Cross-cultural representations of dementia: an exploratory study

Abstract

Background An ageing global population will bring a significant increase in the prevalence of dementia, with the need for a collaborative international effort to combat this public health challenge being increasingly recognised. To be successful, this cooperation must be sensitive to the different cultural environments in which dementia is positioned, which shape the variety of clinical, political and social approaches to the condition worldwide. The aim of this project is to examine the social representations of dementia among people from three countries with different health care systems. More specifically, to investigate the internal structure of the social representations of dementia within the framework of the structural approach among British, American and Chinese lay-people. Methods A sample of 194 participants completed a free association task and a justification task in response to the stimulus word ‘dementia’. The data was subsequently analysed within the framework of the structural approach to social representations, using prototypical analysis. Results The American group’s unique elements were nearly exclusively concerned with physical and cognitive decline, and elements referring to care were focused on external support, namely nursing homes. In the Chinese group, there were several elements referring to behaviour, but a much greater emphasis on cognition than predicted by the literature. Elements concerning care were, as expected, focused on the family. In the British group, there was also a cognitive focus, but this was accompanied by elements which portrayed the experience of the condition from the perspective of those affected, and a reference to relative well-being in the context of care. Conclusions Social representation theory proved to be a viable method in gathering data on cross-cultural differences in how dementia is understood and approached. The current study demonstrated how the conceptualisation of the condition’s relationship with the cognitive, behavioural and affective dimensions might have an impact on the structure and form of care for those living with dementia in each culture.

A cross‐national study of depression in preclinical dementia: A COSMIC collaboration study

“…Other studies have suggested it to be a reaction to loss of competence, which could be culturally determined. [14][15][16] Few studies have investigated the incidence and clinical course of depression longitudinally within the preclinical phase of dementia, and as far as we are aware this is the first to examine cross-national differences. This study has thus been able to examine the hypothesis that if depression is prodromal, that is, an early feature of the disease…”

“…On the other hand, the observed associations between depression and smaller hippocampal volume, neurotransmitter imbalance, tau accumulation, and amyloid metabolism in persons with diagnosed AD 4‐7 have supported the alternative hypothesis that depression is linked to the underlying pathological brain changes and therefore constitutes a prodrome of the disease rather than a risk factor. Other studies have suggested it to be a reaction to loss of competence, which could be culturally determined 14‐16 …”

“…Cross‐national differences in AD‐related depression trajectories may help resolve the question of the direction of causality. Depression prevalence, patterns of depressive symptomatology (affective versus somatic), risk factors for depression, and social stigma in relation to dementia are known to vary widely across ethnic groups 14‐16 whereas the underlying brain changes may be expected to be similar.…”

Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration

“…Further, the lack of a culturally valid assessment tool for cognitive impairment, and the high cost of diagnostic imaging tools such as fluorodeoxyglucose (FDG)-positron emission tomography (PET) and Pittsburgh Compound-B (PIB) PET, are other challenges for research and diagnosis in LMICs [13-14]. Calia et al [13] explore the differences in the representation of dementia between people from the United States, United Kingdom, and China. They caution readers about the effect that these differences might have on the ways in which dementia is experienced and care is provided.…”

Extracts or Active Components from Acorus gramineus Aiton for Cognitive Function Impairment: Preclinical Evidence and Possible Mechanisms

“…With the average life expectancy increasing, there is concern about the proportion of cognitive impairment in the global population, which results from degeneration of the brain and very high prevalence in elderly individuals [ 1 ]. The World Health Organization estimates that the number of people over the age of 60 will be around 2 billion in 2050, while the number of cognitive impairment patients is expected to rise rapidly along with the aging population worldwide [ 2 , 3 ]. However, so far, clinical trials have not identified efficacious neuroprotective therapies for cognitive impairment patients [ 4 ].…”