Jalani is 27 years old and recently graduated from an elite  Public Health Law program where she focused on civil rights law for women in 3rd world countries. She describes herself as passionate, principled, goal-oriented, rational and a bit irritable. She is highly articulate and an expert in arguing any point she sees as important and has a tendency to become impassioned about social issues and social justice in a way that makes her a powerhouse in her law program. Jalani says she feels like it's her job in the world to crusade for justice and fight for equity for those who don't have a voice.  She has always considered herself to be ethically minded and fair but she knows that her emotional investment and zeal can be intimidating to others (a strength she uses in her work). She is short but has broad shoulders and a strong sturdy, muscular body, with well developed legs. She was a successful track athlete in high school and college. she has a squared jaw and fierce and penetrating  yet somewhat intimidating eyes. Jalani has often found it difficult to let people into her life in an intimate way because she can come across as too opinionated, judgmental or stern. She's idealistic, well learned and studious but her delivery is often blunt and strident which makes people feel like she's angry and disapproving even when she's not (and even if she is she has trouble admitting it). She's very focused on facts and the practical application of life so she very rarely enjoys things like art, food or music or what she says are "frivolous things" partially because she's so busy pursuing her new career as a lawyer at a non profit and partially because she says she "doesn't see the point". Jalani lacks rhythm and fluidity in her movements but she's strong, physically grounded and good at taking care of practical resources. At times, when she cares to, Jalani can be very charming utilizing diplomacy, tact and a smooth professionalism to get her goals met. She has a knack for social networking, mostly because she is so knowledgeable and can be funny and self-deprecating when necessary, she's good at adapting somewhat to get what she needs, but for the most part what you see is what you get. Jalani is typically expedient and efficient and derives a lot of joy from completing a task and doing it with detailed precision and accuracy. has difficulty relaxing and so experienced insomnia, tension headaches and has struggled with asthma throughout her life. Lin has been pursuing Jalani for a over a year now, she is 28, curvy, with wider hips and a soft feminine frame. She has a sweet smile and big, inviting and seductive eyes. She loves to spend time making herself look beautiful and decorating her environment. Lin met Jalani during a mock trial in their litigation class and fell for her immediately. Lin is accommodating, kind, gregarious and seemingly friends with everyone, and she loves more than anything to be in a monogamous relationship with someone she's ...

1. Jalani is 27 years old and recently graduated from an elite
Public Health Law program where she focused on civil rights
law for women in 3rd world countries. She describes herself as
passionate, principled, goal-oriented, rational and a bit irritable.
She is highly articulate and an expert in arguing any point she
sees as important and has a tendency to become impassioned
about social issues and social justice in a way that makes her a
powerhouse in her law program. Jalani says she feels like it's
her job in the world to crusade for justice and fight for equity
for those who don't have a voice. She has always considered
herself to be ethically minded and fair but she knows that her
emotional investment and zeal can be intimidating to others (a
strength she uses in her work). She is short but has broad
shoulders and a strong sturdy, muscular body, with well
developed legs. She was a successful track athlete in high
school and college. she has a squared jaw and fierce and
penetrating yet somewhat intimidating eyes. Jalani has often
found it difficult to let people into her life in an intimate way
because she can come across as too opinionated, judgmental or
stern. She's idealistic, well learned and studious but her
delivery is often blunt and strident which makes people feel like
she's angry and disapproving even when she's not (and even if
she is she has trouble admitting it). She's very focused on facts
and the practical application of life so she very rarely enjoys
things like art, food or music or what she says are "frivolous
things" partially because she's so busy pursuing her new career
as a lawyer at a non profit and partially because she says she
"doesn't see the point". Jalani lacks rhythm and fluidity in her
movements but she's strong, physically grounded and good at
taking care of practical resources. At times, when she cares to,
Jalani can be very charming utilizing diplomacy, tact and a
smooth professionalism to get her goals met. She has a knack
for social networking, mostly because she is so knowledgeable
and can be funny and self-deprecating when necessary, she's

2. good at adapting somewhat to get what she needs, but for the
most part what you see is what you get. Jalani is typically
expedient and efficient and derives a lot of joy from completing
a task and doing it with detailed precision and accuracy. has
difficulty relaxing and so experienced insomnia, tension
headaches and has struggled with asthma throughout her life.
Lin has been pursuing Jalani for a over a year now, she is 28,
curvy, with wider hips and a soft feminine frame. She has a
sweet smile and big, inviting and seductive eyes. She loves to
spend time making herself look beautiful and decorating her
environment. Lin met Jalani during a mock trial in their
litigation class and fell for her immediately. Lin is
accommodating, kind, gregarious and seemingly friends with
everyone, and she loves more than anything to be in a
monogamous relationship with someone she's attracted to. Lin
enjoys the arts and is a great lover of music and dance. She
plays 3 instruments and can spend hours dancing and singing
when she should be working on her cases. She lives a relatively
carefree life and likes to keep her life free from stress and
conflict. However, if necessary Lin can be assertive and
resolute qualities that come in handy as a women's health
advocate in the same nonprofit organization as Jalani. Lin feels
like her job in the world is to bring beauty and happiness to
people. Lin has recently started to think that law isn't the right
fit for her and wants to pursue a degree in midwifery.
Jalani has difficulty prioritizing spending time with Lin, and
rebukes most of Lin's efforts to get close to her. They've had
some casual dates (and casual sex) but Jalani resists opening up
and calls emotional intimacy "gross and sticky" and she has
similar problems expressing herself sexually (often feeling
restrained and awkward in that arena). Lin laughs it off and is
patient but it's beginning to hurt her feelings and she's afraid
she'll have to move on if Jalani doesn't open up. Lin's biggest
problem with Jalani is the way she becomes cold and critical
and then escalates to being biting and brusque when they
disagree. Lin, who isn't afraid to express a dissenting opinion,

3. shies away from it with Jalani because she gets "mean". Lin also
lets Jalani tell her what to do, what to eat, and what to wear
sometimes because she wants to please her and because
sometimes she just "doesn't care" what she wants outside of
pleasing Jalani. Jalani cares for Lin and is fearing that her
inability to get close will push her away but doesn't know how
to soften or be more vulnerable, she's never felt like love was
freely given and that everything comes with a price tag.
What is Jalani's Enneagram type (and potential wing), tritype,
instinct and explain.
What is Jalani's character structure (top 2 choices) and explain
What is Jalani's archetype (top 2 choices)?
What can you say about Jalani's potential chakra imbalances
(overactive, underactive, balanced) and what are some things
she could do to improve them?
What Enneagram type, potential type or tritype, character
structure and archetype is Lin?
What could Lin do to improve her relating to Jalani and vice
versa? What advice would you give each of them both
personally and interpersonally?
Utilize the handouts and powerpoints in your analysis
~5 pages (or as long as you need to make an analysis)
Double Spaced, Times or Times New Roman font
1" margins around page
APA or MLA format
Gaps in Alzheimer’s Knowledge
Among College Students
Elaine M. Eshbaugh

4. School of Applied Human Sciences, University of Northern
Iowa, Cedar Falls,
Iowa, USA
Despite the prevalence of the disease, it appears that there may
be a need for increased education for
formal and family caregivers of those with Alzheimer’s disease
and related dementias. Today’s
college students will be asked to fill both of these roles in the
future. This study examined the level
of knowledge of Alzheimer’s disease among college students.
Two-hundred college students at a
mid-sized midwestern university completed an online survey
that included the Alzheimer’s Disease
Knowledge Scale (Carpenter et al., 2009). Although most
participants knew that people with
Alzheimer’s remember things from the distant past better than
more recent events, many college
students were unfamiliar with risk factors and average life
expectancy. Implications and recommen-
dations for educational programs and curriculum are discussed.
Alzheimer’s disease and related dementias are significant health
concerns affecting our older
adult population (Sullivan & Muscat, 2007). As our population
continues to age and our

5. demography shifts to higher proportions of elders, the number
of individuals diagnosed with
Alzheimer’s and dementia continues to increase. Although the
causes of dementia are numerous,
Alzheimer’s disease, which is irreversible and ultimately fatal,
is the most common cause of
dementia. About 70% of dementias in the United States are
caused by Alzheimer’s disease
(Brookmeyer, Evans, Hebert, Langa, & Herringa, 2011). This
percentage increases to nearly
80% among those 90 years old or greater who have dementia
(Brookmeyer et al., 2011).
Strikingly, one in eight persons in the U.S. aged 65 years or
older has Alzheimer’s disease
(Hebert, Scherr, Bienias, Bennett, & Evans, 2003). Because the
Baby Boom generation is
reaching the age of greatest risk for dementia and Alzheimer’s
disease, the number of individuals
living with dementia in the U.S. will increase in the next
several decades barring the develop-
ment a significant medical breakthrough.
Despite the prevalence of Alzheimer’s and related dementias, it
appears that there may be a
need for increased education among both family and
professional caregivers. Research suggests

6. that families, in particular, are often overwhelmed by the
caregiving needs of those with
dementia and lack the knowledge to confidently provide for
those needs (Manthrope & Iliffe,
2009). Unfortunately, families of those with dementia,
particularly early stage dementia, have
substantial educational needs that are not always met (Moniz-
Cook & Woods, 1997). Caregivers
Address correspondence to Elaine M. Eshbaugh, University of
Northern Iowa, School of Applied Human Sciences,
217 Latham Hall, Cedar Falls, IA 50614-0332. E-mail:
[email protected]
Educational Gerontology, 40: 655–665, 2014
Copyright # Taylor & Francis Group, LLC
ISSN: 0360-1277 print / 1521-0472 online
DOI: 10.1080/03601277.2013.863573
also may be reluctant to ask questions and may not know how to
make sure their need for
education is met (Boise, Morgan, Kaye, & Camicolli, 1999).
It follows that less than adequate levels of knowledge of
Alzheimer’s among family

7. caregivers have been found, particularly among spouses of those
with the disease and those fam-
ily members with low levels of education (Werner, 2001).
Family caregivers show a lack of
knowledge in the areas of prevalence, symptoms, and causes of
the disease. This is notable
because 80% of care provided at home for those with
Alzheimer’s is provided by family
members, and 15 million Americans provide unpaid, informal
care for a loved one living with
Alzheimer’s or another dementia (Alzheimer’s Association,
2012).
However, it should be noted that there is some evidence that
first-degree relatives of those
with Alzheimer’s have a relatively high level of knowledge
about the disease compared to other
populations (Roberts & Connell, 2000). Persons who have a
family member with Alzheimer’s
typically know more about the disease than persons who do not
have a family member with the
disease (Carpenter, Zoller, Balsis, Otilingham, & Gatz, 2011).
In addition, family caregivers
participating in Alzheimer’s support groups may have more
knowledge of the disease than other
caregivers (Graham, Ballard, & Sham, 1997). Not surprisingly,

8. family caregivers may be more
capable of negotiating the demands of dementia and effectively
implementing treatment plans
when they have a better understanding of Alzheimer’s (Sullivan
& Muscat, 2007). Caregivers
with more understanding of the illness can be more active in the
care of their loved one
(Ham, 1999) and be more rational decision-makers (Werner,
2001).
Lack of knowledge about Alzheimer’s is not only problematic in
the case of family caregivers.
It may also be an issue for professional caregivers.
Unfortunately, there is a shortage of healthcare
professionals and social workers who can knowledgably and
effectively provide services for those
with dementia (Bartels & Smyer, 2002). More specifically,
survey research has suggested that
there is a need for healthcare and social service professionals to
be more empathetic and under-
standing of the needs of those with dementia and their families
(Thompson, Hope, & Pulsford,
2009). Research has suggested that knowledge of dementia
among professionals is important
because it leads to earlier diagnosis and more competent

9. referrals for those with dementia (Reimer,
Slaughter, Donaldson, Currie, & Eliaziw, 2004). Furthermore,
dementia training can increase
professionals’ competence in managing the behaviors of those
with dementia (Hughes, Bagley,
Reilly, Burns, & Challis, 2008). Although some researchers
(Carpenter et al., 2011) have found
that caregiving professionals are more familiar with the disease
and have greater levels of
knowledge than families, there may still be a need for increased
education among this group.
It is also important to consider the level of knowledge of
Alzheimer’s disease among college
students. Obviously, they are future family and professional
caregivers. Even those college stu-
dents who will pursue careers that require interaction with
individuals with Alzheimer’s may
lack knowledge. Undergraduates, including those intending to
pursue careers in the healthcare
and social services area, tend to have an inadequate level of
knowledge about Alzheimer’s
(Kwok, Yip, & Ho, 2011). They may have a low level of
knowledge about dementia drugs
and their limited effectiveness, in particular. Research has

10. suggested that nursing students
who interact with individuals with dementia receive little
education on care (Pulsford, Hope,
& Thompson, 2007). Furthermore, students’ knowledge of the
cognition of older adults may
be limited by their overgeneralization of the elders that they
come into contact with, such as fam-
ily members and friends (Jackson, Cherry, Smitherman, &
Hawley, 2008). In other words, they
often underestimate the diversity in the cognitive functioning of
older adults.
656 E. M. ESHBAUGH
Education for future health and social work professionals is
variable in level and type of
dementia coverage, and this variability may result in a work
force with deficient skills in
working with those who have dementia. Authors (Nordhus,
Sivertsen, & Pallesen, 2012) have
suggested that a challenge is strengthening the Alzheimer’s
knowledge base of those who will
work in mental health settings with our aging global population.
In addition, even those students

11. who do not seek careers in working with older adults and their
families will likely be confronted
with family members and friends of their own with dementia.
Increasing knowledge of
Alzheimer’s among these potential informal and unpaid
caregivers may serve to reduce future
caregiver stress, decrease early institutionalization, and increase
access of support services
(Bailey, 2000). Therefore, it is important to examine the level
of knowledge of undergraduates
have regarding Alzheimer’s disease and related dementias.
PURPOSES OF THE STUDY
Provide Further Validation of the ADKS with a College Student
Sample
In 1988, the Alzheimer’s Disease Knowledge Test (Diekman,
Zarit, Zarit, & Gatz, 1988) was
developed as a 20-item multiple choice assessment to determine
what individuals know about
Alzheimer’s disease. The test was used for assessment in
various populations including college
students and health professionals. Although the knowledge
reflected in this measure became
dated due to advances in knowledge in the field of Alzheimer’s
and dementia, researchers

12. continued to use the test until the development of the
Alzheimer’s Disease Knowledge Scale
(ADKS) in 2009 (Carpenter et al., 2009).
The ADKS, a 30-item, true=false measure, takes 5–10 minutes
to complete. Respondents
receive one point for each correct answer for a maximum of 30
points. This measure can be used
to examine individuals’ levels of knowledge about Alzheimer’s
for a variety of purposes such as
targeting educational needs. Furthermore, administering the
assessment can help to make
individuals aware of what they do not know about Alzheimer’s
disease and be an educational
tool in itself.
The ADKS has been validated for use with groups such as
senior center staff, dementia
caregivers, dementia professionals, older adults, and college
students (Carpenter et al., 2009).
Group differences in knowledge of Alzheimer’s were generally
in the expected directions, with
dementia professionals having the greatest level of knowledge.
The scale’s authors suggest
further research to confirm the reliability and validity of the
scale with various populations.

13. The current study aimed to further validate the assessment for
use with college students.
Determine the Level of Knowledge and Identify Gaps
in Knowledge Among College Students
It has been recommended that collegiate programs educating
students, particularly those students
who may work with individuals who have dementia, incorporate
more dementia-related material
into the curriculum (Kwok et al., 2011). It has even been
suggested that such additions to the
curriculum could increase students’ interest in working with an
aging population (Sullivan &
GAPS IN ALZHEIMER’S KNOWLEDGE AMONG COLLEGE
STUDENTS 657
O’Conor, 2001). Yet, more specific recommendations need to be
made in order to create
programs that target gaps in knowledge among students.
Gerontological researchers have been called on to identify what
students do and do not know
about memory in aging because this is the first step in
developing educational programs (Jackson
et al., 2008). These educational programs are an integral part of

14. developing a work force to meet
the demands of our aging population. Furthermore, college
students are likely to be called on in
the future as informal caregivers for our aging population.
Those who do not choose a career
path working with individuals who have dementia are likely to
be part of a network of family,
friends, neighbors, and community members that are asked to
provide support for those living
with Alzheimer’s and related dementias. For this reason, it is
important to identify common
misconceptions that college students have about Alzheimer’s
and determine what gaps this
population has in its knowledge of the disease.
METHOD
Participants
After Institutional Review Board approval was obtained, college
students (N ¼ 200) in several
large lecture courses at a mid-sized midwestern university were
sent an e-mail by their instructor
asking them to complete an online survey through
SurveyMonkey.com. The online survey
took about 7–10 minutes to complete. Data for this study were
collected over two consecutive

15. semesters.
Over 60% (n ¼ 121) of participants were female. Participants
ranged in age from 18 to 59
years (M ¼ 22.71, SD ¼ 3.21). Eight percent (n ¼ 16) of
students were freshmen; 12% (n ¼ 24)
sophomores; 17% (n ¼ 34) juniors; and 11.5% (n ¼ 79) seniors.
In addition, 47 participants
identified themselves as graduate students. Students indicated
diverse majors, such as education
(n ¼ 42), business (n ¼ 23), psychology (n ¼ 22), and family
services (n ¼ 18). More than 81% of
students (n ¼ 163) identified themselves as European-American.
Nineteen (9.5%) were African-
American, and eight (4%) were Hispanic. Two participants
identified as multiracial, and two
participants identified as other.
Twenty-two respondents (11%) indicated that they currently
work, or have worked, in a nurs-
ing home. Thirty-two (16%) currently work, or have worked in a
health care setting. Seventy-six
students (38%) reported that one of their loved ones currently
had Alzheimer’s disease or
dementia or had experienced Alzheimer’s disease or dementia in
the past. Twenty-nine parti-
cipants (14.5%) had been a caregiver for a loved one with
Alzheimer’s disease.
Measures
Demographics

16. Participants were asked to indicate their gender, age, major, and
intended future career. They were
asked to indicate whether or not they had received any
information on Alzheimer’s disease in their
college courses. In addition, they were asked whether or not
they had worked in a nursing home or a
health care setting and whether or not they had ever had a loved
one with Alzheimer’s disease.
658 E. M. ESHBAUGH
Self-Reported Alzheimer’s Knowledge
Participants were asked to rate their knowledge of Alzheimer’s
disease by responding to the
following item: ‘‘I feel that I know a lot about Alzheimer’s
disease.’’ Response choices ranged
from 1: strongly disagree to 5: strongly agree.
Alzheimer’s Disease Knowledge Scale (Carpenter et al., 2009)
The Alzheimer’s Disease Knowledge Scale (ADKS) is a 30-item
true=false questionnaire
designed to assess knowledge of Alzheimer’s disease. Test-
retest reliability is .81 over intervals
of 2-to-50 hours. Internal consistency reliability for the scale is
.71, but the internal consistently

17. was only .55 in a preliminary study of college students
(Carpenter et al., 2009). Although the
scale identifies items with one of six content areas (course, risk
factors, symptoms, treatment
and management, assessment and diagnosis, and caregiving),
Carpenter et al. suggest the scale
is best-used as an overall knowledge scale rather than as
separate subscales.
RESULTS
The mean on the ADKS was 20.78 (SD ¼ 4.24, min. ¼ 12, max.
¼ 29). Fifty-seven percent
(n ¼ 114) of participants had more than 20 correct responses on
the scale. Cronbach’s alpha
was .70. No items on the scale had an item-difficulty index of
more than .95, meaning that
95% or less indicated the correct response on each item. Only
one item (‘‘It has been scientifi-
cally proven that mental exercise can prevent a person from
getting Alzheimer’s disease’’) had a
significant, negative item-total correlation (see Table 1).
Twenty-one of the 30 items had a
significant positive item-total correlation at the .05 level.
The mean for women on the ADKS was 20.49 (SD ¼ 4.45), and
the mean for men was 20.97
(SD ¼ 4.11). ADKS scores did not differ significantly by
gender, t (198) ¼ .77, p ¼ .44. Number
of years of college completed was positively corrected with the

18. ADKS, r ¼ .30, p < .001, indi-
cating that students who had completed a greater number of
years of college had a greater
knowledge of Alzheimer’s. Age was also significantly and
positively correlated with the ADKS,
r ¼ .17, p < .02.
Participants who indicated that they had a loved one who
currently has or has had
Alzheimer’s (M ¼ 21.30, SD ¼ 4.46) had slightly, but not
significantly, higher ADKS scores
than other participants (M ¼ 20.45, SD ¼ 4.09; t (198) ¼ 1.36,
p ¼ .17). The students who indi-
cated that they had been a caregiver for a loved one with
Alzheimer’s (M ¼ 22.03, SD ¼ 3.96)
did not show statistically significant greater levels of
knowledge than other students (M ¼ 20.56,
SD ¼ 4.26; t (198) ¼ 1.73, p ¼ .08). Over half (50.5%; n ¼
101) of the participants indicated that
they had received some information on Alzheimer’s throughout
their college coursework, and
these students had higher scores on the ADKS (M ¼ 21.63, SD
¼ 4.49) than did other students
(M ¼ 19.91, SD ¼ 3.81; t (198) ¼ 2.93, p < .01)
On a scale of 1 to 5, the mean for self-reported knowledge of
Alzheimer’s was 3.04
(SD ¼ 1.01). Responses ranged from 1 to 5, with 37% (n ¼ 74)
indicating that they agreed or
strongly agreed with the statement ‘‘I feel that I know a lot
about Alzheimer’s disease.’’ There

19. was a significant positive correlation between self-reported
knowledge of Alzheimer’s and the
GAPS IN ALZHEIMER’S KNOWLEDGE AMONG COLLEGE
STUDENTS 659
T
A
B
L
E
1
A
lz
h
e
im
e
r’
s
D
is
e
a
s
e
K
n
o
w
le
d

20. g
e
S
c
a
le
(N
¼
2
0
0
)
It
em
C
o
n
te
n
t
C
o
rr
ec
t
R
es
p
o
n
se

21. N
u
m
b
er
R
es
p
o
n
d
in
g
C
o
rr
ec
tl
y
(%
)
It
em
-T
o
ta
l
C
o
rr

22. el
a
ti
o
n
P
e
o
p
le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
a
re
p
a
rt

23. ic
u
la
rl
y
p
ro
n
e
to
d
e
p
re
ss
io
n
.
L
if
e
im
p
a
c
t
T
ru
e
1
4

24. 8
(7
4
.0
)
.6
3
�
It
h
a
s
b
e
e
n
sc
ie
n
ti
fi
c
a
ll
y
p
ro
v
e
n
th
a
t
m

25. e
n
ta
l
e
x
e
rc
is
e
c
a
n
p
re
v
e
n
t
a
p
e
rs
o
n
fr
o
m
g
e
tt
in
g
A

26. lz
h
e
im
e
r’
s
d
is
e
a
se
.
R
is
k
fa
c
to
rs
F
a
ls
e
8
6
(4
3
.0
)
�

27. .1
8
�
A
ft
e
r
sy
m
p
to
m
s
o
f
A
lz
h
e
im
e
r’
s
d
is
e
a
se
a
p
p
e
a

28. r,
th
e
a
v
e
ra
g
e
li
fe
e
x
p
e
c
ta
n
c
y
is
6
to
1
2
y
e
a
rs
.
C
o

29. u
rs
e
T
ru
e
1
1
9
(5
9
.5
)
.3
0
�
W
h
e
n
a
p
e
rs
o
n
w
it
h
A
lz
h

30. e
im
e
r’
s
d
is
e
a
se
b
e
c
o
m
e
s
a
g
it
a
te
d
,
a
m
e
d
ic
a
l
e
x

31. a
m
in
a
ti
o
n
m
ig
h
t
re
v
e
a
l
o
th
e
r
h
e
a
lt
h
p
ro
b
le
m
s
th
a
t
c
a

32. u
se
d
th
e
a
g
it
a
ti
o
n
.
A
ss
e
ss
m
e
n
t
a
n
d
d
ia
g
n
o
si
s
T
ru
e

33. 1
5
0
(7
5
.0
)
.4
9
�
P
e
o
p
le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se

34. d
o
b
e
st
w
it
h
si
m
p
le
,
in
st
ru
c
ti
o
n
s
g
iv
e
n
o
n
e
st
e
p
a
t
a
ti

35. m
e
.
C
a
re
g
iv
in
g
T
ru
e
1
6
9
(8
4
.5
)
.6
1
�
W
h
e
n
p
e
o
p

36. le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
b
e
g
in
to
h
a
v
e
d
if
fi
c
u
lt

37. y
ta
k
in
g
c
a
re
o
f
th
e
m
se
lv
e
s,
c
a
re
g
iv
e
rs
sh
o
u
ld
ta
k
e
o
v

38. e
r
ri
g
h
t
a
w
a
y
.
C
a
re
g
iv
in
g
F
a
ls
e
1
2
0
(6
0
.0
)
.1
0

39. If
a
p
e
rs
o
n
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
b
e
c
o
m
e
s
a
le
rt
a

40. n
d
a
g
it
a
te
d
a
t
n
ig
h
t,
a
g
o
o
d
st
ra
te
g
y
is
to
tr
y
to
m
a
k
e

41. su
re
th
a
t
th
e
p
e
rs
o
n
g
e
ts
p
le
n
ty
o
f
p
h
y
si
c
a
l
a
c
ti
v
it

42. y
d
u
ri
n
g
th
e
d
a
y
.
C
a
re
g
iv
in
g
T
ru
e
1
4
6
(7
3
.0
)
.4
1
�

43. In
ra
re
c
a
se
s,
p
e
o
p
le
h
a
v
e
re
c
o
v
e
re
d
fr
o
m
A
lz
h
e
im

44. e
r’
s
d
is
e
a
se
.
C
o
u
rs
e
F
a
ls
e
1
6
2
(8
1
.0
)
.0
3
P
e
o
p

45. le
w
h
o
se
A
lz
h
e
im
e
r’
s
d
is
e
a
se
is
n
o
t
y
e
t
se
v
e
re
c
a

46. n
b
e
n
e
fi
t
fr
o
m
p
sy
c
h
o
th
e
ra
p
y
fo
r
d
e
p
re
ss
io
n
a
n
d
a
n
x

47. ie
ty
.
T
re
a
tm
e
n
t
a
n
d
m
a
n
a
g
e
m
e
n
t
T
ru
e
1
2
3
(6
1
.5

48. )
.4
4
�
If
tr
o
u
b
le
w
it
h
m
e
m
o
ry
a
n
d
c
o
n
fu
se
d
th
in
k
in
g
a

49. p
p
e
a
rs
su
d
d
e
n
ly
,
it
is
li
k
e
ly
d
u
e
to
A
lz
h
e
im
e
r’
s
d
is
e

50. a
se
.
A
ss
e
ss
m
e
n
t
a
n
d
d
ia
g
n
o
si
s
F
a
ls
e
1
5
5
(7
7
.5
)

51. .1
5
�
M
o
st
p
e
o
p
le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
li
v
e
in

52. n
u
rs
in
g
h
o
m
e
s.
L
if
e
im
p
a
c
t
F
a
ls
e
1
2
0
(6
0
.0
)
.0
8

53. P
o
o
r
n
u
tr
it
io
n
c
a
n
m
a
k
e
th
e
sy
m
p
to
m
s
o
f
A
lz
h
e
im
e
r’

54. s
d
is
e
a
se
w
o
rs
e
.
T
re
a
tm
e
n
t
a
n
d
c
a
re
g
iv
in
g
T
ru
e

55. 1
4
0
(7
0
.0
)
.6
0
�
P
e
o
p
le
in
th
e
ir
3
0
’s
c
a
n
h
a
v
e
A
lz
h

56. e
im
e
r’
s
d
is
e
a
se
.
R
is
k
fa
c
to
rs
T
ru
e
1
3
4
(6
7
.0
)
.4
7
�

57. A
p
e
rs
o
n
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
b
e
c
o
m
e
s
in
c
re
a

58. si
n
g
ly
li
k
e
ly
to
fa
ll
d
o
w
n
a
s
th
e
d
is
e
a
se
g
e
ts
w
o
rs
e
.

59. C
o
u
rs
e
T
ru
e
1
2
5
(6
2
.5
)
.4
3
�
660
W
h
e
n
p
e
o
p
le

60. w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
re
p
e
a
t
th
e
sa
m
e
q
u
e
st
io
n
o

61. r
st
o
ry
se
v
e
ra
l
ti
m
e
s,
it
is
h
e
lp
fu
l
to
re
m
in
d
th
e
m
th
a
t
th
e

62. y
a
re
re
p
e
a
ti
n
g
th
e
m
se
lv
e
s.
C
a
re
g
iv
in
g
F
a
ls
e
1
7
3

63. (8
6
.5
)
.2
1
�
O
n
c
e
p
e
o
p
le
h
a
v
e
A
lz
h
e
im
e
r’
s
d
is
e
a

64. se
,
th
e
y
a
re
n
o
lo
n
g
e
r
c
a
p
a
b
le
o
f
m
a
k
in
g
in
fo
rm
e
d

65. d
e
c
is
io
n
s
a
b
o
u
t
th
e
ir
o
w
n
c
a
re
.
C
a
re
g
iv
in
g
F
a
ls
e

66. 1
5
0
(7
5
.0
)
.1
8
�
E
v
e
n
tu
a
ll
y
,
a
p
e
rs
o
n
w
it
h
A
lz
h
e
im

67. e
r’
s
d
is
e
a
se
w
il
l
n
e
e
d
2
4
-h
o
u
r
su
p
e
rv
is
io
n
.
C
o
u
rs

68. e
T
ru
e
1
1
4
(7
2
.0
)
.4
2
�
H
a
v
in
g
h
ig
h
c
h
o
le
st
e
ro
l
m
a

69. y
in
c
re
a
se
a
p
e
rs
o
n
’s
ri
sk
o
f
d
e
v
e
lo
p
in
g
A
lz
h
e
im
e

70. r’
s
d
is
e
a
se
.
R
is
k
fa
c
to
rs
T
ru
e
6
5
(3
2
.5
)
.4
4
�
T
re
m
o

71. r
o
r
sh
a
k
in
g
o
f
th
e
h
a
n
d
s
o
r
a
rm
s
is
a
c
o
m
m
o
n
sy
m
p
to
m

72. in
p
e
o
p
le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
.
S
y
m
p
to
m
s
F

73. a
ls
e
1
1
4
(5
7
.%
)
�
.0
4
S
y
m
p
to
m
s
o
f
se
v
e
re
d
e
p
re
ss
io

74. n
c
a
n
b
e
m
is
ta
k
e
n
fo
r
sy
m
p
to
m
s
o
f
A
lz
h
e
im
e
r’
s
d
is
e
a

75. se
.
A
ss
e
ss
m
e
n
t
a
n
d
d
ia
g
n
o
si
s
T
ru
e
1
0
3
(5
1
.5
)
.5
1

76. �
A
lz
h
e
im
e
r’
s
d
is
e
a
se
is
o
n
e
ty
p
e
o
f
d
e
m
e
n
ti
a
.
A

77. ss
e
ss
m
e
n
t
a
n
d
d
ia
g
n
o
si
s
T
ru
e
1
6
5
(8
2
.5
)
.4
8
�
T
ro

78. u
b
le
h
a
n
d
li
n
g
m
o
n
e
y
o
r
p
a
y
in
g
b
il
ls
is
a
c
o
m
m
o
n
e
a

79. rl
y
sy
m
p
to
m
o
f
A
lz
h
e
im
e
r’
s
d
is
e
a
se
.
S
y
m
p
to
m
s
T

80. ru
e
1
2
9
(6
4
.5
)
.6
2
�
O
n
e
sy
m
p
to
m
th
a
t
c
a
n
o
c
c
u
r
w

81. it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
is
b
e
li
e
v
in
g
th
a
t
o
th
e
r
p
e
o

82. p
le
a
re
st
e
a
li
n
g
o
n
e
’s
th
in
g
s.
S
y
m
p
to
m
s
T
ru
e
1
5

83. 4
(7
7
.0
)
.6
7
�
W
h
e
n
a
p
e
rs
o
n
h
a
s
A
lz
h
e
im
e
r’
s
d
is
e
a

84. se
,
u
si
n
g
re
m
in
d
e
r
n
o
te
s
is
a
c
ru
tc
h
th
a
t
c
a
n
c
o
n
tr
ib
u
te

85. to
d
e
c
li
n
e
.
T
re
a
tm
e
n
t
a
n
d
m
a
n
a
g
e
m
e
n
t
F
a
ls
e

86. 1
5
2
(7
6
.0
)
.0
3
P
re
sc
ri
p
ti
o
n
d
ru
g
s
th
a
t
p
re
v
e
n
t
A
lz
h

87. e
im
e
r’
s
d
is
e
a
se
a
re
a
v
a
il
a
b
le
.
R
is
k
fa
c
to
rs
F
a
ls
e

88. 1
6
5
(8
2
.5
)
.0
2
H
a
v
in
g
h
ig
h
b
lo
o
d
p
re
ss
u
re
m
a
y
in
c
re

89. a
se
a
p
e
rs
o
n
’s
ri
sk
o
f
d
e
v
e
lo
p
in
g
A
lz
h
e
im
e
r’
s
d
is

90. e
a
se
.
R
is
k
fa
c
to
rs
T
ru
e
7
1
(3
5
.5
)
.4
1
�
G
e
n
e
s
c
a
n

91. o
n
ly
p
a
rt
ia
ll
y
a
c
c
o
u
n
t
fo
r
th
e
d
e
v
e
lo
p
m
e
n
t
o
f
A
lz
h

92. e
im
e
r’
s
d
is
e
a
se
.
R
is
k
fa
c
to
rs
T
ru
e
1
5
3
(7
6
.%
)
.6
1

93. �
It
is
sa
fe
fo
r
p
e
o
p
le
w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
to
d
ri
v

94. e
,
a
s
lo
n
g
a
s
th
e
y
h
a
v
e
a
c
o
m
p
a
n
io
n
in
th
e
c
a
r
a
t
a

95. ll
ti
m
e
s.
L
if
e
im
p
a
c
t
F
a
ls
e
1
6
9
(8
4
.5
)
.0
5
A
lz
h
e

96. im
e
r’
s
d
is
e
a
se
c
a
n
n
o
t
b
e
c
u
re
d
.
T
re
a
tm
e
n
t
a
n
d

97. m
a
n
a
g
e
m
e
n
t
T
ru
e
1
6
7
(8
3
.5
)
.4
7
�
M
o
st
p
e
o
p
le

98. w
it
h
A
lz
h
e
im
e
r’
s
d
is
e
a
se
re
m
e
m
b
e
r
re
c
e
n
t
e
v
e
n
ts
b

99. e
tt
e
r
th
a
n
th
in
g
s
th
a
t
h
a
p
p
e
n
e
d
in
th
e
p
a
st
.
S
y
m
p

100. to
m
s
F
a
ls
e
1
8
5
(9
2
.5
)
.0
1
N
o
te
.
p
<
.0
5
is
d
e
n
o
te
d
b

101. y
� .
661
ADKS, r (198) ¼ .25, p < .001. In other words, students who
reported that they had a greater
level of knowledge about Alzheimer’s scored higher on the
ADKS.
What College Students Know About Alzheimer’s Disease (See
Table 1)
Greater than 90% of participants correctly identified that ‘‘Most
people with Alzheimer’s disease
remember recent events better than things that happened in the
past’’ is false, and greater than
85% responded correctly to ‘‘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.’’ In addition,
84.5% responded correctly to ‘‘It is safe for people with
Alzheimer’s disease to drive, as long as
they have a companion in the car at all times, and 83.5%
responded correctly to ‘‘Alzheimer’s
disease cannot be cured.’’ Furthermore, 82.5% knew that
‘‘Alzheimer’s disease is one type
of dementia,’’ and 82.5% indicated the correct answer to
‘‘Prescription drugs that prevent
Alzheimer’s disease are available.’’

102. What College Students Don’t Know About Alzheimer’s Disease
(See Table 1)
Only 32.5% responded correctly to ‘‘Having high cholesterol
may increase a person’s risk of devel-
oping Alzheimer’s disease.’’ In addition, 35.5% of participants
responded correctly to ‘‘Having
high blood pressure may increase a person’s risk of developing
Alzheimer’s disease,’’ and 43%
responded correctly to the item ‘‘It has been scientifically
proven that mental exercise can prevent
a person from getting Alzheimer’s disease.’’ It should be noted
that all three of these items focus on
‘‘risk factors’’ as classified by the authors of the ADKS
(Carpenter et al., 2009, pp. 240–241).
DISCUSSION
The mean on the ADKS for this college-student sample was
20.78. By way of comparison, a
college-student sample in the original study using the ADKS
had a mean of 20.19 (Carpenter,
et al., 2009). In the same study, older adults had a mean of
24.01, dementia professionals 27.40,
dementia caregivers 22.70, and senior center staff 20.15. The
internal consistency for college
students in previous research is only .55 (Carpenter et al.,
2009). However, it was more
acceptable (.70) in the present study of students.

103. A particular area of weakness for students in the present study
was risk factors. This is a trend
that was also evident in Carpenter et al.’s (2009) research.
Students were generally unaware that
factors such as high blood pressure and increased cholesterol
were linked to a greater risk of
Alzheimer’s disease. Educational programs and curriculum may
want to focus on increasing stu-
dent knowledge of risk factors, particularly because having
adequate knowledge of risk factors
might encourage healthy habits throughout the lifespan.
However, most students had an under-
standing that it is not effective to remind people with
Alzheimer’s disease that they are repeating
themselves, and most knew that Alzheimer’s impacts short-term
memory more severely than
long-term memory.
Students who indicated that they had coursework pertaining to
Alzheimer’s disease had a
greater level of knowledge. Of course, this might be because
those who were more receptive
to learning about the disease were likely to enroll in courses
with relevant content. Interestingly,

104. 662 E. M. ESHBAUGH
participants with a loved one who had experienced Alzheimer’s
did not have significantly great-
er knowledge. One explanation is that having a family member
diagnosed does not necessarily
cause a person to seek out resources or learn more about the
disease. This could also be because
the students in the study had an older relative diagnosed with
Alzheimer’s when the student was
too young to fully understand the effects of the disease. They
may have also been sheltered from
the impact of the disease as children. Unfortunately,
participants were not asked to give more
details about their family member with Alzheimer’s (e.g., how
old the student was when their
family member was diagnosed, if the family member was still
living, how far away the family
member lived). Although neglected in the present study, these
may be key factors to explore
when determining the impact of having a loved one with
Alzheimer’s on the level of knowledge
a college student has about the disease.

105. Recommendations for Educational Program Development
A primary purpose of this research is to identify areas of focus
for Alzheimer’s curricula at the
college level. This information could be conveyed in traditional
course formats or in educational
seminars or opportunities outside the classroom.
Interdisciplinary faculty from a variety of
areas (e.g., health, psychology, gerontology, social work, family
studies) could play a role in
educating the student population on Alzheimer’s and related
dementias.
First, any Alzheimer’s education should stress that there is no
cure and that the disease is
terminal. Over 80% of students correctly indicated that there
was no cure for Alzheimer’s. There
were many items that proved to be more difficult than this item
for the student sample, but it should
still be noted that 16.5% indicated that they think Alzheimer’s
disease can be cured. According to
the present study, 19% of students think that people have
recovered from Alzheimer’s disease. Of
course, thinking that Alzheimer’s disease is curable or
reversible could set an individual and
family up for false hope when a loved one is diagnosed.
Furthermore, a significant minority of
individuals who think that Alzheimer’s is curable could hamper

106. fundraising efforts to help those
affected and to end Alzheimer’s. As the Baby Boom generation
ages, individuals of all ages will be
notified that family members, friends, coworkers, and
acquaintances have been diagnosed with
Alzheimer’s. A person who hears this news but does not realize
this is a fatal disease with no cure
could respond quite inappropriately and risk being perceived as
insensitive and unsupportive.
Based on this research, another recommendation would be to
emphasize risk factors for
Alzheimer’s disease. In general, students were unaware that
high cholesterol and high blood
pressure may increase a person’s risk of developing the disease.
Although over 75% of
students indicated that they knew genes were only partially
responsible for the development
of Alzheimer’s, they did not correctly identify what other risk
factors were. It is important to
address this lack of knowledge because individuals should be
aware of what they can do to lower
their risk of having the disease. Obviously, we are hopeful that
a cure is on the horizon. Until
then, people should be educated about health behaviors that can
decrease their likelihood of

107. developing Alzheimer’s and other dementias.
Furthermore, it might be useful to emphasize to students that
severe depression can be mis-
taken for symptoms of Alzheimer’s (and vice versa). Only about
half of this sample responded
correctly to this item. It is of particular importance that
individuals understand the potential over-
lap between depression and dementia symptoms. There are
prescription medications available
GAPS IN ALZHEIMER’S KNOWLEDGE AMONG COLLEGE
STUDENTS 663
for those with dementia, and there are drugs prescribed to those
with depression. There are also
support groups and other resources available. For this reason, it
is key that individuals are
diagnosed accurately as early as possible after significant
changes occur so they can receive
appropriate medication and referrals. Family members and
friends should encourage individuals
to seek medical care when they experience major changes and
avoid making assumptions about
diagnosis.

108. Many participants indicated that the majority of individuals who
have Alzhiemer’s disease
live in nursing homes. In fact, this is not the case. Persons with
Alzheimer’s commonly live
in the community, and some even live alone. Assuming that
Alzheimer’s is a disease that is iso-
lated to nursing homes is problematic for many reasons. For
example, if family members believe
that most people with Alzheimer’s live in nursing homes, they
may assume in the future that
their loved ones, if diagnosed with the disease, must
immediately move to a nursing home. Most
individuals with Alzheimer’s prefer to stay in their home as
long as possible, and hastening the
process of moving to a nursing home may not improve their
quality of life. Furthermore, there
are many resources that can help people with dementia live in
their own homes after diagnosis.
Assuming that someone who has dementia must live in a nursing
home might prohibit family
members from seeking out these resources. In addition, it is
important for community members
to realize that they will come in contact with individuals who
have Alzheimer’s at places like the

109. grocery store, the coffee shop, or at a local fast food restaurant.
If someone shows symptoms of
dementia at the grocery checkout or while ordering at a
restaurant, it is key that their fellow com-
munity members show patience and understanding rather than
frustration.
CONCLUSIONS
Despite the prevalence of Alzheimer’s in today’s aging society,
it is disease that is misunder-
stood and stigmatized. Today’s college students subscribe to
many myths about the disease,
and these misconceptions may have negative consequences for
individuals, families, and society
because college students are future formal and informal
caregivers. Students pursuing careers in
areas such as human services, health care, social work,
gerontology, and health promotion
will undoubtedly be confronted with populations who are
directly or indirectly impacted by
Alzheimer’s and related dementias. Even those students who do
not plan careers in these areas
will not be able to avoid that challenges presented by
Alzheimer’s in our society. The prevalence

110. of this disease indicates it is highly unlikely a college student
would not be exposed to a family
member, friend, coworker, or neighbor diagnosed with
Alzheimer’s in the future. If today’s col-
lege students do not become caregivers for someone with
Alzheimer’s, they will be asked to
support caregivers. For this reason, it is imperative that we
focus on providing education on
the disease to young adults. The first step in providing
education is developing time-efficient
programs that target gaps in knowledge among this population.
This research provides an
empirical basis for development of these programs.
REFERENCES
Alzheimer’s Association. (2012). 2012 Alzheimer’s disease
facts and figures. Retrieved from http://www.alz.org/
downloads/facts_figures_2012.pdf
664 E. M. ESHBAUGH
Bailey, K. E. (2000). Student awareness of Alzheimer’s disease.
American Journal of Alzheimer’s Disease and Other
Dementias, 15, 375–378.
Bartels, S. J., & Smyer, M. A. (2002). Mental disorders of

111. aging: An emerging public health crisis? Generations, 26,
14–20.
Boise, L., Morgan, D. L., Kaye, J., & Camicolli, R. (1999).
Delays in the diagnosis of dementia: Perspective of family
caregivers. American Journal of Alzheimer’s Disease, 20–26.
Brookmeyer, R., Evans, D. A., Hebert, L., Langa, K. M., &
Herringa, S. G. (2011). National estimates of prevalence of
Alzheimer’s Disease in the United States. Alzheimer’s &
Dementia, 7, 62–73.
Carpenter, B. D., Balsis, S., Poorni, G., Otilingham, P. G.,
Hanson, P. K., & Gatz, M. (2009). The Alzheimer’s Disease
Knowledge Scale: Development and psychometric properties.
The Gerontologist, 49, 236–247.
Carpenter, B. D., Zoller, S. M., Balsis, S., Otilingham, P. G., &
Gatz, M. (2011). Demographic and contextual factors
related to knowledge about Alzheimer’s disease. American
Journal of Alzheimer’s Disease and Other Dementias, 26,
121–126.
Diekman, L., Zarit, S. H., Zarit, J. M., & Gatz, M. (1988). The
Alzheimer’s Disease Knowledge Test. The Gerontologist,
28, 402–407.
Graham, C., Ballard, C., & Sham, P. (1997). Carer’s knowledge
of dementia and their expressed concerns. International
Journal of Geriatric Psychiatry, 12, 470–473.

112. Ham, R. J. (1999). Evolving standards in patient and caregiver
support. Alzheimer’s Disease & Associated Disorders,
13, 470–473.
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A., &
Evans, D. A. (2003). Alzheimer disease in the U.S.
population: Prevalence estimates using the 2000 census.
Archives of Neurology, 60, 119–122.
Hughes, J., Bagley, H., Reilly, S., Burns, A., & Challis, D.
(2008). Care staff working with people with dementia:
Training, knowledge and confidence. Dementia, 7, 227–238.
Jackson, E. M., Cherry, K. E., Smitherman, E. A., & Hawley, K.
S. (2008). Knowledge of memory aging and
Alzheimer’s disease in college students and mental health
professionals. Aging & Mental Health, 12, 258–266.
Kwok, T. L., Yip, A., & Ho, F. (2011). Knowledge of dementia
among undergraduates in the health and social care
professions in Hong Kong. Social Work in Mental Health, 9,
287–301.
Manthrope, J., & Iliffe, S. (2009). Changing the culture of
social work support for people with early dementia. Australian
Social Work, 62, 232–244.
Moniz-Cook, E., & Woods, R. T. (1997). The role of memory
clinics and psychosocial intervention in the early stages of
dementia. International Journal of Geriatric Psychiatry, 12,
1143–1145.

113. Nordhus, I. H., Sivertsen, B., & Pallesen, S. (2012). Knowledge
about Alzheimer’s diease among Norwegian psychol-
ogists: The Alzheimer’s Disease Knowledge Scale. Aging &
Mental Health, 521–528.
Pulsford, D., Hope, K., & Thompson, R. (2007). Higher
education provision for professionals working with people with
dementia. Nurse Education Today, 27, 5–11.
Reimer, M. A., Slaughter, S., Donaldson, C., Currie, G., &
Eliaziw, M. (2004). Special care facility compared with
traditional environments for dementia care: A longitudinal study
of quality of life. Journal of the American Geriatrics
Society, 52, 1085–1092.
Roberts, J. S., & Connell, C. M. (2000). Illness representation
among first-degree relatives of people with Alzheimer’s
disease. Alzheimer’s Disease and Associated Disorders, 14,
129–136.
Sullivan, K. A., & Muscat, T. M. (2007). Knowledge of
Alzheimer’s disease amongst patients, carers, and non-carer
adults: Misconceptions, knowledge gaps, and correct beliefs.
Topics in Geriatric Rehabilitation, 23, 148–159.
Sullivan, K., & O’Conor, F. (2001). Providing education about
Alzheimer’s disease. Aging & Mental Health, 5, 5–13.
Thompson, R., Hope, K., & Pulsford, D. (2009). More trainings,
yes, but don’t forget education. Journal of Dementia
Care, 17, 27–30.

114. Werner, P. (2001). Correlates of family caregivers’ knowledge
about Alzheimer’s disease. International Journal of
Geriatric Psychiatry, 16, 32–38.
GAPS IN ALZHEIMER’S KNOWLEDGE AMONG COLLEGE
STUDENTS 665
Copyright of Educational Gerontology is the property of
Routledge and its content may not be
copied or emailed to multiple sites or posted to a listserv
without the copyright holder's
express written permission. However, users may print,
download, or email articles for
individual use.
Knowledge of Alzheimer’s Disease Among Norwegian
Undergraduate Health and Social Care Students:
A Survey Study
Sundaran Kada
Faculty of Health and Social Sciences, Bergen University
College, Bergen, Norway
With an aging general population and a concurrent increase in
the prevalence of dementia, health and
social care professional students are increasingly exposed to
this group of patients during their clini-

115. cal placements and after graduation. A sound dementia-related
knowledge base among health and
social care students is important in providing high-quality
dementia care. The present study assessed
dementia-related knowledge in health and social care students.
The Alzheimer’s Disease Knowledge
Scale (ADKS) was utilized to measure the level of dementia
knowledge. A total of 321 undergrad-
uate students from various disciplines in their final years of
study, but prior to graduation, partici-
pated in this study. The study identified a moderate dementia
knowledge base (mean score: 23.51
out of 30) among health and social care students. The results
revealed that the students were also
ignorant of many facts and had many misconceptions pertaining
to Alzheimer’s Disease (AD). In
addition, significant differences in knowledge were evident
between student groups. These results
suggest that the current dementia curriculum should be
evaluated in an attempt to improve the
dementia knowledge base of health and social care students.
Dementia is a condition affecting a large number of people of
advanced age. The most common

116. cause of dementia is Alzheimer’s disease (AD), which accounts
for 50–75% of all dementias
(Alzheimer’s Disease International, 2012). Approximately 36
million people suffered from
dementia worldwide in 2010, and this number is expected to
increase to 115 million by 2050
(World Alzheimer’s Report, 2009). In Norway, approximately
71,000 people of the total popu-
lation of 5 million currently suffer from some form of dementia,
and this number is expected to
surpass 205,000 by 2060 (Engedal & Haugen, 2009). As
dementia progresses, patients might
become unable to stay at home or family caregivers might
become unable to continue caring
for these patients at home, leading to the need for institutional
care. Dementia is the most com-
mon reason for admitting older individuals into nursing homes
in Norway (Engedal & Haugen,
2009), and behavioral symptoms are cited as a frequent reason
for admission (Nygaard, 1991).
Approximately 40% of Norwegian people with dementia live in
nursing homes (Engedal &
Haugen, 2009), and this percentage is expected to increase to
50% by 2030 (Selbæk, 2006).
Thus, a large proportion of these people will require the
expertise of health and social care

117. professionals.
Address correspondence to Sundaran Kada, Faculty of Health
and Social Sciences, Bergen University College, Post
Box 7030, 5020, Bergen, Norway. E-mail: [email protected]
Educational Gerontology, 41: 428–439, 2015
Copyright # Taylor & Francis Group, LLC
ISSN: 0360-1277 print / 1521-0472 online
DOI: 10.1080/03601277.2014.982009
mailto:[email protected]
http://dx.doi.org/10.1080/03601277.2014.982009
Early diagnosis is a key element of comprehensive and high-
quality dementia care (Iliffe
et al., 2002), benefitting both the patient and caregiver. Early
diagnosis allows for the
possibility of pharmacological interventions that can slow the
progression of the disease
and could even delay institutionalization (Rosler et al., 1999;
Rimmer, Wojciechowska, Stave,
Sganga, & O’Connell, 2005). In addition, it enables persons
with dementia and their caretakers
to plan the patients’ futures and to mobilize support (Kennedy
& Rossor, 1993) for making

118. decisions regarding financial and legal issues (Solomon &
Murphy, 2005) while self-advocacy
remains feasible (Woods, 2001). However, only one in four
people, or fewer, receives a formal
diagnosis of dementia globally (World Alzheimer’s report,
2009). Studies in Norway have
indicated that dementia is underdiagnosed in the primary care
setting in one-third of
persons admitted to long-term care in nursing homes (Nygaard
& Ruths, 2003) and in approxi-
mately 50% of persons with dementia who live at home
(Lystrup, Lillesveen, Nygård, &
Engedal, 2006).
Studies have also reported on a number of dementia-specific
concerns, including the need for
stimulating daytime activities and companionship during
daytime hours (Hancock, Wood,
Challis, & Orrell, 2006) and the issue of neglect (e.g., not
receiving necessary help with every-
day tasks) (Hawes, 2003). These studies reported that persons
with dementia spent only 50
minutes of a six-hour observation period (14% of the time)
communicating with staff members
or other residents and less than 12 minutes (3% of the time)
participating in constructive every-
day activities (Ballard et al., 2001). An investigation of

119. Norwegian nursing homes reported that
most patients did not participate in leisure activities, such as
going out for walks (Kirkevold &
Engedal, 2006), and persons with dementia received a lower
quality of care (Kirkevold &
Engedal, 2008). Although efforts have been undertaken to
improve the quality of dementia care,
these efforts can be negated by providers’ limited knowledge
(Chodosh et al., 2004). The knowl-
edge of dementia possessed by persons with the condition,
family caregivers, and health and
social care professionals has a positive impact on the quality of
dementia care. Persons with
good knowledge of dementia tend to seek medical help at earlier
stages. Family members raise
alerts earlier, and health professionals recognize the symptoms
and can facilitate early diagnosis
if they are cognizant of dementia (Perry et al., 2008; Millard,
Kennedy, & Baune, 2011; Low &
Anstey, 2009). In contrast, poor knowledge results in
inadequate utilization of treatment services
(Steckenrider, 1993) and delayed diagnosis, thereby resulting in
poor outcomes for persons with
dementia and their caregivers (e.g., misinterpretation of

120. behavior and increased stress)
(Steckenrider, 1993; Spector, Orrell, Schepers, & Shanathan,
2012). Dementia-related knowl-
edge is, therefore, important for health and social care
professionals who work with people with
dementia. However, studies have indicated that many
professionals have limited specialized
educations to prepare them for working with this group of
people (Adams, 2001; Aveyard,
2001). A recent study revealed poor AD knowledge among
undergraduate health and social care
students in Hong Kong (Kwok, Lam, & Ho, 2011). Measuring
levels of knowledge in health and
social care professional students could be an important step in
providing evidence for the need to
improve dementia care training in the curriculum. Dementia
care is interdisciplinary and requires
efforts from a team of health and social care professionals
(Goins, Gainor, Pollard, & Spencer,
2003). Identifying patterns in knowledge could be helpful for
educators in anticipating the need
for knowledge (Carpenter, Zoller, Balsis, Otilingam, & Gatz,
2011). It is, therefore, important to
understand health and social care professional students’ current

121. knowledge of dementia to
evaluate geriatric issues in the study curriculum. The current
study’s aim was to assess the
DEMENTIA 429
dementia-related knowledge base of undergraduate health and
social care professional students
in their final years of training prior to graduating.
The present study attempted to address the following research
questions:
. What is health and social care students’ level of knowledge
regarding dementia?
. Are there any differences between different professional
student groups?
METHODS
Design and Subjects
This was a descriptive study using a one-time survey with a
convenience sample. The current
study was performed in Bergen, the second largest city in
Norway with a population of approxi-
mately 300,000 people. Faculty of medicine and the university
college were asked to participate

122. in this study. Norwegian undergraduate medical education
consists of a six-year university
degree program, and health and social care (nursing,
physiotherapy, occupational therapy,
radiography, social work and social education) undergraduate
studies consist of a three-year
bachelor’s degree university college curriculum. The data were
collected by means of a self-
administered questionnaire that required approximately 5–10
minutes to complete.
Participants
A total of 321 undergraduate health and social care professional
students in the final terms of
their graduating years (scheduled to graduate in 2014)
participated in this study. This cohort
included medical (n¼27), nursing (n¼122), physiotherapy
(n¼47), occupational therapy
(n¼19), radiography (n¼23), social work (n¼32), and social
educator students (n¼51).
Measurements
Knowledge of dementia was assessed utilizing the Norwegian
version of a validated English
assessment tool, the Alzheimer’s Disease Knowledge Scale
(ADKS) (Carpenter, Balsis,

123. Otilingam, Hanson, & Gatz, 2009). This instrument is an
updated version of the original
Alzheimer’s Disease Knowledge Test (ADKT) (Dieckmann,
Zarit, Zarit, & Gatz, 1988). The
ADKS has adequate psychometric properties (reliability test-
retest correlation¼ .81, p < .001;
internal consistency reliability¼ .71 with split half reliability of
.55, p < .001; predictive validity
correlation¼ .50, p < 0.001; for undergraduates, r¼ .20). This
tool has been used in studies with
health care staff (Smyth et al., 2013) and psychologists
(Nordhus, Sivertsen, & Pallesen, 2012).
The ADKS consists of 30 true=false items that cover domains
including life impact (items 1, 11
and 28); risk factors (items 2, 13, 18, 25, 26 and 27); symptoms
(items 19, 22, 23 and 30); treat-
ment and management (items 9, 12, 24 and 29); assessment and
diagnosis (items 4, 10, 20 and
21); care giving (items 5, 6, 7, 15 and 16); and the course of the
disease (items 3, 8, 14 and 17).
In the analysis, a true answer was given one mark, and no mark
was provided for false answers.
Thus, the total score ranged from 0 to 30, with higher scores
signifying good knowledge about
430 S. KADA

124. Alzheimer’s disease. Furthermore, the participants were asked
to state their dementia knowledge
on an 11-point Likert scale from 0 (I know nothing at all) to 10
(I am very knowledgeable). The
Norwegian version of the ADKS was adapted by a standard
translation-back translation
procedure. The study also collected demographic information,
including sex, age and pro-
fessional qualifications, after completion of the program.
Procedures
The heads of the medical faculty and the faculty of health and
social sciences at the university
colleges were contacted to request their consent regarding their
institutions’ participation in this
study. After approval, the questionnaire was distributed. For the
health science and social
science students, the questionnaire was distributed on site to all
nursing, physiotherapy, occu-
pational therapy, radiography, social work, and social educator
undergraduate students attending
classes. Before distributing the questionnaire, the aim of the
project was explained to students. In
addition, students were informed that their participation was
voluntary, that they were guaran-

125. teed anonymity, and that no personal names or identifiers would
be collected. Participants were
informed that they could access the results by contacting the
investigator. For the medical
students, a link to an online questionnaire and an information
letter was sent to the medical
faculty; the letter requested that faculty distribute the
questionnaire and information letter to
medical students. The information letter outlined the aim of the
project, provided assurances
of the confidential treatment of the information gathered from
the questionnaire, emphasized
the voluntary nature of participation and informed the
participants that they could access the
results of the survey by contacting the investigator. Considering
the low priority given to ger-
iatric specialty training among Norwegian medical students
(Album, 1991; Album & Westin,
2008), a low participation rate of approximately 30% was
anticipated.
Ethical Considerations
The study followed the standard ethical guidelines for research
conducted on students in
Norway. The heads of the faculty of medicine and the faculty of

126. health and social care at the
university college granted permission for the study. The
participants were provided detailed
information about the purpose of the research and participation
so they could make informed
decisions regarding participation. The students were also
assured that the material that they
provided would remain confidential, and that only the
researcher would have access to their
answers. In addition, they were assured that any information
they provided would be of a generic
and confidential nature and would not identify them personally.
Approval from the Medical
Research Ethical Committee and the Norwegian Social Science
Data Services was not required
for this study.
Statistical Analysis
Summary statistics (frequencies and percentages) are presented
for sociodemographic character-
istics such as sex, education, and ADKS summary scores.
Independent t tests were used to
DEMENTIA 431

127. compare the ADKS score between sexes (male versus female
students) and between students’
self-rated dementia knowledge (less knowledge¼�5 versus
more knowledge¼6–10). Statisti-
cal comparisons were performed using one-way analysis of
variance (with Tukey’s post hoc test)
to assess the mean ADKS score and ADKS domain scores as the
dependent variable with the
students’ graduating education. A p value of �.05 was
considered to indicate statistical signifi-
cance. All of the statistical analyses were conducted using the
Statistical Package for the Social
Sciences (SPSS) software, version 21.0 for Windows (SPSS
Inc., Chicago, IL, USA).
RESULTS
Of a total of 296 questionnaires that were distributed among
nursing, physiotherapy, radiogra-
phy, occupational therapy, social work, and social educator
students attending classes, 294 stu-
dents completed and returned the questionnaire, yielding a
response rate of 99.3%. Among
medical students (n¼80), only 27 students completed and
returned the questionnaires, yielding
a response rate of 34%. Thus a total of 321 questionnaires
(294þ27) were analyzed. The mean
age of the students included in this study was 25.68 (standard
deviation (SD) 5.91) years old,

128. and 84% were female (Table 1). In assessing their own
knowledge of dementia on an 11-point
scale, 205 students reported having less knowledge, and 116
students reported having more
knowledge.
The summary score of dementia knowledge, as measured by the
ADKS, was 23.51 (SD 2.90;
range 15–29). Nursing, medicine and physiotherapy students
attained the highest mean total
ADKS scores (24.34, 24.22 and 24.21, respectively), followed
by occupational therapy and
social educator students. Radiography students reported the
lowest mean score (19.70). The total
mean ADKS score and ADKS domain mean scores are presented
in Table 2. Independent t �
tests demonstrated no significant difference in ADKS mean
scores between sexes (male students
mean score 23.20 versus female mean score 23.57, p¼ .401),
and students that rated themselves
as having more knowledge scored significantly higher than
those who rated themselves as
having less knowledge (mean score 24.26 versus 23.06, p <
.001).
TABLE 1
Baseline Characteristics of the Participating Students
Variable n(%) Mean age (SD)

129. Education
Nursing 122(38) 25.52(6.44)
Physiotherapy 47(15) 23.63(2.01)
Occupational therapy 19(6) 24.11(2.70)
Radiography 23(7) 25.57(5.96)
Medicine 27(8) 26.19(1.82)
Social educator 51(16) 29.10(9.05)
Social worker 32(10) 25.91(6.00)
Sex
Male 50 (16)
Female 271(84)
432 S. KADA
T
A
B
L
E
2

130. P
a
rt
ic
ip
a
n
ts
’
m
e
a
n
A
D
K
S
s
c
o
re
(S
D
)
a
n
d

131. A
D
K
S
c
o
n
te
n
t
d
o
m
a
in
s
s
c
o
re
s
(S
D
)
N
u

132. rs
in
g
(n
¼
1
2
2
)
O
cc
u
p
a
ti
o
n
a
l
T
h
er
a

133. p
y
(n
¼
1
9
)
P
h
ys
io
th
er
a
p
y
(n
¼
4
7
)
R
a
d
io

134. g
ra
p
h
y
(n
¼
2
3
)
M
ed
ic
in
e
(n
¼
2
7
)
S
o
ci

135. a
l
W
o
rk
er
(n
¼
3
2
)
S
o
ci
a
l
E
d
u
ca
to
r
(n

136. ¼
5
1
)
p
va
lu
es
T
o
ta
l
(N
¼
3
2
1
)
A
D
K
S
sc

137. o
r
e
2
4
.3
4
(2
.3
7
)
2
3
.5
8
(2
.8
7
)
2
4
.2
1
(2

138. .1
0
)
1
9
.7
0
(3
.1
2
)
2
4
.2
2
(3
.5
8
)
2
2
.0
3
(2

139. .8
6
)
2
3
.1
4
(2
.5
4
)
<
.0
0
1
2
3
.5
1
(2
.9
0
)
C

140. o
n
te
n
t
d
o
m
a
in
s:
L
if
e
im
p
a
c
t
2
.7
0
(0
.4
7

141. )
2
.7
4
(0
.4
5
)
2
.5
7
(0
.5
4
)
1
.9
6
(0
.9
2
)
2
.7

142. 0
(0
6
6
)
2
.6
9
(0
.4
7
)
2
.5
1
(0
.5
7
)
<
.0
0
1
2
.6

143. 0
(0
.5
9
)
R
is
k
fa
c
to
rs
4
.1
7
(1
.1
0
)
3
.8
4
(0
.8

144. 9
)
4
.2
8
(1
.1
7
)
3
.2
2
(1
.0
4
)
4
.1
9
(1
.2
1
)
3

145. .9
4
(1
.3
1
)
3
.7
6
(1
.2
2
)
.0
0
4
4
.0
1
(1
.1
7
)
S
y

146. m
p
to
m
s
3
.4
3
(0
.7
6
)
3
.6
3
(0
.5
9
)
3
.7
2
(0
.5

147. 8
)
3
.0
0
(0
.9
0
)
3
.4
4
(0
.6
4
)
2
.9
4
(0
.8
4
)
3

148. .3
5
(0
.7
7
)
.0
2
9
3
.3
9
(0
.7
7
)
T
re
a
tm
e
n
t
a
n

149. d
m
a
n
a
g
e
m
e
n
t
3
.7
6
(0
.4
4
)
3
.5
3
(0
.6
1

150. )
3
.6
8
(0
.5
1
)
3
.0
9
(0
.8
4
)
3
.6
3
(0
.5
6
)
3
.3

151. 1
(0
.7
8
)
3
.3
7
(0
.7
2
)
.0
0
1
3
.5
7
(0
.6
3
)
A
ss

152. e
ss
m
e
n
t
a
n
d
d
ia
g
n
o
si
s
3
.5
7
(0
.6
0
)
3
.1

153. 6
(0
.8
3
)
3
.2
8
(0
.8
0
)
2
.8
7
(0
.7
5
)
3
.7
4
(0
.5
2

154. )
3
.0
0
(1
.0
4
)
3
.1
8
(0
.8
8
)
<
.0
0
1
3
.3
5
(0
.7
9

155. )
C
a
re
g
iv
in
g
3
.9
8
(0
.9
8
)
3
.9
5
(0
.8
4
)
3
.9

156. 6
(0
.9
5
)
2
.9
1
(1
.1
6
)
3
.9
6
(1
.0
1
)
3
.8
8
(1
.0
0

157. )
3
.9
6
(0
.9
7
)
<
.0
0
1
3
.8
8
(1
.0
2
)
C
o
u
rs
e

158. o
f
th
e
d
is
e
a
se
2
.9
2
(0
.9
0
)
3
.0
0
(0
.8
8
)
2
.8

159. 5
(0
.8
3
)
2
.5
2
(0
.8
9
)
2
.7
0
(0
.9
9
)
2
.3
8
(1
.0
7

160. )
3
.0
0
(0
.9
3
)
<
.0
0
1
2
.8
3
(0
.9
4
)
433
Analysis of variance revealed a statistically significant
difference in mean ADKS score based

161. on the students’ graduating educations (p < .001). Post hoc
comparisons using Tukey’s honest
significant difference (HSD) test indicated that the mean ADKS
score of radiography
students (mean score 19.70, SD 3.12) was significantly lower
compared with nursing students
(mean score 24.34, SD 2.37, p < .001); medical students (mean
score 24.22, SD 3.58,
p < .001); physiotherapy students (mean score 24.21, SD 2.10, p
< .001); occupational therapy
students (mean score 23.58, SD 2.87, p¼ .001); social educator
students (mean score 23.14,
SD 2.54, p < .001); and social work students (mean score 22.03,
SD 2.86, p¼ .021). The
mean ADKS score for social work students (22.03, SD 2.86)
was significantly lower com-
pared with nursing students (mean score 24.34, SD 2.37, p¼
.001); physiotherapy students
(mean score 24.21, SD 2.10, p¼0.006); and medical students
(mean score 24.22, SD 3.58,
p¼ .025).
With regard to the ADKS domains, the mean score for social
work students in the symptoms
domain (mean score 2.94, SD 0.84) was significantly lower
compared with nursing students
(mean score 3.43, SD 0.76, p < .017); occupational therapy
students (mean score 3.63, SD
0.59, p¼ .022); and physiotherapy students (mean score 3.72,
SD 0.57, p < .001). Radiography
students’ mean score (mean score 3.00, SD 0.91) was
significantly lower compared with physio-
therapy students (mean score 3.72, SD 0.57, p¼ .003). For the
risk factors domain, the mean

162. score of radiography students (3.22, SD 1.04) was significantly
lower compared with nursing
students (4.17, SD 1.10, p¼ .006) and physiotherapy students
(4.28, SD 1.17, p¼ .006). For
the course of the disease domain, the mean score of social work
students (2.38, SD 1.07) was
significantly lower compared with social educator students
(mean score 3.00, SD 0.93,
p¼ .046). Radiography students’ mean score for the care giving
domain (mean score 2.91,
SD 1.16) was significantly lower compared with nursing
students (mean score 3.98, SD 0.98,
p < .001); medical students (mean score 3.96, SD 1.01, p¼<
.004); physiotherapy students
(mean score 3.96, SD 0.95, p¼ .001); occupational therapy
students (mean score 3.95, SD
0.84, p¼ .015); social work students (mean score 3.88, SD 1.01,
p < .008); and social educator
students (mean score 3.96, SD 0.97, p¼ .001). For the life
impact domain, the mean score of
radiography students (1.96, SD 0.47) was significantly lower
compared with nursing students
(mean score 2.70, SD 0.47, p < .001); medical students (mean
score 2.70, SD 0.66, p < .001);
physiotherapy students (mean score 3.962.57, SD 0.54, p <
.001); occupational therapy students
(mean score 2.74, SD 0.45, p < .001); social work students
(mean score 2.69, SD 0.47, p < .001);
and social educator students (mean score 2.51, SD 0.57, p¼
.002). The mean scores of medical
students (mean score 3.74, SD 0.52) and nursing students (mean
score 3.57, SD 0.60) for the
assessment and diagnosis domain were significantly higher
compared with radiography students
(2.87, SD 0.76, p¼ .001; p¼ .004, respectively); social work

163. students (3.00, SD 1.04, p¼ .001;
p¼0.003, respectively); and social educator students (mean
score 3.18, SD 0.88, p¼ .030;
p¼ .029, respectively). For the treatment and management
domain, the nursing students’ mean
score (3.76, SD 0.44) and medicine students’ mean score (3.63,
SD 0.56) were significantly
higher compared with radiography students (3.09, SD 0.84, p <
.001; p < .001, respectively);
social work students (3.31, SD 0.78, p¼ .003; 3.31, SD 0.78, p¼
.004, respectively); and social
educator students (3.37, SD 0.72, p¼ .002; 3.37, SD 0.72, p¼
.030, respectively). The mean
score of physiotherapy students on this domain (3.68, SD 0.51)
was significantly higher
compared with radiography students (3.09, SD 0.84, p¼ .002).
434 S. KADA
The mean scores for the risk factors (67% correct answers),
course of the disease (71%
correct answers) and caregiving (78% correct answers) domains
were lower than those on the
other domains (i.e., less than 80% correct answers).
DISCUSSION
The aim of this study was to identify dementia-related
knowledge among Norwegian undergrad-
uate health and social care students in the final term of their
graduating year. One of the key
findings of the present study was that students reported

164. moderate knowledge (mean score
23.51 out of 30.00 [78.4% correct]). The study findings were
similar to those of earlier studies
that were performed by Smyth et al. (2013) in health care staff
(mean score 23.6) and by
Nordhus et al. (2012) in Norwegian psychologists (mean score
24.1). The scores of the current
study were higher than those in the original study of nonhealth
profession students (mean score
20.19) conducted by Carpenter et al. (2009). The ADKS mean
score of Norwegian nursing stu-
dents (mean score 24.34, SD 2.37) was significantly higher than
that of the Maltese nursing stu-
dents (mean score 20.18, SD 3.48, p¼< .001) (Scerri & Scerri,
2013). Similarly, the Norwegian
health and social care undergraduate students reported higher
AD knowledge (78.4% correct
answers) than the Canadian professional health caregivers (58%
correct answers) and undergrad-
uate students (41.9% correct answers) (Rust & See, 2007).
Comparing the Norwegian students’
findings with those for Hong Kong health and social care
students, the analyses of the percent-
age of correct answers reveals the following: for nursing
students there is a difference of 32.5%
(Norwegian 81% vs. Hong Kong students 48.5% correct
answers); for occupational therapy stu-
dents the difference is 29.6% (Norwegian 78.6% vs. Hong Kong
students 49% correct answers);
and for social work students the difference is 48.3% (Norwegian

165. 74.3% vs. Hong Kong students
26% correct answers) (Kwok et al., 2011). However, it must be
noted that the Canadian
professional caregivers and undergraduate students and the
Hong Kong health and social care
undergraduate students AD knowledge test was assessed using
the modified version of ADKT
that contains only 18 and 20 multiple choice questions,
respectively. Potential reasons for
this finding could be the introduction of a national dementia
plan in Norway (Norwegian
Ministry of Health and Care Services, 2008) emphasizing the
need for increased dementia-
related knowledge and skills among healthcare professionals,
the importance of implementing
dementia topics in undergraduate health care students’ study
curricula, and the increased
exposure to people with dementia during their practical
placements. Dementia education has
a positive impact on the dementia knowledge of health
professionals (Jackson, Cherry,
Smitherman, & Hawley, 2008); there is a positive relationship
between dementia knowledge
and the quality of care provided, and education is critical in
improving care (Moyle, Borbasi,

166. Wallis, Olorenshaw, & Gracia, 2011). Personnel who care for
individuals with dementia should
have knowledge of symptoms and understand how to address
cognitive symptoms and how to
maximize individual independence (McGilton et al., 2007).
Another key finding was that there were significant differences
in mean total ADKS scores
and content domains scores among undergraduate students. A
potential reason for these knowl-
edge differences could be the variation in the number of
teaching hours and the coverage of
dementia topics. Studies have reported that the coverage of
dementia has varied in numbers
of hours, and that not all dementia-related topics were covered
(Pulsford, Hope, & Thompson,
DEMENTIA 435
2007). In addition, a positive association between the number of
teaching hours and AD knowl-
edge has been reported (Kwok et al., 2011). Medical students
answered 93.5% of questions
correctly in the assessment and diagnoses domain. The study
findings were positive and encour-
aging, and these results supported earlier studies that identified

167. the highest levels of knowledge
among medical students (Kwok et al., 2011) and reported that
younger general practitioners had
better knowledge of diagnostic, therapeutic, and management
approaches with regard to
dementia care (Downs, Cook, Rae, & Collins, 2000;
Kaduszkiewicz, Wiese, & van den Bussche,
2008). Physicians with good knowledge of dementia make
earlier diagnoses and more timely
referrals (Reimer, Slaughter, Donaldson, Currie, & Eliasziw,
2004). General practitioners play
an important role in dementia recognition and management
(Downs, 1996), and a diagnosis
of dementia should generally be made within the primary health
care system (Engedal, 2000).
Exposure to this discipline in an undergraduate medicine
program could increase interest in
geriatric medicine as a career and could positively influence the
management of older patients
(Ni Chróinı́n et al., 2013). For example, one third of senior
medical students reported that they
would consider geriatric medicine as their future specialty (Ni
Chróinı́n et al., 2013). Radiogra-
phy students reported the least knowledge among health and

168. social care profession undergrad-
uate students (58% correct answers). This finding was
surprising and was not expected because
imaging examinations, such as computed tomography (CT) or
magnetic resonance imaging
(MRI), are routinely performed in evaluations of AD patients.
The low knowledge among radi-
ography students suggests that current dementia education is not
adequate, or that students are
receiving inappropriate supervision during their clinical
placements. Radiographers reported
negative attitudes toward individuals with dementia (Kada,
2009).
The participants in this study obtained lower ADKS scores on
the risk factors (67% correct
answers), course of the diseases (71% correct answers), and
caregiving (78% correct answers)
domains. The current study findings supported an earlier study
that identified deficient knowl-
edge on the risk factors (65% correct answers) and course of the
disease (75% correct answers)
domains among Australian health care staff (Smyth et al.,
2013). Possible explanations for these
results could be that some of the questions on the risk factors
and course of the disease domains
were medically oriented. On the caregiving domain, although
the mean total score was less than

169. 80%, it was positive that nursing students who play a major role
in care of persons diagnosed
with dementia attained a score of 80%, thereby potentially
indicating that the participants lacked
specific knowledge about dementia. Studies have reported that
the curriculum of health care
professional students should include a sufficient geriatric
component covering all aspects of
dementia (Goins et al., 2003), and that dementia-specific
education could be an important
contributor to improving knowledge (Smyth et al., 2013).
Limitations
The limitations of this study were as follows. First, convenience
samples were used due to a lack
of time and resources. Because data regarding the students’
previous exposure to persons with
dementia (frequency of indirect exposure to dementia through
patients in roles of family mem-
bers and percentages of patients with dementia whom students
met in clinical experience) were
not collected, there is a possibility that students with and
without exposure to persons with
dementia might have biased the result. Furthermore, data
regarding the semester during which

170. 436 S. KADA
this education was provided were not available. If the students
completed their education
immediately before the questionnaires were distributed, it might
have affected the results of
the knowledge scores. Another limitation was that the data
collection occurred on site on the
day of data collection, and it was possible that not all of the
groups of students were represented
in the sample. The ADKS questionnaire focuses exclusively on
AD and, therefore, did not
evaluate the students’ knowledge of other dementias. Further
research is needed to explore
actual dementia care practices and knowledge of dementia.
Clinical Implications
It is essential that health and social care professionals working
in dementia care be educated and
supported in the development of their skills and knowledge in
this area given the increasing
number of people with dementia globally. The number of
teaching hours in geriatrics, therefore,
must be increased and must cover all aspects of dementia.

171. Conclusion
Performance on the ADKS indicated that health and social care
professional students in the final
term of the graduating year exhibited a moderate knowledge
base regarding AD, but they were
also ignorant of many facts and had many misconceptions
regarding AD.
Knowledge of AD is essential for providing appropriate care to
individuals with dementia,
and dementia education plays an important role in securing the
quality of care. Therefore, the
geriatric component in the present curriculum should be
evaluated to ensure that it covers all
aspects of dementia and to raise awareness of AD. Education
should focus on the biomedical
aspects of dementia (cause, treatment, and prognosis); the
course of the disease; and caregiving.
Participation in theoretical and practical training in dementia
should be compulsory in study
programs.
ACKNOWLEDGMENTS
The author is indebted to all of the participating institutions and
participants.

172. REFERENCES
Adams, T. (2001). Developing a multi-professional education
and training pathway in dementia care. Mental Health and
Learning Disabilities Care, 4, 370–371.
Album, D. (1991). The prestige of diseases and medical
specialties. Tidsskrift for den Norske Legeforening, 106,
232–236.
Album, D., & Westin, S. (2008). Do diseases have a prestige
hierarchy? A survey among physicians and medical
students. Social Science & Medicine, 66, 182–188. doi:
10.1016=j.socscimed.2007.07.003
Alzheimer’s Disease International. (2012). Alzheimer’s disease.
Retrieved from http://www.alz.co.uk/info/alzheimers-
disease
Aveyard, B. (2001). Education and person-centred approaches
to dementia care. Nursing Older People, 12, 17–19.
doi:10.7748=nop2001.02.12.10.17.c2151
DEMENTIA 437
http://dx.doi.org/ 10.1016/j.socscimed.2007.07.003
http://dx.doi.org/ 10.1016/j.socscimed.2007.07.003
http://www.alz.co.uk/info/alzheimers-disease
http://www.alz.co.uk/info/alzheimers-disease
http://dx.doi.org/10.7748/nop2001.02.12.10.17.c2151

173. http://dx.doi.org/10.7748/nop2001.02.12.10.17.c2151
Ballard, C., Fossey, J., Chithramohan, R., Howard, R., Burns,
A., Thompson, P., . . . Fairbairn, A. (2001). Quality of care
in private sector and NHS facilities for people with dementia:
Cross sectional survey. BMJ (Clinical Research Ed.),
323, 426–427. doi: 10.1136=bmj.323.7310.426
Carpenter, B. D., Balsis, S., Otilingam, P. G., Hanson, P. K., &
Gatz, M. (2009). The Alzheimer’s disease knowledge
scale: Development and psychometric properties. Gerontologist,
49, 236–247. doi: 10.1093=geront=gnp023
Carpenter, B. D., Zoller, S. M., Balsis, S., Otilingam, P. G., &
Gatz, M. (2011). Demographic and contextual factors
related to knowledge about Alzheimer’s disease. American
Journal of Alzheimer’s Disease and Other Dementias,
26, 121–126. doi: 10.1177=1533317510394157
Chodosh, J., Petitti, D. B., Elliott, M., Hays, R. D., Crooks, V.
C., Reuben, D. B., . . . Wenger, N. (2004). Physician
recognition of cognitive impairment: Evaluating the need for
improvement. Journal of the American Geriatrics
Society, 52, 1051–1059. doi: 10.1111=j.1532–
5415.2004.52301.x
Dieckmann, L., Zarit, S. H., Zarit, J. M., & Gatz, M. (1988).
The Alzheimer’s disease knowledge test. Gerontologist, 28,
402–407. doi: 10.1093=geront=28.3.402
Downs, M. G. (1996). The role of general practice and primary

174. care team in dementia diagnosis and management.
International Journal of Geriatric Psychiatry, 11, 937–942.
Downs, M., Cook, A., Rae, C., & Collins, K. E. (2000). Caring
for patients with dementia: The GP perspective. Aging &
Mental Health, 4, 301–304.
Engedal, K. (2000). Is it dementia? Assessment of dementia in
primary care and specialist health services. Oslo, Norway:
Norwegian Center for Dementia.
Engedal, K., & Haugen, P. K. (2009). Demens, fakta og
utfordringer. Aldring og helse [Dementia—facts and challenges,
aging and health] (5th ed.). Oslo, Norway: Forlaget Aldring og
helse.
Goins, R. T., Gainor, A. J., Pollard, C., & Spencer, S. M.
(2003). Geriatric knowledge and educational needs among rural
health professionals. Educational Gerontology, 29, 261–272.
doi: 10.1080=713844301.
Hancock, G. A., Woods, B., Challis, D., & Orrell, M. (2006).
The needs of older people with dementia in residential care.
International Journal of Geriatric Psychiatry, 21, 43–49. doi:
10.1002=gps.1421
Hawes, C. (2003). Elder abuse in residential long-term care
settings: What is known and what information is needed?.
In R. J. Bonnie & R. B. Wallace (Eds.), Elder mistreatment:
abuse, neglect and exploitation in an aging America
(pp. 446–500). Washington, DC: National Academics Press.

175. Iliffe, S., Wilcock, J. M., Austin, T., Walters, K., Rait, G.,
Turner, S., . . . Downs, M. (2002). Dementia diagnosis and
management in primary care: Developing and testing
educational models. Dementia, 1, 11–24.
Jackson, E. M., Cherry, K. E., Smitherman, E. A., & Hawley, K.
S. (2008). Knowledge of memory aging and Alzhei-
mer’s disease in college students and mental health
professionals. Aging & Mental Health, 12, 258–266.
doi:10.1080=13607860801951861
Kada, S. (2009). Radiographers’ attitudes towards persons with
dementia. European Journal of Radiography, 1,
163–168.
Kaduszkiewicz, H., Wiese, B., & van den Bussche, H. (2008).
Self-reported competence, attitude and approach of
physicians towards patients with dementia in ambulatory care:
Results of a postal survey. BMC Health Services
Research, 8, 54. doi: 10.1186=1472–6963-8–54
Kennedy, A., & Rossor, M. (1993). Management of dementia.
Practitioner, 237(1523), 103–104, 107.
Kirkevold, Ø., & Engedal, K. (2006). The quality of care in
Norwegian nursing homes. Scandinavian Journal of Caring
Sciences, 20, 177–183. doi: 10.1111=j.1471–6712.2006.00396.x
Kirkevold, Ø., & Engedal, K. (2008). Quality of care in
Norwegian nursing homes–deficiencies and their correlates.

176. Scandinavian Journal of Caring Sciences, 22, 560–567. doi:
10.1111=j.1471–6712.2007.00575.x
Kwok, T., Lam, K. C., & Ho, F. (2011). Knowledge of dementia
among undergraduates in the health and social
care professions in Hong Kong. Social Work in Mental Health,
9, 287–301. doi: 10.1080=15332985.2011.
572696
Low, L. F., & Anstey, K. J. (2009). Dementia literacy:
Recognition and beliefs on dementia care of the Australian
public.
Alzheimer’s & Dementia, 5, 43–49.
Lystrup, L. S., Lillesveen, B., Nygård, A. M., & Engedal, K.
(2006). Omsorgstilbud til hjemmeboende personer Med
demens [Public social health services to demented persons
living at home in Norway]. Tidsskrift for den Norske
Lægeforening, 126, 1917–1920.
McGilton, K. S., Lever, J. A., Mowat, J., Parnell, L.,
Perivolaris, A., & Biscardi, M. (2007). Guideline
recommendations
to improve dementia care. Alzheimer’s Care Quarterly, 8, 109–
115.
438 S. KADA
http://dx.doi.org/ 10.1136/bmj.323.7310.426
http://dx.doi.org/ 10.1136/bmj.323.7310.426
http://dx.doi.org/ 10.1093/geront/gnp023

177. http://dx.doi.org/ 10.1093/geront/gnp023
http://dx.doi.org/ 10.1093/geront/gnp023
http://dx.doi.org/ 10.1177/1533317510394157
http://dx.doi.org/ 10.1177/1533317510394157
http://dx.doi.org/ 10.1111/j.1532--5415.2004.52301.x
http://dx.doi.org/ 10.1111/j.1532--5415.2004.52301.x
http://dx.doi.org/ 10.1093/geront/28.3.402
http://dx.doi.org/ 10.1093/geront/28.3.402
http://dx.doi.org/ 10.1093/geront/28.3.402
http://dx.doi.org/ 10.1080/713844301.
http://dx.doi.org/ 10.1080/713844301.
http://dx.doi.org/ 10.1002/gps.1421
http://dx.doi.org/ 10.1002/gps.1421
http://dx.doi.org/10.1080/13607860801951861
http://dx.doi.org/10.1080/13607860801951861
http://dx.doi.org/ 10.1186/1472--6963-8&ndash;54
http://dx.doi.org/ 10.1186/1472--6963-8&ndash;54
http://dx.doi.org/ 10.1111/j.1471--6712.2006.00396.x
http://dx.doi.org/ 10.1111/j.1471--6712.2006.00396.x
http://dx.doi.org/ 10.1111/j.1471--6712.2007.00575.x
http://dx.doi.org/ 10.1111/j.1471--6712.2007.00575.x
http://dx.doi.org/ 10.1080/15332985.2011.572696
http://dx.doi.org/ 10.1080/15332985.2011.572696
http://dx.doi.org/ 10.1080/15332985.2011.572696
Millard, F. B., Kennedy, R. L., & Baune, B. T. (2011).
Dementia: Opportunities for risk reduction and early detection
in
general practice. Australian Journal of Primary Health, 17, 89–
94. doi: 10.1071=PY10037
Moyle, W., Borbasi, S., Wallis, M., Olorenshaw, R., & Gracia,
N. (2011). Acute care management of older people

178. with dementia: A qualitative perspective. Journal of Clinical
Nursing, 20, 420–428. doi: 10.1111=j.1365-2702.
2010.03521.x
Ni Chroinin, D., Cronin, E., Cullen, W., O’Shea, D., Steele, M.,
Bury, G., & Kyne, L. (2013). Would you be a geria-
trician? Student career preferences and attitudes to a career in
geriatric medicine. Age and Ageing, 42, 654–657.
doi:10.1093=ageing=aft093
Nordhus, I. H., Sivertsen, B., & Pallesen, S. (2012). Knowledge
about Alzheimer’s disease among Norwegian psychol-
ogists: The Alzheimer’s disease knowledge scale. Aging &
Mental Health, 16, 521–528. doi: 10.1080=
13607863.2011.628973
Norwegian Ministry of Health, & Care Services. (2008).
Dementia Plan 2015. Subplan for care plan 2015. Oslo, Norway:
Author.
Nygaard, H. A. (1991). Who cares for the caregiver? Factors
exerting influence on nursing home admissions of demented
elderly. Scandinavian Journal of Caring Sciences, 5, 157–162.
doi: 10.1111=j.1471–6712.1991.tb00101.x
Nygaard, H. A., & Ruths, S. (2003). Missing the diagnosis:
Senile dementia in patients admitted to nursing homes.
Scandinavian Journal of Primary Health Care, 21, 148–152. doi:

179. 10.1080=02813430310001798
Perry, M., Draskovic, I., van Achterberg, T., Borm, G. F., van
Eijken, M. L. J., Lucassen, P. L., . . . Olde Rikkert,
M. G. M. (2008). Can an EASYcare based dementia training
programme improve diagnostic assessment and
management of dementia by general practitioners and primary
care nurses? The design of a randomized controlled
trail. BMC Health Services Research, 8, 71.
Pulsford, D., Hope, K., & Thompson, R. (2007). Higher
education provision for professionals working with people with
dementia: A scoping exercise. Nurse Education Today, 27, 5–
13. doi: 10.1016=j.nedt.2006.02.003
Reimer, M. A., Slaughter, S., Donaldson, C., Currie, G., &
Eliasziw, M. (2004). Special care facility compared with
traditional environments for dementia care: A longitudinal study
of quality of life. Journal of the American Geriatrics
Society, 52, 1085–1092. doi: 10.1111=j.1532–
5415.2004.52304.x
Rimmer, E., Wojciechowska, M., Stave, C., Sganga, A., &
O’Connell, B. (2005). Implications of the facing dementia
survey for the general population, patients and caregivers across
Europe. International Journal of Clinical Practice.
Supplement, 59, 17–24.
Rosler, M., Anand, R., Cicin-Sain, A., Gauthier, S., Agid, Y.,

180. Dal-Bianco, P., . . . Gharabawi, M. (1999). Efficacy and
safety of rivastigmine in patients with Alzheimer’s disease:
international randomised controlled trail. British Journal
of Medicine, 318, 633–638.
Rust, T. B., & See, S. K. (2007). Knowledge about aging and
Alzheimer disease: A comparison of caregivers and
noncaregivers. Educational Gerontology, 33, 349–364. doi:
10.1080=03601270701199065
Scerri, A., & Scerri, C. (2013) Nursing students’ knowledge and
attitudes towards dementia—A questionnaire survey.
Nurse Education Today, 33, 962–968.
Selbæk, G. (2006). Demens-Behov for et kvalitetsløft
[Dementia—need of quality improvement]. Tidsskrift for den
Norske Laegeforening, 126, 1892.
Smyth, W., Fielding, E., Beattie, E., Gardner, A., Moyle, W.,
Franklin, S., . . . MacAndrew, M. (2013). A survey-based
study of knowledge of Alzheimer’s disease among health care
staff. BMC Geriatrics, 13, 2. doi: 10.1186=1471–
2318-13-2
Solomon, P. R., & Murphy, C. A. (2005). Should we screen for
Alzheimer’s disease? A review of the evidence for and
against screening Alzheimer’s disease in primary care practice.
Geriatrics, 60, 26–31.
Spector, A., Orrell, M., Schepers, A., & Shanathan, N. (2012).
A systematic review of knowledge of dementia outcome

181. measures. Aging Research Reviews, 11, 67–77.
Steckenrider, J. (1993). What people know about Alzheimer’s
disease: a study of public knowledge. American Journal of
Alzheimer’s Disease and Other Dementias, 8, 6–14.
Woods, R. T. (2001). Discovering the person with Alzheimer’s
disease: cognitive, emotional and behavioural aspects.
Aging & Mental Health, 5(Suppl 1), S7–16.
World Alzheimer’s Report. (2009). London, United Kingdom:
Alzheimer’s disease International.
DEMENTIA 439
http://dx.doi.org/ 10.1071/PY10037
http://dx.doi.org/ 10.1071/PY10037
http://dx.doi.org/ 10.1111/j.1365-2702.2010.03521.x
http://dx.doi.org/ 10.1111/j.1365-2702.2010.03521.x
http://dx.doi.org/ 10.1111/j.1365-2702.2010.03521.x
http://dx.doi.org/10.1093/ageing/aft093
http://dx.doi.org/10.1093/ageing/aft093
http://dx.doi.org/10.1093/ageing/aft093
http://dx.doi.org/ 10.1080/13607863.2011.628973
http://dx.doi.org/ 10.1080/13607863.2011.628973
http://dx.doi.org/ 10.1111/j.1471--6712.1991.tb00101.x
http://dx.doi.org/ 10.1111/j.1471--6712.1991.tb00101.x
http://dx.doi.org/ 10.1080/02813430310001798
http://dx.doi.org/ 10.1080/02813430310001798
http://dx.doi.org/ 10.1016/j.nedt.2006.02.003
http://dx.doi.org/ 10.1016/j.nedt.2006.02.003
http://dx.doi.org/ 10.1111/j.1532--5415.2004.52304.x
http://dx.doi.org/ 10.1111/j.1532--5415.2004.52304.x
http://dx.doi.org/ 10.1080/03601270701199065
http://dx.doi.org/ 10.1080/03601270701199065

182. http://dx.doi.org/ 10.1186/1471--2318-13-2
http://dx.doi.org/ 10.1186/1471--2318-13-2
http://dx.doi.org/ 10.1186/1471--2318-13-2
Copyright of Educational Gerontology is the property of
Routledge and its content may not be
copied or emailed to multiple sites or posted to a listserv
without the copyright holder's
express written permission. However, users may print,
download, or email articles for
individual use.
METHODSDesign and
SubjectsParticipantsMeasurementsProceduresEthical
ConsiderationsStatistical
AnalysisRESULTSDISCUSSIONLimitationsClinical
ImplicationsConclusionACKNOWLEDGMENTSREFERENCES