Perceptions of Chinese Towards Dementia in Hong Kong—Diagnosis, Symptoms and Impacts
Abstract
:1. Introduction
2. Materials and Methods
2.1. Questionnaire
2.2. Sample
2.3. Statistical Analysis
3. Results
3.1. Participants Recruited
3.2. Fear of Dementia
3.3. Perceived Impact of Dementia
3.4. Preferences for the Timing of Diagnosis Disclosure
3.5. Causes of Dementia
3.6. Symptoms of Dementia
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Dementia: A Public Health Priority; World Health Organization: Geneva, Switzerland, 2012. [Google Scholar]
- Alzheimer’s Research, UK. Deaths Due to Dementia; Alzheimer’s Research UK: Cambridge, UK, 2018. [Google Scholar]
- Dementia Australia. Dementia Statistics; Dementia Australia: Canberra, Australia, 2018. [Google Scholar]
- Alzheimer’s Association US. Facts and Figures; Alzheimer’s Association U.S.: Chicago, IL, USA, 2018. [Google Scholar]
- Elderly Health Service, Department of Health, Hong Kong. Dementia; Department of Health: Hong Kong, China, 2016. [Google Scholar]
- Lam, L.C.W.; Tam, C.W.C.; Lui, V.W.C.; Chan, W.C.; Chan, S.S.M.; Wong, S.; Wong, A.; Tham, M.K.; Ho, K.S.; Chan, W.M.; et al. Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int. Psychogeriatr. 2008, 20, 135–148. [Google Scholar] [CrossRef] [PubMed]
- Census and Statistics Department HKSAR. Hong Kong Population Projections; Census and Statistics Department: Hong Kong, China, 2010. [Google Scholar]
- Yu, R.; Chau, P.H.; McGhee, S.M.; Cheung, W.L.; Chan, K.C.; Cheung, S.H.; Woo, J. Trends in prevalence and mortality of dementia in elderly Hong Kong population: Projections, disease burden, and implications for long-term care. Int. J. Alzheimer’s Dis. 2012, 2012, 406852. [Google Scholar] [CrossRef] [PubMed]
- Census and Statistics Department HKSAR. Hong Kong Population Projections; Census and Statistics Department: Hong Kong, China, 2015. [Google Scholar]
- Li, R.; Cooper, C.; Livingston, G. Relationship of coping style to mood and anxiety disorders in dementia carers. Curr. Opin. Psychiatry 2014, 27, 52–56. [Google Scholar] [CrossRef] [PubMed]
- Stirling, C.; Andrews, S.; Croft, T.; Vickers, J.; Turner, P.; Robinson, A. Measuring dementia carers’ unmet need for services—An exploratory mixed method study. BMC Health Serv. Res. 2010, 10, 122. [Google Scholar] [CrossRef] [PubMed]
- Peel, E.; Harding, R. ‘It’s a huge maze, the system, it’s a terrible maze’: Dementia carers’ constructions of navigating health and social care services. Dementia 2014, 13, 642–661. [Google Scholar] [CrossRef] [PubMed]
- Alzheimer’s Disease International. World Alzheimer Report 2011—The Benefits of Early Diagnosis and Intervention; Alzheimer’s Disease International: London, UK, 2011. [Google Scholar]
- Brodaty, H. Six reasons why early diagnosis of dementia does not occur and ten reasons why it should. Les Cah. De La Found. Me Decic Alzheimer 2005, 1, 12–17. [Google Scholar]
- Brodaty, H.; Donkin, M. Family caregivers of people with dementia. Dialogues Clin. Neurosci. 2009, 11, 217–228. [Google Scholar]
- Daviglus, M.L.; Bell, C.C.; Berrettini, W.; Bowen, P.E.; Connolly, E.S., Jr.; Cox, N.J. National Institutes of Health State-of-the-Science Conference statement: Preventing alzheimer disease and cognitive decline. Ann. Intern. Med. 2010, 153, 176–181. [Google Scholar] [CrossRef]
- Forlenza, O.V.; Diniz, B.S.; Radanovic, M.; Santos, F.S.; Talib, L.L.; Gattaz, W.F. Disease-modifying properties of long-term lithium treatment for amnestic mild cognitive impairment: Randomised controlled trial. Br. J. Psychiatry 2011, 198, 351–356. [Google Scholar] [CrossRef]
- Mayeux, R. Early Alzheimer’s disease. N. Engl. J. Med. 2010, 362, 2194–2201. [Google Scholar] [CrossRef]
- Rountree, S.; Chan, W.; Pavlik, V.; Darby, E.; Siddiqui, S.; Doody, R. Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer disease. Alzheimer’s Res. Ther. 2009, 1, 7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tan, C.C.; Yu, J.T.; Wang, H.F.; Tan, M.S.; Meng, X.F.; Wang, C.; Jiang, T.; Zhu, X.-C.; Tan, L. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: A systematic review and meta-analysis. J. Alzheimer’s Dis. 2014, 41, 615–631. [Google Scholar] [CrossRef] [PubMed]
- Bradford, A.; Kunik, M.E.; Schulz, P.; Williams, S.P.; Singh, H. Missed and delayed diagnosis of dementia in primary care: Prevalence and contributing factors. Alzheimer Dis. Assoc. Disord. 2009, 23, 306–314. [Google Scholar] [CrossRef] [PubMed]
- Fowler, N.R.; Boustani, M.A.; Frame, A.; Perkins, A.J.; Monahan, P.; Gao, S.; Sachs, G.A.; Hendrie, H.C. Effect of patient perceptions on dementia screening in primary care. J. Am. Geriatr. Soc. 2012, 60, 1037–1043. [Google Scholar] [CrossRef] [PubMed]
- McCarten, J.; Anderson, P.; Kuskowski, M.; McPherson, S.; Borson, S. Screening for cognitive impairment in an elderly veteran population: Acceptability and results using different versions of the Mini-Cog. J. Am. Geriatr. Soc. 2011, 59, 309–313. [Google Scholar] [CrossRef] [PubMed]
- Phillipson, L.; Magee, C.; Jones, S.; Reis, S.; Skladzien, E. Dementia attitudes and help-seeking intentions: An investigation of responses to two scenarios of an experience of the early signs of dementia. Aging Ment. Health 2015, 19, 968–977. [Google Scholar] [CrossRef]
- Riley McCarten, J.; Anderson, P.; Kuskowski, M.A.; McPherson, S.; Borson, S.; Dysken, M. Finding dementia in primary care: The results of a clinical demonstration project. J. Am. Geriatr. Soc. 2012, 60, 210–217. [Google Scholar] [CrossRef] [PubMed]
- Watson, R.; Bryant, J.; Sanson-Fisher, R.; Mansfield, E.; Evans, T.-J. What is a ‘timely’diagnosis? Exploring the preferences of Australian health service consumers regarding when a diagnosis of dementia should be disclosed. BMC Health Serv. Res. 2018, 18, 612. [Google Scholar] [CrossRef]
- Tan, W.; Hong, S.-I.; Luo, N.; Lo, T.; Yap, P. The lay public’s understanding and perception of dementia in a developed Asian nation. Dement. Geriatr. Cogn. Disord. Extra 2012, 2, 433–444. [Google Scholar] [CrossRef]
- Lee, S.; Lin, X.; Haralambous, B.; Dow, B.; Vrantsidis, F.; Tinney, J. Factors impacting on early detection of dementia in older people of A sian background in primary healthcare. Asia-Pac. Psychiatry 2011, 3, 120–127. [Google Scholar] [CrossRef]
- Mansfield, E.; Noble, N.; Sanson-Fisher, R.; Mazza, D.; Bryant, J. Primary care physicians’ perceived barriers to optimal dementia care: A systematic review. Gerontologist 2018. [Google Scholar] [CrossRef] [PubMed]
- Harvard, T.H. Chan School of Public Health. International Survey Highlights Great Public Desire to Seek Early Diagnosis of Alzheimer’s; Harvard T.H. Chan School of Public Health: Boston, MA, USA, 2011. [Google Scholar]
- Suhr, J.A.; Kinkela, J.H. Perceived threat of Alzheimer disease (AD): The role of personal experience with AD. Alzheimer Dis. Assoc. Disord. 2007, 21, 225–231. [Google Scholar] [CrossRef] [PubMed]
- Sheng, B.; Law, C.; Yeung, K. Characteristics and diagnostic profile of patients seeking dementia care in a memory clinic in Hong Kong. Int. Psychogeriatr. 2009, 21, 392–400. [Google Scholar] [CrossRef] [PubMed]
- Cheng, S.; Lam, L.; Kwok, T. Neuropsychiatric symptom clusters of Alzheimer disease in Hong Kong Chinese: Correlates with caregiver burden and depression. Am. J. Geriatr. Psychiatry 2013, 21, 1029–1037. [Google Scholar] [CrossRef] [PubMed]
- Huang, S.S.; Lee, M.C.; Liao, Y.C.; Wang, W.F.; Lai, T.J. Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly. Arch. Gerontol. Geriatr. 2012, 55, 55–59. [Google Scholar] [CrossRef] [PubMed]
- Yan, E.S.; Kwok, T. Abuse of older Chinese with dementia by family caregivers: An inquiry into the role of caregiver burden. Int. J. Geriatr. Psychiatry 2011, 26, 527–535. [Google Scholar] [CrossRef] [PubMed]
- Wang, J.; Xiao, L.D.; Li, X.; De Bellis, A.; Ullah, S. Caregiver distress and associated factors in dementia care in the community setting in China. Geriatr. Nurs. 2015, 36, 348–354. [Google Scholar] [CrossRef] [PubMed]
- Xiao, L.D.; Wang, J.; He, G.P.; De Bellis, A.; Verbeeck, J.; Kyriazopoulos, H. Family caregiver challenges in dementia care in Australia and China: A critical perspective. BMC Geriatr. 2014, 14, 6. [Google Scholar] [CrossRef]
- Cerejeira, J.; Lagarto, L.; Mukaetova-Ladinska, E. Behavioral and psychological symptoms of dementia. Front. Neurol. 2012, 3, 73. [Google Scholar] [CrossRef]
- Gauthier, S.; Cummings, J.; Ballard, C.; Brodaty, H.; Grossberg, G.; Robert, P.; Lyketsos, C. Management of behavioral problems in Alzheimer’s disease. Int. Psychogeriatr. 2010, 22, 346–372. [Google Scholar] [CrossRef]
- Chien, W.T.; Lee, Y.M. A disease management program for families of persons in Hong Kong with dementia. Psychiatr. Serv. 2008, 59, 433–436. [Google Scholar] [CrossRef] [PubMed]
- Leung, C.W.; Lam, T.P.; Wong, K.W.; Chao, V.K.D. Early detection of dementia: The knowledge and attitudes of primary care physicians in Hong Kong. Dementia 2018. [Google Scholar] [CrossRef] [PubMed]
Chronic Disease | <40 n = 41 | 40–64 n = 169 | ≥65 n = 40 |
---|---|---|---|
% | % | % | |
Coronary heart disease (not high blood pressure or high cholesterol) | 2.4% | 0.6% | 2.5% |
Dementia and Alzheimer’s disease | 7.3% | 14.8% | 27.5% |
Cerebrovascular disease (such as stroke) | 14.6% | 23.7% | 17.5% |
Cancer | 70.7% | 49.1% | 22.5% |
Chronic obstructive pulmonary disease (such as emphysema) | 0.0% | 0.6% | 0.0% |
Diabetes | 0.0% | 1.8% | 5.0% |
Heart failure | 4.9% | 1.8% | 10.0% |
None of the above | 0.0% | 4.7% | 12.5% |
Others | 0.0% | 3.0% | 2.5% |
Perceived Impact of Dementia | Self | Significant Others | McNemar Test | ||
---|---|---|---|---|---|
n | % | n | % | p-Value | |
Emotional impact (e.g., stress, loss of identity) | 157 | 58.4% | 157 | 58.4% | 1.000 |
Social impact (e.g., loss of friends or hobbies) | 88 | 32.7% | 49 | 18.2% | <0.001 ** |
Practical issues (e.g., needing assistance with daily tasks, unable to drive) | 165 | 61.3% | 192 | 71.4% | 0.003 * |
Financial strain (e.g., difficulty paying for medical expenses) | 104 | 38.7% | 113 | 42.0% | 0.362 |
Physical health (e.g., problems with toileting) | 164 | 61.0% | 151 | 56.1% | 0.218 |
Legal issues (e.g., appointing someone to make decisions on my behalf) | 20 | 7.4% | 11 | 4.1% | 0.049 * |
Dealing with the health system (e.g., getting what I need from health providers) | 57 | 21.2% | 69 | 25.7% | 0.162 |
Perceived Impact of Dementia | Knew Someone with Dementia | Did Not Know Someone with Dementia | Pearson χ2 Test | ||
---|---|---|---|---|---|
n | % | n | % | p-Value | |
Emotional impact (e.g., stress, loss of identity) | 39 | 58.2% | 121 | 59.9% | 0.807 |
Social impact (e.g., loss of friends or hobbies) | 12 | 17.9% | 36 | 17.8% | 0.987 |
Practical issues (e.g., needing assistance with daily tasks, unable to drive) | 49 | 73.1% | 141 | 69.8% | 0.604 |
Financial strain (e.g., difficulty paying for medical expenses) | 17 | 25.4% | 92 | 45.5% | 0.004 * |
Physical health (e.g., problems with toileting) | 35 | 52.2% | 113 | 55.9% | 0.598 |
Legal issues (e.g., appointing someone to make decisions on my behalf) | 2 | 3.0% | 8 | 4.0% | 0.715 |
Dealing with the health system (e.g., getting what I need from health providers) | 25 | 37.3% | 43 | 21.3% | 0.009 * |
Cause | Strongly Agree | Agree | Disagree | Strongly Disagree | Not Sure | Pearson χ2Test with Age Groups | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | p-Value | |
(a) Family history or genes | 57 | 20.5% | 163 | 58.6% | 16 | 5.8% | 2 | 0.7% | 40 | 14.4% | 0.920 |
(b) Stress or worry | 34 | 12.5% | 161 | 59.0% | 25 | 9.2% | 1 | 0.4% | 52 | 19.0% | 0.083 |
(c) Smoking | 19 | 7.1% | 79 | 29.5% | 76 | 28.4% | 12 | 4.5% | 82 | 30.6% | 0.476 |
(d) Poor diet | 22 | 8.1% | 86 | 31.5% | 71 | 26.0% | 11 | 4.0% | 83 | 30.4% | −0.048 * |
(e) Drinking too much alcohol | 21 | 7.7% | 119 | 43.9% | 53 | 19.6% | 5 | 1.8% | 73 | 26.9% | 0.494 |
(f) Lack of exercise | 27 | 10.0% | 138 | 51.1% | 51 | 18.9% | 6 | 2.2% | 48 | 17.8% | 0.424 |
(g) Being overweight | 17 | 6.4% | 64 | 24.0% | 97 | 36.3% | 8 | 3.0% | 81 | 30.3% | 0.357 |
(h) Medications | 32 | 11.9% | 149 | 55.2% | 25 | 9.3% | 3 | 1.1% | 61 | 22.6% | 0.578 |
(i) Chemicals in the home (e.g., cleaning products) | 13 | 4.9% | 73 | 27.5% | 76 | 28.7% | 7 | 2.6% | 96 | 36.2% | 0.181 |
(j) Food additives/preservatives | 14 | 5.2% | 110 | 40.9% | 50 | 18.6% | 4 | 1.5% | 91 | 33.8% | 0.283 |
(k) Pesticides | 18 | 6.7% | 105 | 39.0% | 54 | 20.1% | 5 | 1.9% | 87 | 32.3% | 0.709 |
(l) Air pollution | 17 | 6.3% | 100 | 37.0% | 66 | 24.4% | 9 | 3.3% | 78 | 28.9% | 0.244 |
(m) Working hours (e.g., long hours, shift work) | 26 | 9.7% | 101 | 37.7% | 65 | 24.3% | 5 | 1.9% | 71 | 26.5% | 0.130 |
(n) High blood pressure | 22 | 8.1% | 105 | 38.5% | 53 | 19.4% | 4 | 1.5% | 89 | 32.6% | 0.454 |
(o) Brain injury (e.g., from a car accident) | 53 | 19.3% | 155 | 56.6% | 16 | 5.8% | 1 | 0.4% | 49 | 17.9% | 0.303 |
Symptoms of Dementia | Strongly Agree | Agree | Disagree | Strongly Disagree | Not Sure | Pearson χ2Test with Age Groups | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | p-Value | |
(a) Trouble remembering recent events | 95 | 34.4% | 161 | 58.3% | 11 | 4.0% | 0 | 0.0% | 9 | 3.3% | +, 0.018 * |
(b) Trouble recognising family members | 104 | 38.0% | 152 | 55.5% | 6 | 2.2% | 5 | 1.8% | 7 | 2.6% | +, 0.001 * |
(c) Losing or misplacing things | 73 | 26.6% | 161 | 58.8% | 20 | 7.3% | 3 | 1.1% | 17 | 6.2% | +, 0.001 * |
(d) Forgetting what day it is | 66 | 24.2% | 155 | 56.8% | 28 | 10.3% | 4 | 1.5% | 20 | 7.3% | +, 0.008 * |
(e) Destroying property | 11 | 4.1% | 66 | 24.7% | 118 | 44.2% | 10 | 3.7% | 62 | 23.2% | 0.054 |
(f) Talking loudly and rapidly | 12 | 4.5% | 65 | 24.2% | 101 | 37.5% | 20 | 7.4% | 71 | 26.4% | 0.092 |
(g) Being aggressive towards others | 12 | 4.5% | 53 | 19.8% | 114 | 42.5% | 18 | 6.7% | 71 | 26.5% | 0.342 |
(h) Showing inappropriate sexual behaviours | 10 | 3.7% | 36 | 13.5% | 115 | 43.1% | 23 | 8.6% | 83 | 31.1% | 0.098 |
(i) Wandering away from home | 102 | 37.0% | 154 | 55.8% | 6 | 2.2% | 3 | 1.1% | 11 | 4.0% | +, 0.047 * |
(j) Needing assistance with everyday tasks (e.g., dressing) | 54 | 19.9% | 143 | 52.8% | 42 | 15.5% | 4 | 1.5% | 28 | 10.3% | 0.108 |
(k) Problems getting to the toilet on time | 31 | 11.4% | 114 | 42.1% | 57 | 21.0% | 6 | 2.2% | 63 | 23.2% | 0.640 |
(l) Lacking interest in personal hygiene or grooming | 25 | 9.4% | 99 | 37.1% | 80 | 30.0% | 8 | 3.0% | 55 | 20.6% | 0.138 |
(m) Clingy behaviour (e.g., following spouse around) | 11 | 4.1% | 80 | 30.0% | 81 | 30.3% | 12 | 4.5% | 83 | 31.1% | 0.698 |
(n) Trouble finding the right word or misnaming things | 32 | 11.8% | 150 | 55.4% | 31 | 11.4% | 4 | 1.5% | 54 | 19.9% | 0.123 |
(o) Feeling paranoid or suspicious | 43 | 15.8% | 114 | 41.9% | 46 | 16.9% | 5 | 1.8% | 64 | 23.5% | 0.649 |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lam, T.P.; Sun, K.S.; Chan, H.Y.; Lau, C.S.; Lam, K.F.; Sanson-Fisher, R. Perceptions of Chinese Towards Dementia in Hong Kong—Diagnosis, Symptoms and Impacts. Int. J. Environ. Res. Public Health 2019, 16, 128. https://doi.org/10.3390/ijerph16010128
Lam TP, Sun KS, Chan HY, Lau CS, Lam KF, Sanson-Fisher R. Perceptions of Chinese Towards Dementia in Hong Kong—Diagnosis, Symptoms and Impacts. International Journal of Environmental Research and Public Health. 2019; 16(1):128. https://doi.org/10.3390/ijerph16010128
Chicago/Turabian StyleLam, Tai Pong, Kai Sing Sun, Hoi Yan Chan, Chak Sing Lau, Kwok Fai Lam, and Robert Sanson-Fisher. 2019. "Perceptions of Chinese Towards Dementia in Hong Kong—Diagnosis, Symptoms and Impacts" International Journal of Environmental Research and Public Health 16, no. 1: 128. https://doi.org/10.3390/ijerph16010128