Perceptions, beliefs, attitudes, and knowledge of US Latino adults pertaining to dementia and brain health: a systematic review

OBJECTIVES

Latinos in the USA are 1.5 times more likely to develop Alzheimer's Disease and Related Dementias (ADRD) than non-Latino Whites. This systematic review aims to summarize current understanding of the perceptions, knowledge, beliefs, and attitudes about ADRD and brain health of Latinos to inform public health efforts addressing disparities.

METHODS

Searches were completed across six databases (Medline, PsycINFO, WoS, LILACS, ProQUEST, and CINAHL). Studies were required to capture attitudes and/or knowledge of ADRD or brain health among US-based Latino adults who were not cognitively impaired and were not caregivers or healthcare providers. Results were synthesized narratively.

RESULTS

A total of 5528 unique records were identified. Following de-duplication and screening, 24 articles met the inclusion criteria for this review. Overall, knowledge about brain health and ADRD among Latinos is quite mixed. A consistent finding was that participants recognized memory loss as a symptom of cognitive impairment, but demonstrated limited recognition of other signs of impairment. The studies also highlighted variable knowledge of protective factors for maintaining brain health.

CONCLUSIONS

Opportunities exist to increase knowledge of ADRD signs and symptoms, and awareness of risk and protective factors. Given the heterogeneity of Latinos in the USA, more research is warranted to better elucidate nuances in conceptualizations of brain health and aging among diverse Latino subgroups.

Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician

BACKGROUND

Primary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer's disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. With the expanding array of evidence-based interventions for ADRD, from multidomain care management to novel biotherapeutics for early-stage AD, incorporating conversations about brain health into routine healthcare should become a standard of care. We conducted a systematic review to identify barriers to and facilitators of brain health conversations in primary care settings.

METHODS

We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies conducted in the US between January 2000 and October 2022 that evaluated perceptions of cognition and provider-patient brain health conversations prior to formal screening for, or diagnosis of, mild cognitive impairment or ADRD. We assessed the quality of the included studies using the Mixed Methods Appraisal Tool.

RESULTS

In total, 5547 unique abstracts were screened and 22 articles describing 19 studies were included. The studies explored perceptions of cognition among laypersons or clinicians, or provider-patient interactions in the context of a patient's cognitive concerns. We identified 4 main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement.

CONCLUSIONS

Early conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.

Knowledge, Attitudes, and Cultural Beliefs about Healthy Aging and Alzheimer's Disease among Older Chinese Americans in New York City

Alzheimer's Disease (AD) and Related Dementias (ADRD) are a growing concern across the globe. Unfortunately, racial/ethnic minorities in the United States (U.S.), such as Chinese Americans, have lower ADRD knowledge, and these individuals are less likely to be targeted and engaged in recommended dementia prevention and care. The objective of this study is to examine knowledge, attitudes, and beliefs about healthy aging and ADRD among older Chinese Americans living in New York City. Chinese Americans with very low English proficiency were recruited from a senior center in New York City. Accordingly, surveys were translated and focus groups were conducted in Mandarin or Cantonese. Questionnaires assessed demographic and health characteristics. Focus groups followed an open-ended protocol which was guided by the published literature. Focus group discussions were audio recorded, transcribed, and translated to English for qualitative analysis. Analysis of qualitative data proceeded according to the constant comparative method. A total of 18 participants were recruited. Average age of participants was 76.4 years and participants were 72.2% female. The majority were married (72.2%). Participants reported chronic conditions, including diabetes (38.9%) and dyslipidemia (22.2%). Participants commonly reported that their health limited their ability to accomplish things (66.7%) and achieve things (66.7%). While 16.7% of participants reported no bodily pain, slight pain was reported by 44.4%, moderate pain by 33.3%, and extreme pain by 5.6%. Qualitative analysis revealed several prominent themes, including: (1) perceptions about normal aging; (2) fears about loneliness and cognitive decline; (3) understanding of healthy aging; (4) cultural influences on aging; and (5) perceptions of ADRD. Results from this study highlight a set of cultural beliefs about healthy aging as well as knowledge, attitudes, and beliefs pertaining to ADRD. These results may inform opportunities for increasing healthy aging practices and knowledge about dementia among underserved older Chinese Americans.

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

BACKGROUND

Evidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population's perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts.

METHODS AND FINDINGS

We searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data.

CONCLUSIONS

This systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.

Exploring Individuals' Willingness to Engage in Interventions to Improve Cognitive Health and Prolong Late-Life Independence: An Extension of Harrell, Kmetz, and Boot (2019)

Interventions designed to preserve cognition have become increasingly popular as our population ages. In exploring intervention effectiveness, however, researchers have often overlooked a potentially important factor: willingness to engage. Recent findings from Harrell, Kmetz, Boot (2019) showed that perceived cognitive deficits and perceived training efficacy were significant predictors of willingness to engage in a brain training intervention designed to preserve cognition. However, they did not explore another potentially important factor: anticipated intervention enjoyment. In the current study, younger, middle-aged, and older adults (N = 169) completed surveys that assessed their willingness to engage in different types of training (aerobic exercise, brain, meditation) to improve cognition and the extent that factors such as health, perceived cognitive deficits, belief in training efficacy, and personality contributed to willingness to engage. Participants reported being least willing to engage in meditation training and meditation training was rated by participants as the least likely to improve cognition. Anticipated training enjoyment was the overriding factor that predicted willingness. These findings provide additional insights into why, and for how long, individuals may be willing to engage in training to prolong independence and have implications for understanding intervention adoption and adherence.

The Effects of Useful Field of View Training on Brain Activity and Connectivity

OBJECTIVES

Useful Field of View training (UFOVt) is an adaptive computerized cognitive intervention that improves visual attention and transfers to maintained health and everyday functioning in older adults. Although its efficacy is well established, the neural mechanisms underlying this intervention are unknown. This pilot study used functional MRI (fMRI) to explore neural changes following UFOVt.

METHOD

Task-driven and resting-state fMRI were used to examine changes in brain activity and connectivity in healthy older adults randomized to 10 hr of UFOVt (n = 13), 10 hr of cognitively stimulating activities (CSA; n = 11), or a no-contact control (NC; n = 10).

RESULTS

UFOVt resulted in reduced task-driven activity in the majority of regions of interest (ROIs) associated with task performance, CSA resulted in reduced activity in one ROI, and there were no changes within the NC group. Relative to NC, UFOVt reduced activity in ROIs involved in effortful information processing. There were no other significant between-group task-based differences. Resting-state functional connectivity between ROIs involved in executive function and visual attention was strengthened following UFOVt compared with CSA and NC.

DISCUSSION

UFOVt enhances connections needed for visual attention. Together with prior work, this study provides evidence that improvement of the brain's visual attention efficiency is one mechanism underlying UFOVt.

Is Cognitive Training Worth It? Exploring Individuals' Willingness to Engage in Cognitive Training

We assessed how much time individuals would be willing to spend engaging in game-based cognitive training to gain prolonged functional independence. In Study 1 (N = 294), participants completed a survey with questions assessing how much time they would be willing to invest in daily cognitive training to extend their functional independence by certain amounts of time using a slider response that ranged from 0 to 100 minutes. Participants also completed surveys that measured self-perceived health and cognitive functioning, personality, and other demographic variables. Even for relatively small gains, participants reported being willing to dedicate an average of 11 minutes every day to cognitive training, with some participants willing to engage for significantly longer. The best predictor of willingness to invest time in training was belief in cognitive training efficacy, followed by openness to experience, and participants' self-perceived cognitive deficit. Study 2 examined the same question in a sample of 120 older adults, this time allowing for open-ended responses. Participants reported being willing to invest significantly more time, ranging from more than 40 minutes every day to gain just one week of independence, to over 2.5 hours every day to gain an additional 3 years of independence. Again, perception of cognitive training efficacy was the strongest predictor of willingness to invest time. Results confirm that older adults are willing to invest significant amounts of time to gain independence later in life, and have implications for predicting the adoption of, and adherence to, potentially effective treatments for cognitive decline.

The impact of behavioral interventions on cognitive function in healthy older adults: A systematic review

Behavioral interventions to improve cognitive function in older adults are widespread and can vary from theater classes to cognitive training programs. However, the effectiveness in maintaining different cognitive domains varies greatly both across and within intervention types. To date, no systematic reviews have synthesized findings across more than a few types of interventions (e.g., cognitive vs. exercise). This systematic review examined 11 types of behavioral interventions and the respective transfer to 19 cognitive domains, as well as transfer to everyday function. Study inclusion criteria were: peer-reviewed articles in English, samples of healthy adults aged 65 and older, and randomized controlled trials of behavioral interventions with reported cognitive outcomes. The 2017 search yielded 75 eligible articles comprising cognitive training, exercise training, combination interventions, cognitively-stimulating activities, and action video games. In general, process- (n = 26) and strategy-based (n = 16) cognitive training improved the trained domains but had weak transfer to non-trained domains. Aerobic training (n = 13) most consistently improved executive function, and strength/resistance (n = 8) and aerobic/resistance combination training (n = 6) most consistently improved cognitive inhibition and visual working memory. Combination interventions (n = 15 nonfactorial, n = 3 factorial) showed promise in improving verbal delayed recall and executive function. Few studies examined cognitively-stimulating activities or action video games, leaving inconclusive results about their effect on cognitive function. Few studies examined everyday function (n = 9), however, process- and strategy-based training demonstrated notable long-term transfer. Recommendations for future research and practice are highlighted.

Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature

BACKGROUND

Preventing and/or delaying cognitive impairment is a public health priority. To increase awareness of and participation in behaviors that may help maintain cognitive function or reduce risk of impairment, we need to understand public perceptions about risk and protective factors.

METHODS

We conducted a scoping review of studies examining the public's perceptions about risk and protective factors related to cognitive health and impairment published since the 2007 National Public Health Road Map to Maintaining Cognitive Health.

RESULTS

A search of five databases yielded 1,115 documents published between June 2007 and December 2013. Initial review of abstracts identified 90 potentially eligible studies. After full-article review, 30 met inclusion criteria; four additional articles identified in reference lists also met inclusion criteria. Of the 34, 16 studies addressed Alzheimer's disease (AD) specifically, 15 dementia broadly, 5 mild to moderate cognitive impairment, and 8 normal functioning, with some content overlap. Across studies, respondents reported genetics (n = 14 studies), older age (n = 8), stress (n = 7), brain/head injury (n = 6), and mental illness/brain disease (n = 6) as perceived risk factors for AD and dementia. Protective factors most commonly identified for maintaining cognitive health were intellectual/mental stimulation (n = 13), physical activity (n = 12), healthy diet (n = 10), and social/leisure activities (n = 10).

CONCLUSIONS

Studies identified genetics and older age as key perceived risk factors more so than behaviors such as smoking. Individuals perceived that numerous lifestyle factors (e.g. intellectual stimulation, physical activity) could protect against cognitive impairment, AD, and/or dementia. Results can inform national and international education efforts about AD and other dementias.

Public beliefs and knowledge about risk and protective factors for Alzheimer's disease

BACKGROUND

The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer's disease (AD).

METHODS

A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50.

RESULTS

Respondents were 1641 adults (mean age=64.4 years, 53.6% female, 81.7% White). Most (60.1%) indicated interest in learning their AD risk, with 29.4% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1%) or that having an affected first-degree relative is associated with increased disease risk (32%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk.

CONCLUSION

Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors.

Beliefs and communication practices regarding cognitive functioning among consumers and primary care providers in the United States, 2009

INTRODUCTION

Limited research has examined primary care providers' communication with patients about maintaining cognitive functioning. Our study's objective was to compare the perceptions of consumers and primary care providers related to beliefs and communication practices about lifestyle behaviors beneficial for overall health and for maintaining cognitive functioning.

METHODS

In 2009, we submitted 10 questions to Porter Novelli's HealthStyles survey and 6 questions to their DocStyles survey. We compared consumers' (n = 4,728) and providers' (n = 1,250) beliefs, practices, and information sources related to maintaining health and cognitive functioning. We made comparisons using nonparametric statistics.

RESULTS

Approximately 76% of consumers considered their health to be good or very good; 73.4% were concerned or very concerned about the possibility that their memory may worsen with age. Women were significantly more concerned than men, and white consumers were more concerned than black and Hispanic consumers. Consumers reported they believed that intellectual stimulation (86.6%), physical activity (82.6%), and healthful diet (82.5%) prevented or delayed cognitive impairment. Providers reported advising patients to reduce cognitive impairment risk through physical activity (85.9%), intellectual stimulation (80.3%), and social involvement (67.4%). Few consumers (7.8%) reported receiving this information from providers but reported learning about strategies to maintain memory, primarily from television (50.1%), magazines (44.1%), and newspapers (33.7%).

CONCLUSION

Providers reported advising patients about how to reduce risks of cognitive impairment. Consumers reported receiving this information from other sources. Findings suggest a need to examine and assess media messages and to better understand patient-provider communication about cognitive functioning.

Beliefs about promoting cognitive health among Filipino Americans who care for persons with dementia

We examined beliefs about promoting cognitive health among Filipino Americans who care for persons with dementia, their awareness of media information about cognitive health, and their suggestions for communicating such information to other caregivers. We conducted three focus groups (25 participants). The constant comparison method compared themes across focus groups. Caregivers most frequently described cognitive health benefits of social engagement and leisure; next in emphasis were benefits of healthy diets. There was less emphasis on physical activity. Participants had heard from television that avoiding smoking, alcohol, and drugs might promote cognitive health. Ways to inform others about cognitive health included information in Filipino newspapers, and handouts in Filipino languages, distributed in Filipino stores, workplaces, community organizations, and health care facilities. Findings suggest an opportunity to develop public health messages promoting cognitive health that are in-language, published in ethnic-specific media, and that are culturally appropriate for Filipino and other Asian Americans.

Promoting cognitive health: a web site review of health systems, public health departments, and senior centers

Growing evidence suggests that healthy behaviors such as being physically active, having a heart healthy diet, and being socially involved may promote cognitive health. The United States has recently begun encouraging such behaviors for that purpose. To help evaluate the diffusion of this policy, we sought to measure a baseline of activity in this area. We examined Web sites of 156 large health care systems, the health departments of all 50 states and the 20 largest US cities, and 181 nationally accredited senior centers, to identify information, products, programs, or services recommended for cognitive health. Among health care systems, 40% promoted cognitive health: 24% recommended mental activity, 20% healthy diets, 20% physical activity, and 16% social involvement. Among health departments, 30% promoted cognitive health in the same ways. Among senior centers, 21% offered strategies, primarily mental activity. Results suggest emerging activity in this area and opportunities for continued development.

It takes two to talk about prostate cancer: a qualitative assessment of African American men's and women's cancer communication practices and recommendations

Prostate cancer (PrCA) is the most commonly diagnosed nonskin cancer among men. African American (AA) men in South Carolina have a PrCA death rate 150% higher than that of European American (EA) men. This in-depth qualitative research explored AA men's and women's current practices, barriers, and recommended strategies for PrCA communication. A purposive sample of 43 AA men and 38 AA spouses/female relatives participated in focus groups (11 male groups; 11 female groups). A 19-item discussion guide was developed. Coding and analyses were driven by the data; recurrent themes within and across groups were examined. Findings revealed AA men and women agreed on key barriers to discussing PrCA; however, they had differing perspectives on which of these were most important. Findings indicate that including AA women in PrCA research and education is needed to address barriers preventing AA men from effectively communicating about PrCA risk and screening with family and health care providers.

A content analysis of cognitive health promotion in popular magazines

Health behaviors, particularly physical activity, may promote cognitive health. The public agenda for health behaviors is influenced by popular media. We analyzed the cognitive health content of 20 United States magazines, examining every page of every 2006-2007 issue of the highest circulating magazines for general audiences, women, men, African Americans, and the health conscious (n = 178). Diet was the greatest focus. Physical activity coverage was limited. Important behavior-related cognitive health risks, including hypertension and diabetes, were not mentioned. Publications for African Americans had little cognitive health content. Coverage of cognitive health was not commensurate with growing evidence that health behaviors may help to maintain it. Findings may be useful to public health officials, health care providers, non-profit organizations that promote cognitive health, individuals evaluating cognitive health information in popular media, and those responsible for magazines or other media.

How do top cable news websites portray cognition as an aging issue?

PURPOSE OF THE STUDY

We examined messages that the websites of the top cable news companies (MSNBC, FOX, and CNN) conveyed about cognition between January 2007 and March 2010. Drawing on agenda-setting theory, this work assessed the frequency, prominence, and attributes of cognitive topics in messages targeting an aging audience.

DESIGN AND METHODS

We used quantitative content analysis to examine the frequency and prominence of cognitive topics and cognitive goals, as well as how the cognitive discussions were framed. Chi-square analyses were conducted to compare cognitive health information discussed in news items that did and did not target an "aging audience." Qualitative analysis of the aging audience subgroup was used to further examine age-associated cognitive messages.

RESULTS

Within the 229 cognitive items identified, we found significantly more coverage of cognitive functioning and unspecified dementia and significantly less coverage of cognitive disease not dementia, specified dementia, and accidents or injury for the aging audience. Our qualitative analysis of news items aimed at an aging audience documented a focus on maintaining functioning and avoiding decline through various individual lifestyle behaviors. However, contextual information about level of cognition to be maintained, particular cognitive functions targeted, specific norms about cognitive aging, and how cognitive function is determined was lacking.

IMPLICATIONS

Our research points to a communication gap in the delivery of academic research findings to a lay audience through online journalism. We suggest more clarity by researchers in defining cognitive concepts and measurement of cognitive function for journalistic translation and public consumption.