Monday 19 December 2022

A Narrative Review of Alzheimer's Disease

Misconceptions associated with Alzheimer's Disease (AD) are widespread and do have a profound impact on both people with AD and their caregivers. The stigma around AD causes negative effects  leading to isolation, decreased quality of life, low self-esteem, and poor mental health. It also makes people avoid help-seeking behaviours which again results in delayed diagnosis and little utilisation of health and social services (Rosin et al., 2020).

AD is identified as so-called non-normal ageing, the patient becomes a "non-person", their being destroyed, their body left to be managed in a life without quality, a "living dead" without independence and dignity. The social construction of turning AD patients into zombies dehumanises them and leads to significant stigma and associations as incompetent, burdensome to the family and the system, inable to contribute to society. Compared with other illnesses, such as cancer, Alzheimer's Disease elicits lower intent to help and make donations.

Negative portrayal in the media and the medical field lead to fears and stigma in public perceptions. Advertisments show them in the final stages of the disease, looking lost and infantilised, which furthers stigma and marginalisation. While people with AD desire to partake in "the societal norm of productivity", media portrayals show the opposite. Aspects of dementia patients' interest - such as finding meaning in the disease and learning from it - are not discussed in popular culture.

Furthermore, AD and mental illness are often confused, causes and symptomatology misattributed, which, again, can generate stigma. According to research findings, there is greater stigma around mental illness when it is attributed to one's own behaviour and is hence seen within their control to prevent. A survey carried out in the US demonstrated that 35% of the respondents believed AD was a mental illness. Those who did believe AD was a mental illness also rated symtpoms more severely, i.e., were more stigmatising.

While symptoms of dementia are surely not "normal" effects of ageing, particularly in the early phases of AD distinctions are not always clear. In addition, the general public seems to believe that AD (and dementia in general) is a "normal" part of ageing not knowing how to differentiate between so-called normal symptoms being part of ageing and symptoms of dementia. This misunderstanding may prevent diagnosis but also increase stigma since ...

believing that dementia is a normal age-related process may further a belief that the symptoms of AD are character faults and are not caused by neurodegenerative reasons, increasing perceived causal responsibility

Caregivers experiencing stigma may start avoiding social relationships, hence isolation and depression. They may lose jobs, lose social relationships including those to family members. Extended family members might interact less frequently with caregivers which again puts more pressure on the latter and prevent them from searching for services that can reduce their burden. According to Alzheimer's Association, in 2019 alone, 49% of primary caregivers suffered from depression. In fact ...

A study demonstrated that adult children’s perceptions of being stigmatized by the association with their parents with AD increased their negative caregiving experiences beyond the effects of the behavioral problems associated with AD [70]. (Rosin et al., 2020)

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- Rosin, E. R., Blasco, D., Pilozzi, A. R., Yang, L. H. & Huang, X. (2020). A Narrative Review of Alhzeimer's Disease Stigma. Journal of Alzheimer's Disease, 78(2), 515-528. 
- image of the great Monica Vitti via

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