The Influence of Psychosocial and Cognitive Factors on Perceived Threat of Alzheimer's Disease

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.

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.

How Does Exposure to Dementia Relate to Subjective Cognition? A Systematic Review

Background and Objectives

Subjective cognitive decline (SCD) may be indicative of future objective cognitive decline. However, factors other than objective cognitive performance may influence SCD. This review addresses whether family history or close, nonfamilial exposure to dementia is associated with self-reported SCD.

Research Design and Methods

Searches were conducted in PubMed, PsycINFO, Web of Science, and the Dissertations and Theses database. Eligible articles included measures of self-reported cognition for community-dwelling middle-aged or older adults (40+ years) not diagnosed with dementia, and who had either a family history of dementia, a family member, spouse, or close friend with dementia. The quality of evidence was evaluated using the LEGEND Appraisal Tool. Evidence was synthesized narratively.

Results

A total of 32 articles were included, with 28 rated as good quality. Across studies, the relationship between dementia exposure and SCD was inconsistent. A significant association between exposure and SCD was found in 6 studies; however, 17 reviewed studies found no evidence of a relationship. The remaining 9 studies found mixed associations. Modifying factors that could potentially influence these associations were exploratorily identified among studies to provide context to our results. These factors included dementia worry, emotional closeness, and measurement sensitivity.

Discussion and Implications

Findings of this review suggest that both first-degree relatives and spouses of persons with dementia may have an increased likelihood of reporting SCD, although the current heterogeneity in definitions of exposure to dementia and SCD may influence these findings. In addition to the relationship between dementia exposure and SCD, future research should examine potential modifiers, including meaning attributed to exposure, as identifying how these perceptions affect cognition may promote early intervention.

Influence of mild cognitive impairment on patient and care partner decision-making for acute ischemic stroke

GOALS

Evidence suggests that patients with mild cognitive impairment (MCI) receive fewer treatments for acute ischemic stroke and other cardiovascular diseases than patients with normal cognition. Little is known about how patient and care partner preferences for ischemic stroke treatment differ between the patient population with MCI and the population with normal cognition. This study aimed to understand how patient MCI diagnosis influences patient and care partner decision-making for acute ischemic stroke treatments.

METHODS

Multi-center qualitative study using in-person semi-structured interviews with 20 MCI and normal cognition patient-care partner dyads using a standard guide. The present study reports results on patient and care partner preferences for a clinical vignette patient to receive three non-invasive treatments (intravenous tissue plasminogen activator, inpatient rehabilitation, and secondary preventive medications) and two invasive treatments (feeding tube and carotid endarterectomy) after acute ischemic stroke. We used qualitative content analysis to identify themes.

FINDINGS

We identified three major themes: (1) Patients with MCI desired non-invasive treatments after stroke, similar to patients with normal cognition and for similar reasons; (2) Patients with MCI expressed different preferences than patients with normal cognition for two invasive treatments after stroke: carotid endarterectomy and feeding tube placement; and (3) Patients with MCI expressed more skepticism of the stroke treatment options and less decisiveness in decision-making than patients with normal cognition.

CONCLUSIONS

These results suggest that patient MCI diagnosis may contribute to differences in patient and care partner preferences for invasive treatments after stroke, but not for non-invasive treatments.

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.

Family History of Dementia in Old-Age Participants with Subjective Memory Complaints Predicts Own Risk for Dementia in a Longitudinal Multi-Center Cohort Study

BACKGROUND

Subjective memory complaints and family history of dementia are possibly intertwined risk factors for the own subsequent dementia risk and Alzheimer's disease. However, their interaction has rarely been studied.

OBJECTIVE

To study the association between subjective memory complaints and family history of dementia with regard to the own subsequent risk of dementia.

METHODS

Cross-sectional and longitudinal analyses over a follow-up period of up to 13 years were conducted in a population sample of participants without dementia at baseline (n = 3,256, mean age = 79.62 years), using group comparisons and Cox proportional hazards models.

RESULTS

Cross-sectionally, participants with subjective memory complaints were significantly more likely to report family history of dementia. Longitudinally, family history of dementia (FH) was significantly associated with subsequent dementia in the subjective memory complaints (SMC) group, but not in those without SMC. A relative excess risk due to interaction analysis confirmed a significant FHxSMC-interaction.

CONCLUSIONS

Family history of dementia was a predictor of incident dementia in those with SMC, which can serve as an additional, clinically relevant criterion to gauge the risk of dementia in older-aged subjects with SMC with and without objective cognitive impairment.

The Association Between Mild Cognitive Impairment Diagnosis and Patient Treatment Preferences: a Survey of Older Adults

BACKGROUND

Older patients (65+) with mild cognitive impairment (MCI) receive less guideline-concordant care for cardiovascular disease (CVD) and other conditions than patients with normal cognition (NC). One potential explanation is that patients with MCI want less treatment than patients with NC; however, the treatment preferences of patients with MCI have not been studied.

OBJECTIVE

To determine whether patients with MCI have different treatment preferences than patients with NC.

DESIGN

Cross-sectional survey conducted at two academic medical centers from February to December 2019 PARTICIPANTS: Dyads of older outpatients with MCI and NC and patient-designated surrogates.

MAIN MEASURES

The modified Life-Support Preferences-Predictions Questionnaire score measured patients' preferences for life-sustaining treatment decisions in six health scenarios including stroke and acute myocardial infarction (range, 0-24 treatments rejected with greater scores indicating lower desire for treatment).

KEY RESULTS

The survey response rate was 73.4%. Of 136 recruited dyads, 127 (93.4%) completed the survey (66 MCI and 61 NC). The median number of life-sustaining treatments rejected across health scenarios did not differ significantly between patients with MCI and patients with NC (4.5 vs 6.0; P=0.55). Most patients with MCI (80%) and NC (80%) desired life-sustaining treatments in their current health (P=0.99). After adjusting for patient and surrogate factors, the difference in mean counts of rejected treatments between patients with MCI and patients with NC was not statistically significant (adjusted ratio, 1.08, 95% CI, 0.80-1.44; P=0.63).

CONCLUSION

We did not find evidence that patients with MCI want less treatment than patients with NC. These findings suggest that other provider and system factors might contribute to patients with MCI getting less guideline-concordant care.

Medical help-seeking intentions for cognitive impairment by the patient

Objectives: Older adults represent one of the fastest growing population groups. As the aged population increases, incidence of Alzheimer's disease (AD) and other dementias will also increase. Professionals agree that early intervention is essential for therapeutic and quality of life purposes; however, many older adults wait several months or years to seek medical help after first noticing signs of cognitive impairment. The present study sought to identify the predictors of help-seeking for cognitive impairment by an individual for him/herself after the first detection of symptoms.Method: An online survey was administered to adults (N = 250) 50 years old and older. Individuals responded about their help-seeking intentions in response to a hypothetical vignette depicting symptoms of cognitive decline derived from a similar study with caregivers conducted by Qualls and colleagues. Additional standardized measures measuring constructs such as knowledge of Alzheimer's disease were completed.Results: The present study reveals that cognitive (i.e. symptom identification and disease attribution) and affective (i.e. symptom impact and threat appraisal) factors, as well as an interaction between the two, are predictive of help-seeking intentions with excellent model fit.Conclusion: Help-seeking intentions by individuals with possible cognitive impairment are comparable to those of potential caregivers. Contrary to hypotheses, high threat appraisal positively predicted help-seeking intentions despite the expectation that threat-induced fear would lead to avoidance. Recommendations are made for future research to further investigate both patients' help-seeking intentions and actions in response to signs of cognitive impairment.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1910791 .

Relevance of Subjective Cognitive Decline in Older Adults with a First-Degree Family History of Alzheimer's Disease

BACKGROUND

It is unclear whether subjective cognitive decline (SCD) is a relevant clinical marker of incipient Alzheimer's disease (AD) and future cognitive deterioration in individuals with a family history of AD (FHAD).

OBJECTIVE

To investigate the association of SCD with cross-sectional cerebrospinal fluid (CSF) AD biomarker levels and cognitive decline in cognitively normal older adults with or without a first-degree FHAD.

METHODS

We analyzed data from cognitively normal individuals with first-degree FHAD (n = 82 "AD relatives"; mean age: 65.7 years (SD = 4.47); 59% female) and a similar group of n =  236 healthy controls without FHAD from the DELCODE study. We measured SCD with an in-depth structured interview from which we derived a SCD score, capturing features proposed to increase likelihood of underlying AD ("SCD-plus score"). We tested whether higher SCD-plus scores were associated with more pathological CSF AD biomarker levels and cognitive decline over time and whether this association varied by group.

RESULTS

AD relatives showed higher SCD-plus scores than healthy controls and more cognitive decline over time. Higher SCD-plus scores also related stronger to cognitive change and abnormal CSF AD biomarker levels in the AD relatives as compared to the healthy controls group.

CONCLUSION

Quantification of specific SCD features can provide further information on the likelihood of early AD pathology and cognitive decline among AD relatives. FHAD and SCD appear as synergistically acting enrichment strategies in AD research, the first one as a permanent indicator of genetic risk, the latter one as a correlate of disease progression.

The Influence of Dementia Beliefs and Knowledge on Perceived Dementia Worry: An Empirical Study Among Adults in Rural China

Alzheimer's disease and related dementias are more prevalent in rural areas than in urban areas in China. This study aims to examine the role of dementia beliefs and knowledge in influencing dementia worry among rural adults in China. Data were generated in a cross-sectional survey of 577 participants. Hierarchical regression analyses found that both the beliefs and knowledge of dementia contributed to higher levels of dementia worry. The propensity score matching method affirmed the robustness of regression results. In addition, those aged 45-64 reported higher worry about dementia than those aged 65 or older, while being married was related to lower dementia worry. As one of the first kind studies that examined dementia worry in rural Chinese population, our findings suggest that policy and practice efforts should address cultural beliefs of dementia as they contributed to higher worry about dementia in rural areas.

A Mixed-Methods Study of the Impact of Mild Cognitive Impairment Diagnosis on Patient and Care Partner Perception of Health Risks

BACKGROUND

Older patients (≥65 years) with mild cognitive impairment (MCI) are undertreated for cardiovascular disease (CVD). One reason for this disparity could be that patients with MCI might underestimate the chances of CVD and overestimate dementia.

OBJECTIVE

To compare conceptions of health risk between older patients with MCI and normal cognition (NC) and their care partners.

METHODS

We conducted a multi-center mixed-methods study of patient-care partner dyads completing written quantitative surveys (73% response rate; 127 dyads: 66 MCI and 61 NC) or semi-structured interviews (20 dyads: 11 MCI, and 9 NC). Surveys assessed two-year patient risks of dementia, heart attack, stroke, and fall. Interviews assessed similar health risks and reasons for risk perceptions.

RESULTS

On surveys, a similarly low proportion of MCI and NC patients felt they were at risk of stroke (5% versus 2%; p = 0.62) and heart attack (2% versus 0%; p = 0.99). More MCI than NC patients perceived dementia risk (26% versus 2%; p < 0.001). Care partners' survey findings were similar. Interviews generally confirmed these patterns and also identified reasons for future health concerns. For both MCI and NC dyads, personal experience with cognitive decline or CVD (personal or family history) increased concerns about each disease. Additionally, perceptions of irreversibility and lack of treatment for cognitive decline increased concern about dementia.

CONCLUSION

Less use of CVD treatments in MCI seems unlikely to be driven by differential perceptions of CVD risk. Future work to improve awareness of CVD risks in older patients and dementia risk in patients with MCI are warranted.

High Prevalence and Low Awareness of Mild Cognitive Impairment in a Suburban Community in Shanghai

BACKGROUND

The prevalence of mild cognitive impairment (MCI), herein China, was without involving the suburban communities, where the awareness of MCI still remains extremely weak.

OBJECTIVE

The objective of this study is to investigate the prevalence of MCI in the Chinese residents aged ≥65 in the suburban communities of Shanghai, China, and study the awareness of MCI in terms of its symptom, prevention, and intervention.

METHODS

A total of 925 suburban community residents aged ≥65 were evaluated with a series of clinical examinations and scale questionnaire, and 600 participated in a five-dimension questionnaire survey pertaining to the awareness of MCI.

RESULTS

The prevalence of MCI was up to 29.8% and of dementia was 11.1%, respectively. A difference was observed among the three groups of dementia, MCI, and normal in each dimension of age, gender, education, being widowed, and living with the next generation (P < 0.05). The degree of cognitive impairment was linearly correlated with age (P < 0.001). The prevalence of MCI was higher in the females (P < 0.001), in the group of low educational level (P < 0.001), in the widowed residents (P < 0.01), and in those who did not live with their next generations (P < 0.01). The family's concern for MCI symptoms in the elderly accounted for 60%; the awareness rate of MCI symptoms, 25.5%; the awareness rate of MCI prevention, 15.5%; and the rate of taking MCI seniors to the doctor, 32%.

CONCLUSIONS

The prevalence of MCI in the suburban communities of Shanghai was high but the awareness of MCI was low.

An Online, Person-Centered, Risk Factor Management Program to Prevent Cognitive Decline: Protocol for A Prospective Behavior-Modification Blinded Endpoint Randomized Controlled Trial

BACKGROUND

Several modifiable risk factors for dementia have been identified, although the extent to which their modification leads to improved cognitive outcomes remains unclear.

OBJECTIVE

The primary aim is to test the hypothesis that a behavior modification intervention program targeting personalized risk factors prevents cognitive decline in community-dwelling, middle-aged adults with a family history of dementia.

METHODS

This is a prospective, risk factor management, blinded endpoint, randomized, controlled trial, where 1510 cognitively normal, community-dwelling adults aged 40-70 years old will be recruited. Participants will be screened for risk factors related to vascular health (including physical inactivity), mental health, sleep, and cognitive/social engagement. The intervention is an online person-centered risk factor management program: BetterBrains. Participants randomized to intervention will receive telehealth-based person-centered goal setting, motivational interviewing, and follow-up support, health care provider communication and community linkage for management of known modifiable risk factors of dementia. Psychoeducational health information will be provided to both control and intervention groups.

RESULTS

The primary outcome is favorable cognitive performance at 24-months post-baseline, defined as the absence of decline on one or more of the following cognitive tests: (a) Cogstate Detection, (b) Cogstate One Card Learning, (c) Cogstate One Back, and (d) Cognitive Function Instrument total score.

CONCLUSION

We will test the hypothesis that the BetterBrains intervention program can prevent cognitive decline. By leveraging existing community services and using a risk factor management pathway that tailors the intervention to each participant, we maximize likelihood for engagement, long-term adherence, and for preserving cognitive function in at-risk individuals.

Individual Differences and Features of Self-reported Memory Lapses as Risk Factors for Alzheimer Disease Among Adults Aged 50 Years and Older: Protocol for a Coordinated Analysis Across Two Longitudinal Data Sets

BACKGROUND

Increasing evidence has promoted the clinical utility of self-reported memory problems for detecting early impairment associated with Alzheimer disease (AD). However, previous studies investigating memory problems often conflated the types of problems (ie, retrospective and prospective) with their features (ie, frequency and consequences). This bias limits the specificity of traditional measures of memory problems and minimizes their ability to detect differential trajectories associated with cognitive decline. In this study, we use a novel measure of self-reported memory problems that uses daily reports of memory lapses to disentangle types from features for analyzing the impact of each dimension in two longitudinal data sets. Furthermore, this study explores the individual difference factors of age and gender as potential moderators of the relationships between self-reported memory lapses and objective cognitive decline.

OBJECTIVE

The aim of this study is to describe the protocol for a secondary data analysis project that explores the relationship between experiences of daily memory lapses and their associations with cognitive decline in middle-aged and older adults.

METHODS

This study uses multilevel, coordinated analyses across two measurement burst data sets to examine the links between features and consequences of memory lapses (retrospective and prospective) and their association with objective cognitive decline. This study's sample (N=392; aged 50-85 years; n=254, 64.8% women) is drawn from two ongoing, nationally funded research studies: The Effects of Stress on Cognitive Aging, Physiology, and Emotion study and the Einstein Aging Study. Both studies assess the daily experience of memory lapses, including the type as well as the emotional and functional outcomes, and objective measures of cognition, such as processing speed and episodic memory. We will use multilevel modeling to test our conceptual model demonstrating that differences in frequency and types of memory lapses show differential trends in their relationships with cognitive decline and that these relationships vary by the age and gender of participants.

RESULTS

This project was funded in August 2019. The approval for secondary data analysis was given by the institutional review board in February 2020. Data analysis for this project has not yet started.

CONCLUSIONS

The early and accurate identification of individuals most at risk for cognitive decline is of paramount importance. Previous research exploring self-reported memory problems and AD is promising; however, limitations in measurement may explain previous reports of inconsistences. This study addresses these concerns by examining daily reports of memory lapses, how these vary by age and gender, and their relationship with objective cognitive performance. Overall, this study aims to identify the key features of daily memory lapses and the differential trajectories that best predict cognitive decline to help inform future AD risk screening tools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25233.

Promoting Successful Cognitive Aging: A Ten-Year Update

A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.

Correlates of Dementia-related Anxiety: Self-Perceived Dementia Risk and Ageism

As public awareness of and exposure to Alzheimer's disease and related dementias (ADRD) have increased worldwide, the fear of developing ADRD, or dementia-related anxiety (DRA), is expected to increase as well. It was hypothesized that at least part of what makes dementia so anxiety provoking, is the association of ADRD with older adults, an often stigmatized group. To test this hypothesis, two online studies examined how ageist beliefs contribute to DRA; the roles of ADRD-related factors, such as self-perceived risk and personal exposure, were also examined. Study 1 included university students (n = 295, age range: 18 to 58 years, M _age = 21.16, SD _age = 4.85) to determine what factors may contribute to young adults' DRA. Study 2 included adults of all ages (n = 352, age range: 18 to 81 years, M _age = 37.85, SD _age = 12.88) to determine whether Study 1 results were replicable among adults of all ages. Hierarchical multiple regressions were used. Results from both studies demonstrated that being female and having higher self-perceived ADRD risk and benevolent ageism uniquely explicated higher levels of DRA. Within Study 2, significant effects of both benevolent and hostile ageism were observed, suggesting that diverse negative attitudes toward older adults are associated with DRA. It is possible that strong ageist attitudes stigmatize older adults as those who are forgetful and this may contribute to DRA, as age is a major risk factor for developing dementia. Study limitations and directions for future research are discussed.

Neuroticism biases memory self-report in women

Reports of memory problems are associated with cognitive decline risk and other adverse health outcomes, and the personality trait of neuroticism is known to influence these reports. Since women tend to have higher neuroticism as well as a unique risk profile for cognitive decline, we examined the relationship between neuroticism and responses to two memory self-report items (self- and age-anchored comparisons) among women (n = 1,132; M_age = 52.71; SD = 13.99) in the Midlife in the United States Refresher Study. Multivariate regression demonstrated that women lower in neuroticism may be more likely to make a distinction between self-comparisons vs. age-anchored comparisons of memory.

Anticipatory anxiety about future dementia-related care needs: towards a dementia-friendly community

AIM

Although a dementia-friendly community is a global goal, community-dwelling persons with dementia continue to have unmet care needs. The aim of this study was to explore the characteristics of persons who experience anxiety about the possibility of not receiving proper dementia care should they need it in the future.

METHODS

A questionnaire was mailed to all residents aged 65 years or older (n = 132 005) living in one Tokyo district. The questionnaire included an item that measured anxiety about the possibility of not receiving proper dementia care as well as items about sociodemographic variables, depressive symptoms, frailty, housebound status, socioeconomic status, social support, access to a general practitioner (GP), and experience of dementia care.

RESULTS

Of the 74 171 participants who responded to the anxiety item, 58 481 (78.8%) reported anxiety about the possibility of not receiving proper dementia care should they need it in the future. Simultaneous multiple logistic regression analysis indicated that factors associated with this anticipatory anxiety were depressive symptoms, frailty or prefrailty, being female, not being currently socioeconomically disadvantaged, not having someone who can take you to the hospital when you do not feel well, being younger (65-74 years), being married, not trusting in neighbours, higher educational level (>9 years), not having someone to consult when you are in trouble, not working, having been socioeconomically disadvantaged in childhood, only greeting or less with neighbours, and not having the experience of dementia care. Having access to a GP, living alone, and going out less than once a week did not show a significant association.

CONCLUSIONS

This large-scale study explored factors associated with anticipatory anxiety about the possibility of not receiving proper dementia care should it be needed in the future. Further studies concerning interventions to decrease such anxiety are needed.

Perceived threat of Alzheimer's disease and related dementias among older Chinese Americans in subsidized housing: Through a cultural lens

PURPOSES

Low socioeconomic status and limited social support may put older residents in subsidized housing at high risk for developing fears of Alzheimer's disease or related dementias. This study examined the perceived threat of Alzheimer's disease or related dementias among older Chinese Americans in subsidized housing facilities in Phoenix, Arizona of the United States, and focused on the effect of cultural beliefs (i.e., beliefs toward Alzheimer's disease or related dementias, and beliefs toward intergenerational support) on the perceived threat of Alzheimer's disease or related dementias.

METHOD

Analyses were based upon a survey of 207 Chinese American older adults (M_age = 75.37, SD = 7.47) living in subsidized housing facilities in the Phoenix metropolitan area. Standardized survey questionnaires were delivered through face-to-face interviews.

RESULTS

Multivariate analyses suggest that fatalism related beliefs about Alzheimer's disease or related dementias, rather than stigmatization, were related to higher levels of concerns for developing Alzheimer's disease or related dementias, while beliefs in intergenerational support were related to lower levels of perceived threat of Alzheimer's disease or related dementias. However, the protective effect of beliefs in intergenerational support tended to diminish in those living with higher levels of depressive symptoms.

DISCUSSION

Cultural beliefs can entail both risks and strengths when low-income Chinese American elders attempt to comprehend the implications of Alzheimer's disease or related dementias. Health education or intervention programs need to address their fatalism beliefs toward Alzheimer's disease or related dementias, and facilitate the accessibility of intergenerational support for this group.

An Appalachian Perspective of Alzheimer's Disease: A Rural Health Nurse Opportunity

Predictions of the devastating impact of Alzheimer's disease (AD) are heightened in disadvantaged rural populations, yet studies investigating AD in this population are limited. Other researchers have shown that when rural Appalachian people are aware of their risk for a chronic illness, they are more willing to adopt healthy behaviors (Della, 2011; Schoenberg et al. 2011), suggesting that educational programs to increase knowledge and perception of risk are needed. The purpose of this article was to report findings from exploring knowledge of Alzheimer's disease in a southern rural West Virginia community of residents (N = 193) and a sample of caregivers (n = 20) using cognitive interview techniques of "Think-aloud" and "Laddering". The cultural fit and relevance of the "Knowledge of Alzheimer's Disease scale or KAD (Jang, Kim, Hansen, & Chiriboga, 2010) was also examined. Findings from the KAD included that an updated AD measure appropriate for use in rural settings is needed. Findings from the cognitive interview included that instead of fatalistic attitudes toward Alzheimer's disease, residents often viewed AD as something potentially preventable through healthier living, use of herbs as children, and eventual discovery of more effective treatment regimens. The themes that emerged were "preventing AD" and "personal knowing of AD". Considering cultural perceptions and determining knowledge gaps in the communities by rural providers is an important component of changing stigma regarding routine cognitive screening for rural older adults at increased risk for Alzheimer's disease.