A Study of Knowledge on Alzheimer's Disease and Attitudes of Chinese Social Residents towards Alzheimer’s disease: a cross-sectional survey in China

doi:10.21203/rs.3.rs-2663436/v1

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A Study of Knowledge on Alzheimer's Disease and Attitudes of Chinese Social Residents towards Alzheimer’s disease: a cross-sectional survey in China

https://doi.org/10.21203/rs.3.rs-2663436/v1

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objective: Social residents become increasingly concerned about Alzheimer's dementia (AD) as a global public health crisis. China's AD population is the largest and growing fastest. However, no study has examined Chinese social residents' knowledge and attitudes concerning Alzheimer's illness. This study examined Chinese social residents' AD knowledge and attitudes using the ADKS and DAS.

Study design: Cross-sectional survey. 338 social residents over 18 from various Chinese regions were recruited using convenient sampling.

Method: The Alzheimer's Disease Knowledge Scale (Chinese) and the Dementia Attitude Scale (Chinese) were used to assess their knowledge and attitude regarding AD.

Results: A total of 328 respondents (97.04%) completed the survey. ADKS = 19.44±3.33; DAS = 86.98±12.7. Age and education level can have a substantial impact on ADKS scores, and education level can have a substantial impact on DAS scores.

Conclusion: Low levels of awareness and acceptance of AD exist among Chinese residents. The results indicate that China must immediately implement comprehensive AD education for its social residents.

Alzheimer's disease

Alzheimer's Disease Knowledge Scale (ADKS)

Dementia Attitudes Scale (DAS)

Chinese Social Residents

What is already know: Alzheimer's disease knowledge scale (ADKS) and dementia attitudes scale (DAS) have been widely used in analyzing the knowledge and attitude of medical related people in different regions.

What this paper adds: We have demonstrated the knowledge level and attitude of social residents in different regions of China regarding AD by ADKS and DAS, which was not reported before.

Alzheimer's disease (AD) cases rise annually due to population aging. The latest data show 50 million people worldwide with dementia, most of whom having Alzheimer's¹. According to the World Health Organization (WHO), the number of dementia patients will reach 78 million in 2030 and 139 million in 2050². China has 6 million AD patients. 20 million AD patients are expected by 2050. China's AD population is the largest and growing fastest^3–5. In China, 5% of 65-year-olds, 11.5% of 75-year-olds, and 30% of 85-year-olds have dementia. 1.8 million dementia cases are diagnosed annually, greater than the global average^6,7.

WHO and ADI urge the public to focus on AD, a global public health issue that must be addressed immediately^2,8. Understanding AD attitudes is essential for adopting psychosocial therapeutic measures. Knowledge about AD can help people diagnose the condition earlier, eliminate misunderstanding, and give early and appropriate medical care for dementia sufferers⁹.No studies have examined ordinary Chinese citizens' AD cognition and attitude utilizing the Alzheimer's disease knowledge scale (ADKS) and dementia attitudes scale (DAS)^10–16. As the country with the greatest population and the quickest rate of AD growth, we need timely understanding of the cognition and attitudes of ordinary social residents towards AD to design more targeted AD prevention, control, and social support methods.

This study employed the ADKS and DAS measures to assess the knowledge and attitudes of social residents in different regions of China on AD, addressing a vacuum in the field and laying the groundwork for more tar-based prevention and treatment efforts.

Aim

This study examines Chinese people' knowledge and attitudes concerning dementia and pertinent factors to fill gaps in relevant research and lay the groundwork for more tailored AD prevention initiatives.

Study Design

From July to August 2020, social inhabitants in representative cities and villages in eastern, western, southern, and northern China were studied cross-sectionally. The study collected dementia information and attitudes.

Participants

In the study, a convenient sampling method was used. This study invites responders who match the following criteria: (1) sound mind, normal cognition, and no mental disorder; (2) willingness to engage in this study; and (3) minimum age of 18.

Measurements

Social residents' demographics include age, gender, education, and monthly income.

Alzheimer's Disease Knowledge Scale (ADKS)^17,18: total of 30 items; assesses seven dimensions of life impact (3 items), assessment and diagnosis (4 items), symptoms (4 items), disease progression (4 items), treatment and management (4 items), caregiving (5 items), risk factors (6 items). The ADKS scale scores 1–30 based on right and wrong judgment. Dementia knowledge increases with score.

Dementia Attitudes Scale (DAS)¹⁹: It has 20 items. The Likert 7-grade scale scored the DAS. 1–7 was "extremely disagreeable" to "quite agreeable." The total score ranged from 20 to 140 for six items with negative descriptions. Higher scores indicate more positive views about dementia.

Statistical analysis

For data analysis, IBM Corp.'s Statistical Product and Service Solution (SPSS) version 22.0 (Armonk, New York, United States) was utilized. Two researchers examined the survey for any missing data and entered the data into SPSS for analysis. The Kolmogorov Smirnov test was used to determine whether all variables have a normal distribution. The means of each group were compared using the t-test for independent samples, one-way ANOVA, and Pearson correlation analysis. Statistical significance was based on p-value < 0.05 in 2-tailed tests.

Statistical demographics of the survey population

Out of 338 respondents, 328 questionnaires were collected (97.04%). Table 1 summarized the society's demographics and regional distribution. The majority of participants were female (62.2%), 45–50 years old (57.93%), with at least 12 years of schooling (59.5%), a personal income between $2,995 and $7,345 (44.2%), and from northern China (70.43%).

Table 1

Statistical demographics of the survey population (N = 328)
Characteristics		N	%
Gender	Male	124	37.80%
	Female	204	62.20%
Age	18–44 years old	190	57.93%
	45–59 years old	81	24.70%
	60 and older	57	17.38%
Education	1–6 years	37	11.28%
	7–12 years	96	29.27%
	Over 12 years	195	59.45%
Monthly income	0-2995 yuan	131	39.94%
	2996–7345 yuan	145	44.21%
	Over 7345 yuan	52	15.85%
Regions of China	North of China	231	70.43%
	East of China	19	5.79%
	West of China	58	17.68%
	South of China	30	9.15%

Analyses Of Adks Scores And Das Scores

Table 2 showed each dimension's DAS and ADKS scores. DAS was 86.98 ± 12.7 and ADKS 19.44 ± 3.33. Assessment and diagnosis had the highest accuracy (79.50%), whereas life effect had the lowest (46.00%).

Table 3 showed correct ADKS item-by-item rates. Evaluation and diagnosis question 28 was most accurate (92.38%). Questions 16, 17, and 2 (life effect and risk factors) had the lowest correct response percentages (18.29%, 38.41%, and 38.41%). Treatment and management (Question 8, 52.13%), caregiving (Question 15, 42.01%), disease progression (Question 19, 65.09%), symptoms (Question 24, 54.88%), and assessment and diagnosis (Question 27, 68.93%) had the lowest accuracy rates in other dimensions.

Table 2

DAS scores and ADKS scores in scores for various dimensions
Dimensions	Total score	Means ± standard deviation	accuracy rate
Total DAS score	140	86.98 ± 12.7	/
Total ADKS score	30	19.44 ± 3.33	64.80%
risk factors	6	4.23 ± 1.26	70.50%
treatment and management	4	2.89 ± 0.88	72.25%
caregiving	5	3.24 ± 1.10	64.80%
life impact	3	1.38 ± 0.75	46.00%
disease progression	4	3.02 ± 0.91	75.50%
symptoms	4	2.72 ± 1.09	68.00%
assessment and diagnosis	4	3.18 ± 0.85	79.50%

Table 3

ADKS item by item accuracy statistics
Items		accuracy rate
risk factors
1	Genes can only partially account for the development of Alzheimer’s disease.	89.02%
2	Prescription drugs that prevent Alzheimer’s disease are available.	38.41%
3	People in their 30s can have Alzheimer’s disease.	64.02%
4	It has been scientifically proven that mental exercise can prevent a person from getting Alzheimer’s disease.	72.27%
5	Having high blood pressure may increase a person’s risk of developing Alzheimer’s disease.	79.57%
6	Having high cholesterol may increase a person’s risk of developing Alzheimer’s disease.	80.18%
treatment and management
7	Alzheimer’s disease cannot be cured.	67.07%
8	When a person has Alzheimer’s disease, using reminder notes is a crutch that can contribute to decline.	52.13%
9	People whose Alzheimer’s disease is not yet severe can benefit from psychotherapy for depression and anxiety.	90.24%
10	Poor nutrition can make the symptoms of Alzheimer’s disease worse.	80.18%
caregiving
11	People with Alzheimer’s disease do best with simple instructions giving one step at a time.	70.12%
12	When people with Alzheimer’s disease repeat the same question or story several times, it is helpful to remind them that they are repeating themselves.	69.21%
13	If a person with Alzheimer’s disease becomes alert and agitated at night, a good strategy is to try to make sure that the person gets plenty of physical activity during the day.	76.04%
14	Once people have Alzheimer’s disease, they are no longer capable of making informed decisions about their own care.	52.44%
15	When people with Alzheimer’s disease begin to have difficulty taking care of themselves, caregivers should take over right away.	42.01%
life impact
16	It is safe for people with Alzheimer’s disease to drive, as long as they have a companion in the car at all times.	18.29%
17	Most people with Alzheimer’s disease live in nursing homes.	38.41%
18	People with Alzheimer’s disease are particularly prone to depression.	79.94%
disease progression
19	In rare cases, people have recovered from Alzheimer’s disease.	65.09%
20	Eventually, a person with Alzheimer’s disease will need 24-hour supervision.	77.13%
21	After symptoms of Alzheimer’s disease appear, the average life expectancy is 6–12 years.	71.60%
22	A person with Alzheimer’s disease becomes increasingly likely to fall down as the disease gets worse.	89.02%
symptoms
23	Tremor or shaking of the hands or arms is a common symptom in people with Alzheimer’s disease.	75.00%
24	Most people with Alzheimer’s disease remember recent events better than things that happened in the past.	54.88%
25	One symptom that can occur with Alzheimer’s disease is believing that other people are stealing one’s things.	69.81%
26	Trouble handling money or paying bills is a common early symptom of Alzheimer’s disease.	73.17%
assessment and diagnosis
27	If trouble with memory and confused thinking appears suddenly, it is likely due to Alzheimer’s disease.	68.93%
28	Alzheimer’s disease is one type of dementia.	92.38%
29	Symptoms of severe depression can be mistaken for symptoms of Alzheimer’s disease.	71.65%
30	When a person with Alzheimer’s disease becomes agitated, a medical examination might reveal other health problems that caused the agitation.	85.80%

Effects Of Various Influencing Factors On The Total Adks And Das Scores

According to Table 4, age (p = 0.039 < 0.05) and education level (p = 0.030 < 0.05) affect Chinese social residents' ADKS scores, while gender, personal monthly income, and other characteristics do not. DAS scores were unaffected by gender, age, education, or monthly income.

Table 4

Study of the influencing factors of the ADKS and DAS scales for social residents of China(n = 328)
Factors		N	ADKS scores	t	P	DAS scores	t	P
Gender	Male	124	19.15 ± 3.19	1.252	0.264	86.93 ± 12.13	0.997	0.319
Gender	Female	204	19.62 ± 3.42	1.252	0.264	87.01 ± 13.07	0.997	0.319
Age	18–44 years old	190	19.84 + 3.30	3.271	0.039*	87.18 ± 11.77	0.170	0.844
	45–59 years old	81	18.79 ± 3.25			87.15 ± 13.58
	60 and older	57	19.07 ± 3.46			86.09 ± 14.48
Education	1–6 years	37	19.38 ± 2.59	3.532	0.030*	82.57 ± 8.81	2.543	0.080
	7–12 years	96	18.72 ± 3.45			87.55 ± 14.51
	Over 12 years	195	19.82 ± 3.36			87.54 ± 12.26
Monthly income	0-2995 yuan	131	19.31 ± 3.07	1.320	0.268	86.79 ± 12.14	0.027	0.973
	2996–7345 yuan	145	19.32 ± 3.44			87.08 ± 12.52
	Over 7345 yuan	52	20.13 ± 3.66			87.19 ± 14.70

Age only affected treatment and management and illness progression, as seen in Table 5. Over-60 seniors scored higher on treatment and management (p = 0.025 < 0.05). Social residents aged 18–45 had greater disease progression scores than the other two age groups (p = 0.004 < 0.05). Table 6 showed that education only affected illness progression. Over-12-year-olds scored higher than the other two age groups (p = 0.075 < 0.05).

Table 5

Age-related effects on ADKA scores in various dimensions
Dimensions	Total scores	Means ± standard deviation			t	p
Dimensions	Total scores	18–44 years old	44–59 years old	≥ 60 years old	t	p
risk factors	6	4.35 ± 1.25	4.10 ± 1.25	4.05 ± 1.27	1.907	0.150
treatment and management	4	2.87 ± 0.92	2.75 ± 0.78	3.15 ± 0.82	3.742	0.025*
caregiving	5	3.25 ± 1.16	3.31 ± 0.98	3.16 ± 1.07	0.312	0.732
life impact	3	1.38 ± 0.74	1.33 ± 0.82	1.42 ± 0.68	0.244	0.784
disease progression	4	3.15 ± 0.91	2.96 ± 0.86	2.70 ± 0.89	5.680	0.004*
symptoms	4	2.69 ± 1.13	2.73 ± 1.08	2.86 ± 0.97	0.530	0.589
assessment and diagnosis	4	3.21 ± 0.83	3.19 ± 0.81	3.09 ± 0.95	0.423	0.655

Table 6

Education-related effects on ADKA scores in various dimensions
Dimensions	Total scores	Means ± standard deviation			t	p
Dimensions	Total scores	≤ 6 years	7–12 years	≥ 12 years	t	p
risk factors	6	4.38 ± 0.95	4.21 ± 1.38	4.23 ± 1.25	0.264	0.768
treatment and management	4	3.22 ± 0.71	2.82 ± 0.83	2.87 ± 0.91	2.945	0.054
caregiving	5	3.43 ± 1.12	3.17 ± 1.04	3.25 ± 1.13	0.780	0.459
life impact	3	1.54 ± 0.69	1.42 ± 0.71	1.33 ± 0.78	1.436	0.239
disease progression	4	3.11 ± 0.81	2.78 ± 0.89	3.13 ± 0.92	4.989	0.007*
symptoms	4	3.03 ± 0.93	2.64 ± 1.13	2.72 ± 1.10	1.744	0.176
assessment and diagnosis	4	3.38 ± 0.83	3.08 ± 0.81	3.19 ± 0.86	1.661	0.192

Analysis of overall total scores of ADKS and DAS

The level of AD knowledge among Chinese residents was moderate. The average ADKS score among the 328 Chinese respondents was 19.44 ± 3.33, with a correct response rate of 64.8%. This result was significantly lower than 21.6 ± 3.73 in a survey conducted in Brazil in 2018 and 20.5 ± 3.51 after excluding health professionals¹⁴, but it was consistent with the results of a survey conducted among American Indians and Alaska Natives in 2021^20,21. This demonstrated that there was still a significant knowledge gap about Alzheimer's disease in China, and that people lack Alzheimer's disease awareness in general.

The residents' cognition accuracy in assessment and diagnosis (79.50%), disease progression (75.50%), treatment and management (72.25%), and risk factors (70.50%) was medium-high, but life impact was less than 50%, indicating that they could understand Alzheimer's disease based on their daily life experiences. Most people don't know enough about science or Alzheimer's disease to effectively foresee how their lives would alter after becoming ill. The average score on the DAS scale (full score 140) for Chinese social residents' attitudes toward AD was 86.98 ± 12.7. Compared to the survey on dementia attitude of community health service personnel in Changsha, China²², the results of this survey indicate that residents have a little bit of pessimistic view of AD, with a significant gap between the average score and the overall positive attitude. Due to their long-term contact with Alzheimer's patients, health service personnel may have a better understanding of patients' suffering.

Accuracy And Dimensional Analysis Of Each Adks Scale Item

Life impact had the lowest accuracy (46%) of the seven characteristics of risk factors, treatment and management, caregiving, life impact, disease processes, symptoms, assessment, and diagnosis. Two caregiving questions, two life effect questions, and one treatment and management, risk factors, and symptoms question had an accuracy rate of less than 60%. The life effect module had the lowest accuracy rate, 18.29% (Table 2).Over 60% of respondents believed that most patients lived in nursing homes, and over 80% believed that patients could drive safely if accompanied. Not so. This suggested that most Chinese people didn’t understand Alzheimer's patients' conditions. Due to real-world social residents' estrangement and maltreatment of Alzheimer's patients, caregiving items were inaccurate. More over half of respondents thought Alzheimer's patients who struggled with self-care should be replaced with caretakers. Nearly half thought Alzheimer's patients couldn't make sensible life decisions. These misperceptions will stress Alzheimer's disease caregivers, burden patients, and cause unnecessary conflict. If we want to spread Alzheimer's disease awareness, the presentation should focus on patient care.

The low accuracy of treatment and management, risk factors, and symptoms suggested that people ignored Alzheimer's disease prevention and therapy as a distant threat. Nearly half of respondents thought Alzheimer's patients' usage of reminder notes was reliance that would exacerbate their condition. Most Alzheimer's patients could only recall recent occurrences. This misperception will lead to improper contact with Alzheimer's sufferers and perpetuate the wrong stereotype. Over 60% thought pharmaceutical medications could prevent Alzheimer's. This mistake in evaluating the majority will make individuals unaware of and underestimate Alzheimer's disease.

Analysis Of The Impact Of Various Variables On Adks And Das

Table 3 showed that residents aged 45–59 had significantly lower scores than those aged 18–44 and 60+. These results showed that the increasing popularization of AD-related knowledge in Chinese society was gradually playing a role, as seen by the highest ADKS score of 18–44-year-old inhabitants, who had the most thorough grasp of AD. Another interesting trend was the drop in ADKS scores for 45–59-year-olds. Residents over 60 have good self-esteem due to ailments. To learn more about Alzheimer's disease, they would monitor and avoid their own disease and observe their peers. However, residents between 45 and 59 may lack the motivation to study and absorb new information and may fear and distance themselves from a distant disease. They had a lower ADKS score than the older age groups because they refused to learn about AD. Risk factor control and early AD prevention suffered. This study suggests that future medical education about Alzheimer's disease should target social residents aged 45–59.

Table 4 showed that social residents 45 to 59 should focus on treatment and management, while those 60 and above should focus on disease progression. Table 3 showed that social residents with 7–12 years of schooling had lower ADKS scores than those with 1–6 years and more than 12 years. Age factors affected ADKS scores similarly. The majority of residents with 1 to 6 years of schooling may have been over 60 and had substantial contact with Alzheimer's patients or caring experience. Their significant knowledge helped them grasp Alzheimer's illness.

The survey showed that education level affected social residents' perceptions toward AD. The study indicated that social residents with fewer than 6 years of schooling had considerably lower DAS scores than those with 7 to 12 years or more. The low DAS score of the education group receiving education from 1 to 6 years may be due to a lack of education guidance on reason and social identity in later education, resulting in a lack of social responsibility for treating vulnerable groups and a lack of understanding and identification for AD patients as socially vulnerable groups. In addition, the DAS scores of social groups with more than 12 years of education had lower DAS scores than those with 7–12 years, which reflected the hidden value problems in higher education. According to a study on the value orientation of Chinese higher education, modern Chinese higher education has achieved great success in popularization, informatization, scale, and other areas, and had trained a large number of outstanding, high-quality talents^23,24. This study suggested that higher education should emphasize morality and values to improve public attitudes and empathy for AD sufferers.

China's aging population, social support ratio, social pension expenditures, and family economic burden are rising. Alzheimer's disease is a senile disease that rises with age, putting families and society under financial and caregiving strain. The world focuses primarily on the knowledge and attitude of medical personnel towards AD. This study collects face-to-face data regarding the cognition and attitude of Chinese social residents regarding AD. As a study on the knowledge and attitude of Chinese social residents toward AD, the results of this study can serve as a powerful reference for relevant research in the field of change and as a relevant basis for more targeted publicity activities about AD among social residents, thereby stimulating widespread concern and in-depth thought about AD.

Acknowledgements

We are grateful to all the participants who took part in this study.

Ethical Approval

The study was approved by the Beijing University of Chinese Medicine's Ethics Committee, Beijing, China (reference code: 2021BZYLL0306).

Conflict of interest

There was no conflict of interest.

Authors’ contributions

Jiang Jing designed the study. Lu Rui, Qiao Ning, Song Jin, Wang Ziqiong and Zhao Jiarui carried out the data collection, data analysis and wrote the first draft of this manuscript. Yu Ruixia and Wang Qiucheng helped to check the manuscript. All authors contributed to data analysis, interpretation, critically commented and approved the final manuscript.

Funding

This study was supported by the National Natural Science Foundation of China (grant no. 82174515).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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A Study of Knowledge on Alzheimer's Disease and Attitudes of Chinese Social Residents towards Alzheimer’s disease: a cross-sectional survey in China

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Abstract

Contribution Of The Paper

Introduction

Method

Aim

Study Design

Participants

Measurements

Statistical analysis

Results

Statistical demographics of the survey population

Analyses Of Adks Scores And Das Scores

Effects Of Various Influencing Factors On The Total Adks And Das Scores

Discussion

Analysis of overall total scores of ADKS and DAS

Accuracy And Dimensional Analysis Of Each Adks Scale Item

Analysis Of The Impact Of Various Variables On Adks And Das

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1