among Chinese Americans

OBJECTIVE

As one of the most popular social media used around the world, YouTube may be able to serve as a new medium for mental health education. This study aims to analyze and compare the performance of YouTube in disseminating dementia education to Chinese Americans at different time points of the upload period.

METHODS

Dementia educational videos were uploaded to YouTube. Data was collected over a 36-month period. Results from the first year was compared to those from the third year using descriptive statistics and chi square analysis.

RESULTS

The dementia educational videos had a total of 9724 viewers, a total combined watch time of 61,720 min, and an overall average view duration of 6.32 min. Compared to the first year, the videos in their third year performed better in delivering content to the targeted viewers (≥ 45 years old). During the third year, the videos had a significant increase in the percentage of viewers who were 45 years or older. The average view duration of viewers who were older than 65 years old was 38.2% longer than viewers who were younger than 25 years old.

CONCLUSION

Over the span of 3 years, YouTube was able to tailor the dementia educational videos to the older population (≥ 45 years old) who were at the highest risk of dementia. YouTube is a valuable tool that is able to deliver content to interested audience across different age groups.

Utilizing YouTube as platform for psychiatric emergency patient outreach in Chinese Americans

OBJECTIVE

Chinese Americans significantly underutilize mental health resources, which leads to delayed diagnosis, suboptimal management, and can be contributing to the large number of psychiatric emergencies seen in the ED. The goal of this study is to understand the role of using YouTube as a platform for psychiatric emergency outreach among Chinese Americans.

METHODS

We posted three videos about psychiatric emergencies in Cantonese on YouTube. We collected viewing data during a five-year period. The recorded parameters include watch time, number of views, average view duration, traffic source, search terms, and watch device type.

RESULTS

The videos generated 40,608 min of watch time and 5976 views, with an average view duration of 6.80 min. The top three traffic sources are YouTube suggested videos, direct YouTube search, and browse features. The three most used viewing devices are mobile phones (25,068 min of watch time, 3491 views, and 7.18 min of average view duration), computer/TV (9222 min of watch time, 1717 views, and 5.37 min of average view duration), and tablets (6318 min of watch time, 768 views, and 8.23 min of average view duration).

CONCLUSION

Majority of the viewers used mobile phones, and mobile phones and tablets had significantly longer average view durations as compared to computer/TV. YouTube and wireless devices may have potential as internet based psychiatric emergency outreach platform. This study calls for further research to explore the effectiveness of using social media and wireless devices for psychiatric emergency education prior to ED arrival, particularly in minority populations with cultural barriers to health care.

Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review

BACKGROUND

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population.

OBJECTIVE

The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans.

METHODS

The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus.

RESULTS

The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities.

CONCLUSION

To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.

How Is Literacy Being Defined and Measured in Dementia Research? A Scoping Review

Literacy plays an important role in Alzheimer's disease and related dementias (ADRD); however, less is known about how literacy is being used and defined in ADRD studies. This study reviewed terminology being used to describe types and definitions of literacy and instruments used to assess literacy in ADRD research. Among the 219 studies retrieved from 3 databases, 50 met our inclusion criteria. Literacy terms used in ADRD studies varied: literacy (n = 28), health literacy (n = 9), and dementia literacy (n = 7) were the most often used terms, followed by financial literacy (n = 4), dementia knowledge (n = 3), AD knowledge (n = 2), mental health literacy (n = 2), AD literacy, digital literacy, health literacy about incontinence, and financial knowledge (n = 1 each). Thirty studies did not define literacy terms used. Among the 20 studies defining literacy, definitions were inconsistent across studies even when they used the same term. Surveys (n = 30), open-ended questions, vignettes, or focus groups (n = 10), self-perceived (n = 3) or interviewer assessed (n = 1) literacy levels were used to assess literacy. Ten studies did not specify literacy measurement. Various literacies have been examined in ADRD research with unclear definitions and some inadequate measures. Well-defined terms with valid measures are needed to better understand the role of literacies in ADRD research.

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.

Comparison of Online Dementia Information in Chinese and in English Languages

Introduction

There is a deficit of avenues for obtaining dementia information in the Asian American community. This study aims to compare the content and quality differences between websites providing information on dementia as found by a Google search conducted both in simplified Chinese characters and in English.

Methods

A Google search was performed for the phrase “dementia” in simplified Chinese characters and in English. The resultant websites were categorized by whether they were commercial in nature, the type of website, and whether the website provided an explanation of dementia signs and symptoms. The quality of the websites was assessed via readability and the Health on the Net Code of Conduct (HONcode). Chi-squared analyses were performed to establish differences between the English and simplified Chinese results.

Results

The simplified Chinese search websites were more likely to be commercial (p=0.045) and were more likely to not meet HONcode standards (p=0.008). No statistical significance was observed between the types of websites (p=0.127), the prevalence of signs and symptom explanations (p=0.073), and the readability of the website (p=0.151).

Conclusion

The quality of websites obtained from the simplified Chinese character Google search was lower than those obtained from searches using the English language. Given the limited sources of language and culturally appropriate information on dementia, improvement of Internet resources may help to improve health outcomes of dementia patients in the Asian American population.

Comparison of Mental Health Service Utilization by Asian Americans and Non-Hispanic Whites versus Their Cardiovascular Care Utilization

INTRODUCTION

This study will determine whether racial/ethnic disparities persist in various psychiatric disorders among Asian Americans.

METHODS

Secondary analyses of data from the second largest public health system in the US (total N=22294) were performed. Chi-squared statistics were used to compare the race for mental health service utilization for five psychiatric diagnoses. Cardiovascular care utilization by Asian Americans and non-Hispanic whites was used as a proxy for overall healthcare utilization rates between the two racial groups and constituted the expected values for the analysis.

RESULTS

Asian Americans were less likely to utilize mental health services for bipolar disorder, schizophrenia, anxiety, depression, and intellectual disabilities.

CONCLUSION

The results of this study call for ways to increase mental health service utilization on par with cardiovascular healthcare utilization among Asian Americans.

Dementia Health Promotion for Chinese Americans

Introduction This study aims to describe the results of a dementia awareness campaign in the Chinese American community.  Methods The campaign consisted of a health fair, four dementia seminars, radio shows, television episodes, and a YouTube series. Descriptive statistics and qualitative data were obtained from various health communication channels.    Results There were 156 and 313 participants in the health fair and dementia seminars, respectively. The participants in each component of the campaign also provided qualitative data on barriers and effective ways to disseminate awareness of dementia and brain health.  Conclusion A dementia awareness campaign may be an effective way to reduce health disparities and dementia in the Chinese American community.

E-mental health in ethnic minority: A comparison of youtube and talk-based educational workshops in dementia

BACKGROUND

Innovation in information and communication technology has been transforming health service delivery.

METHODS

This study aims to compare YouTube against traditional talk-based workshops in delivering dementia knowledge to the Chinese-American population.

RESULTS

Results reveal that E-mental health has enormous potential; however, for the older Chinese-American ethnic population, talk-based workshop is still more desired in delivering dementia education to targeted age groups.

DISCUSSION

As YouTube has become a readily available and widely distributed media for prevention and psychoeducational efforts, this study demonstrates the utility of YouTube in delivering dementia knowledge. Nevertheless, viewer appeals need to be addressed by making the first few minutes engaging.

Association between recognizing dementia as a mental illness and dementia knowledge among elderly Chinese Americans

AIM: To investigate whether older Chinese Americans perceive dementia as a mental illness and the relationship between such perception and their general understanding of dementia remains unclear. Our study aims to understand this relationship and its future implication on improving dementia literacy among ethnic minorities.

METHODS: Elderly Chinese American participants from the Greater Los Angeles were asked to complete an 11-item dementia questionnaire, following a community health seminar. Cross-sectional survey data was analyzed using standard statistical methods.

RESULTS: The questionnaire received an 88.3% response rate. Among 316 responders, only 28.8% (n = 91) of elderly Chinese Americans identified dementia as a mental illness, and 71.2% (n = 225) did not recognize its mental disease origin. Furthermore, in comparison between these two groups, the first group demonstrated significantly higher level of baseline knowledge of the disease.

CONCLUSION: This study reveals that only approximately 1 out of 4 older Chinese Americans recognized dementia as a mental illness, consistent with previous studies on Asian Americans. Our study however showed that when dementia was being perceived as a mental illness, such perception was associated with a higher level of baseline dementia understanding. The current study suggested the potential of improving older Chinese Americans dementia literacy by increasing awareness of its mental illness origin.

Examining the differences in the stigma of dementia and diabetes among Chinese Americans

AIM

One of the major barriers in making a diagnosis and managing dementia in the Chinese American population is the stigma surrounding the disease. The goal of the present study was to examine differences in the stigma and perceptions of dementia and diabetes among Chinese Americans.

METHODS

A total of 449 Chinese Americans answered one survey with two self-administered, true/false questionnaires assessing stigma and perceptions toward dementia and diabetes. Higher total scores were associated with increased stigma and negative perceptions. The results of the two questionnaires were compared to assess for any differences in attitudes.

RESULTS

For the dementia questionnaire, the mean score was 5.58 (95% CI 5.37-5.79) with a standard deviation of 2.31. For the diabetes questionnaire, the mean score was 2.01 (95% CI 1.85-2.18) with a standard deviation of 1.76. Statistical analysis showed that Chinese Americans were more likely to hold stigmatized views toward dementia than diabetes (t = 33.9, d.f. = 448, P < 0.01).

CONCLUSIONS

The higher average score in the dementia questionnaire shows that there are greater stigma and negative perceptions of dementia in comparison with diabetes among Chinese Americans. Considering that stigma delays access to healthcare for dementia-related symptoms, efforts should be taken to minimize negative attitudes associated with dementia. Geriatr Gerontol Int 2017; 17: 760-764.

Exploring the Impact of a Culturally Tailored Short Film in Modifying Dementia Stigma Among Chinese Americans: A Pilot Study

OBJECTIVE

Chinese Americans, one of the fastest growing ethnic groups among the US elderly population, perceive high levels of dementia stigma. The authors examined the extent of the stigma and explored the impact of media through a culturally tailored short film to modify dementia stigma.

METHODS

Chinese American participants were asked to answer a dementia questionnaire. A short film was then used to address the impact of media on dementia stigma.

RESULTS

Among 90 randomly selected participants, 89% (n = 80) found the short film to be a useful way to modify their misconceptions about dementia. In the comparison between the group who felt less influenced by the short film and the group who recognized the short film to be extremely helpful, the latter group had a higher baseline of stigma toward dementia, as well as a shorter duration of residence in the USA.

CONCLUSION

Chinese Americans still perceive severe dementia stigma. Nevertheless, a culturally tailored short film demonstrated promising impact in modifying stigma toward dementia.

Family history and its relationship with dementia stigma beliefs among Chinese Americans

AIM

It is known that Chinese Americans associate dementia with stigma and "loss of face." However, further research is required to provide a more complete picture of the extent and nature of stigma in Chinese Americans with family histories of dementia (FHD). The present study examined whether FHD are associated with quantitative measures of stigma in Chinese Americans.

METHODS

A total of 300 Chinese Americans in two health seminars answered a 15-item, true/false questionnaire to assess their beliefs toward dementia. Two groups were dichotomized and compared based on FHD.

RESULTS

Both groups subscribed to moderately stigmatizing views about dementia. Our findings showed that the group with FHD was more likely to disclose having relatives with dementia. However, this group was also more likely to perceive patients with dementia to be incapable of feeling other people's worries or concerns at once.

CONCLUSIONS

Strategies to decrease stigma toward dementia are required. Cultural interventions must also extend into the Chinese American general public to reduce stigma of dementia. Geriatr Gerontol Int 2017; 17: 122-125.

Immigrant patients with dementia and memory impairment in primary health care in Norway: a national registry study

BACKGROUND

Immigrants comprise a growing proportion of the elderly population. However, knowledge about the diagnosis and management of dementia and memory impairment among immigrants is scarce in Norway and elsewhere.

AIMS

To compare proportions of Norwegians and immigrants aged ≥50 years with a diagnosis of dementia or memory impairment in primary health care and to study the demographic characteristics, utilization of primary health care services and pharmacological treatment of Norwegians and immigrants with either of the two diagnoses in 2008.

METHOD

This is a registry-based study using linked data at the individual level from 4 national Norwegian registers.

RESULTS

A significantly lower proportion of immigrants, especially those from other than high-income countries, had a diagnosis of dementia or memory impairment. Among patients with such diagnoses, anti-dementia medication was purchased 20-50% more often by Norwegians than by immigrants, although the differences remained significant only for immigrants from other than high-income countries after adjustment for several variables.

CONCLUSION

The lower proportions of immigrants with a dementia diagnosis and lower proportions of patients receiving treatment might indicate a lower prevalence or milder forms of dementia among immigrants. However, the cultural validity of the assessment tools, linguistic barriers and challenges for general practitioners should be further investigated.