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DementiaWorryandthePerceptionofPersonalRiskALongitudinalStudy.pdf
GeroPsych Dementia Worry and the Perception of Personal Risk: A Longitudinal Study Kristina Martin, Frieder R. Lang, Roland Rupprecht, and Jessica Nömer Online First Publication, September 8, 2020. http://dx.doi.org/10.1024/1662-9647/a000247
CITATION Martin, K., Lang, F. R., Rupprecht, R., & Nömer, J. (2020, September 8). Dementia Worry and the Perception of Personal Risk: A Longitudinal Study. GeroPsych. Advance online publication. http://dx.doi.org/10.1024/1662-9647/a000247
Full-Length Research Report
Dementia Worry and the Perception of Personal Risk A Longitudinal Study
Kristina Martin, Frieder R. Lang , Roland Rupprecht, and Jessica Nömer
Institute of Psychogerontology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
Abstract: The research examined dementia worry and the perception of personal dementia risk based on a 2-year longitudinal online study (N = 129, 21–79 yrs). Participants completed questionnaires on attitudes, experiences, and worries concerning dementia. A fully saturated cross-lagged model was estimated. Results show that dementia worry was moderately stable, and that changes were unrelated to perceived risk or family history. In contrast, perceived dementia risk was more prone to change and was positively associated with prior dementia worry but not vice versa. Having a family history of dementia was cross-sectionally, but not longitudinally, associated with greater worry and higher perceived risk. Because of the limited variability of dementia worry, focusing on perception of personal risk is a promising approach. Future research may benefit from differentiating the plasticity of the two constructs.
Keywords: dementia worry, risk perception, family history of dementia, stability
Dementia worry is a widespread phenomenon in Western societies and is often defined as an affective and emotional construct. In contrast, the perceived personal dementia risk is a mere cognitive construct. Both are associated with familiarity and genetic predisposition to dementia. Never- theless, because of the primarily cross-sectional studies done to date, not much is known about the predictability and stability of these constructs over time.
The main symptoms of dementia involve cognitive decline and the loss of everyday competence, both of which could be highly anxiety-provoking, particularly because, up to now, there is no cure, though pharmacological treatment may slow down the progressive degenerative process (Daviglus et al., 2010). Research on dementia worry is still a relatively young field in aging psychology and gerontol- ogy. Cutler and Hodgson introduced the term “anticipatory dementia”intheirobservationthatconcernaboutdeclining memory could be the first sign of dementia (Cutler & Hodgson, 1996). In a comprehensive review, Kessler et al. (2012, p. 277) defined dementia worry more precisely as “an emotional response to the perceived threat of develop- ing dementia, independent of chronological age and cogni- tive status.” A well-known definition of worry from Borkovec et al. (1983, p. 10) states:
Worry is a chain of thought and images, negatively affect-laden and relatively uncontrollable. The worry process represents an attempt to engage in mental
problem-solving on an issue whose outcome is uncer- tain but contains the possibility of one or more nega- tive outcomes.
By focusing on the concept of fear of dementia including anxious patternsof behaviourandthoughtssuchas physical reactions, both definitions highlight theaffective-emotional notion ofworry.Inthis study,on theotherhand, werely on a cognitive-emotional concept of dementia worry, which we define as a negative evaluation of the anticipated threaten- ing condition of the future self-developing dementia.
Kessler et al. (2012) named three possible components of dementia worry: perception of personal dementia risk, neg- ative consequences, and perceived coping resources. In this study, we concentrate on perception of personal risk, which may be seen as distinct but interdependent with dementia worry (Bowen et al., 2019; Maxfield & Greenberg, 2020). In this vein, Hiraki et al. (2009, p. 131) specified personal dementia risk perception to be “the risk perceived before any education, counselling, or testing.” In line with this, we define perceived personal dementia risk as the subjec- tive probability of developing dementia oneself. Such risk perceptions were shown to serve as a predictor for preven- tion behaviors, while they were not associated with objec- tive dementia risks such as age (Chung et al., 2009). Nevertheless, perceived personal dementia risk was found to depend on having a family history of dementia (Hiraki et al., 2009; Maxfield & Greenberg, 2020).
� 2020 Hogrefe GeroPsych (2020) https://doi.org/10.1024/1662-9647/a000247
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Moreover, the objective risk factor of having a family his- tory of dementia was often examined in association with dementia worry, for example, suggesting that personal experience with dementia in first-degree relatives is associ- ated with increased dementia worry (Cutler, 2015; Cutler & Brăgaru, 2015; Cutler & Hodgson, 1996, 2001; Kessler, Südhof et al., 2014; Kinzer & Suhr, 2016; Maxfield & Greenberg, 2020; Roberts et al., 2014; Suhr & Kinkela, 2007).
Whilewearguethattheconstructsofdementiaworryand perceived personal dementia risk reflect distinct and sepa- rate constructs, we also recognize that they may be interwo- ven and interdependent. Well-established findings suggest that perceived personal risk of developing a disease is con- nected with more worries regarding this specific disease (DiLorenzo et al., 2006). This agrees with recent findings showing that personal dementia risk perception was associ- ated with stronger dementia worry (Bowen et al., 2019; Maxfield & Greenberg, 2020).
Although prior studies examined correlates and conse- quences of these two concepts of self-perception toward dementia, not much is known about the course of dementia worry and perception of personal risk over time. To the best of our knowledge, no prior research has assessed both dementia worry and perception of personal risk on more than one occasion with the same individuals. Findings sug- gest that dementia worry may have a certain stability through the possible linkage with relatively stable emo- tional personality characteristics such as generalized anxi- ety (French et al., 2012; Kessler, Südhof et al., 2014). In contrast, perception of personal risk may be more strongly influenced by available information and may therefore be more prone to change. The present study examines the stabilityandchangeoftheself-perceptions towardsdemen- tia. A higher variability and openness to change would indicate possibilities for future interventions, aiming to have a positive influence on views on dementia.
Based on previous studies, we expected the two self- related concepts of dementia worry and perceived personal dementia risk to be moderately correlated (e.g., Bowen et al., 2019). Furthermore, we expected positive cross- sectional associations between having a family history of dementia and stronger dementia worry (e.g., Cutler & Brăgaru, 2015; Kinzer & Suhr, 2016) as well as with higher perception of personal risk (e.g., Hiraki et al., 2009; Maxfield & Greenberg, 2020). Because there are no known studies assessing dementia worry and risk perception at
two timepoints, our examination of the cross-lagged paths remains exploratory.
Finally, while it is well-established that higher age and female sex are risk factors for dementia (World Health Organization, 2019), the findings regarding the associations of age and sex with dementia worry and perception of personal risk are inconsistent: Some studies found older people to be more worried (e.g., Cantegreil- Kallen & Pin, 2012) whereas others found no correlation (e.g., Kinzer & Suhr, 2016; Maxfield & Greenberg, 2020) or a quadratic relationship (Bowen et al., 2019). Some stud- ies observed that women express more dementia worry than men (e.g., Bowen et al., 2019; Cutler, 2015), in contrast to findings of no gender differences (e.g., Cutler & Brăgaru, 2015; Kinzer & Suhr, 2016). Thus, we have no specific hypotheses regarding the size and the direction of associa- tions with age or sex.
The present study explores the change sensitivity of the two constructs of worry and risk perception, and how the two constructs are differentially associated with objective risk factors such as family history of dementia. It aims to investigate associations between dementia worry, per- ceivedpersonaldementiarisk,andfamilyhistoryofdemen- tia across a study interval of 2 years.
Method
Participants
Participants of the longitudinal sample (N = 129) completed anonlinequestionnaireconcerningtheirviewsondementia on two occasions over 2 years. At the second occasion, the average age of the participants was 39.0 years (SD = 15.6), with a range of 21 to 79 years. Most of the sample (79.1%) was female, in a relationship (69.7%), with a high level of education (59.7% at least first stage of tertiary education) and income (62.9% at least 2000 €/month). See Table 1, for demographics of the second measurement occasion.
Measures
Dementia Worry In this research, we included a 5-item scale1 with satisfac- tory internal consistency (t1: Cronbach’s α = .83; t2: Cronbach’sα=.84).Thescaleintegratesseveraloften-used
1 An exploratory factor analysis with all five items revealed a one-factor solution to show good fit (explained variance at t1: 61.5%, and at t2: 61.6%) with satisfactory factor loadings of all used items (t1: > .63; t2: > .55). The single-item used in other studies was highly correlated with the other four items in the scale (t1: r = .79; t2: r = .76), suggesting good construct validity. For validation purposes, we included measurements of personality on one occasion. Further validation analyses (based on the cross-sectional sample of t2, N = 326) confirmed convergent validity of the 5-item scale of dementia worry to be significantly associated with neuroticism (r = .26, p < .001). Moreover, the dementia worry scale was also found to be clearly unrelated to dementia knowledge (r = -.07, p = .41), suggesting discriminative validity.
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2 K. Martin et al., Dementia Worry and Risk Perception
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and often-published single-item scales from previous studies with one new item added, i.e., (1) “How concerned are you about developing dementia one day?” (Werner, 2002), (2) “I am worried about my memory.” (Werner, 2002), (3) “Are you afraid of dementia related to yourself?” (DAK-Gesundheit, 2018), (4) “The thought of being affected by dementia is threatening.” (Kofahl et al., 2013), and one new item (5) “How much does the thought of developing dementia occupy your thoughts currently?” Items were rated on a 5-point scale (item 1, 3 and 5: 0 = not at all and 4 = very much; item 2 and 4: 0 = not applicable and 4 = applicable). We then calculated a sum score, so that possible measure- ment scores ranged from 0 to 20, with a higher score indicating greater dementia worry. There were no missing values since all items were mandatory.
Perception of Personal Risk We used a single item from the validated scale of Werner (2003) to assess the subjective probability of developing dementia in the future (“In your opinion, how likely is it that you will develop dementia one day?”). Possible responses ran- ged from 0 = not at all to 4 = very much.
Family History of Dementia A family history of dementia assessed whether the partici- pants had had personal experience with dementia through persons in their social environments. When the answer was yes, participants reported under what contexts such experiences had occurred (e.g., professional contexts, family, acquaintances). Multiple answers were possible. Participants who reported having a relative with dementia were coded as having a family history of dementia.
Sociodemographic Variables Sociodemographic information about age (in years), sex, relationship status, and level of education was mea- sured at the end of the survey to control for possible influences on both occasions. Participants were also asked to report the monthly net household income at the second occasion.
Procedure
Data were collected in the framework of a continuous study assessing knowledge,2 attitudes, personal experience, worry and health behavior with respect to dementia by means of an online survey, which took about 30 minutes on average to complete. Participants were recruited via social media platforms and in the social environment of the researchers. The first measurement (t1) was conducted between March and May of 2017 and resulted in a conve- nience sample of N = 601, whereof 129 people participated againon thesecond occasion (t2)from April toMay of2019, withan averagetime interval ofM=23.9months betweent1 and t2 (SD = 0.43, range 22–25). Since they had given their permission to be contacted again, they could be connected to the data of 2017 through an individual access code. In the present study, only the data of the longitudinal sample were examined.
An analysis of the sample selectivity did not reveal any significantdifferenceswithregardtothesociodemographic variables, dementia worry, or perception of personal risk. However, participants of the longitudinal sample differed from cross-sectional participants significantly with respect to family history (T = �2.49, df = 199.67, p < .05), indicating that people with a family history of dementia were more likely to participate also at the second occasion.
Data Analysis
All data analyses were conducted using IBM SPSS 26.0 software. We used Pearson correlations to examine
2 Dementia knowledge was used only for validation purposes in this study and was assessed with 30 statements about symptoms, course, and risk factors of dementia (Cronbach’s α = .65). Participants had to respond whether the statement is true or false, or whether they were unsure. The correct true or false answers were counted, unsure answers were coded as incorrect (M = 16.5, SD = 4.1).
Table 1. Participants characteristics at t2 (N = 129)
Measure M (SD) Frequency (%)
Age 39.0 (15.6)
Sex
Male 20.9
Female 79.1
Relationship status
No relationship 30.2
Steady relationship 30.2
Married 39.5
Level of education
Lower secondary education 8.5
Upper secondary education 31.8
First stage of tertiary education 58.9
Second stage of tertiary education 0.8
Household net income
< 1000 € 12.4
1000–1999 € 19.4
2000–2999 € 26.4
3000–3999 € 16.3
4000–4999 € 12.4
5000–5999 € 3.9
> 6000 € 3.9
No answer 5.4
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K. Martin et al., Dementia Worry and Risk Perception
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the bivariate interrelationship between variables and the SPSS Macro AMOS graphics for cross-lagged modeling.
Results
Table2showsthemeans,standarddeviations,andfrequen- cies of measurement scores on the two occasions. The sam- ple (N = 129) showed moderate manifestation of dementia worry at both measurement occasions (t1: M = 10.5, SD = 5.0, range 0–20; t2: M = 10.0, SD = 4.7, range 0–20), and 41.8% and 38.8%, respectively, of the participants reported being at least somewhat worried about developing dementia in their lifetime. The participants’ personal dementia risk perception was moderate on both occasions (t1: M = 2.1, SD = 0.9, range 0–4; t2: M = 2.2, SD = 0.9, range 0–4). Approximately half the sample (49.6% and 50.4%, respec- tively) estimated their personal risk as moderate, and only 7.0% and 9.3%, respectively, reported being very likely at risk. At the first measurement, half the sample reported having a family history of dementia (51.9%); 2 years later, the number had increased up to nearly two thirds of the sample (60.2%).
As shown in Table 3, dementia worry at the second mea- surement was positively correlated with personal dementia risk perception and family history at both measurement points (rs > .30; ps < .001), but showed no significant corre- lation with any of the control variables of the first occasion. The monthly household net income was only measured at the second time but showed no correlation to any of the outcome variables. At both measurement points, personal dementia risk perception was correlated with family history, but no significant correlation with sociodemo- graphic variables was found. In summary, the cross- sectional hypotheses were partly confirmed: The expected relationship between dementia worry and perception of personal risk was found. Likewise, as predicted, both self- perceptions of dementia were associated with family history. No significant correlation was found regarding age and sex.3
To examine existing connections between family history, personal dementia risk perception, and dementia worry over the course of 2 years, we fitted a fully saturated cross-lagged path regression model (Figure 1). The control variables did not reveal significant associations with any oftheconcerning variablesandwerethereforenotincluded in the final model. Family history and dementia worry showed an autoregression coefficient indicating a moder- ate to strong stability over the 2 years (rs > .60). Personal dementia risk perception was found to be less stable over time(r=.38).Havingafamilyhistoryofdementiaatthefirst occasion was not significantly correlated with an increased perceived personal dementia risk 2 years later (r = .13, p = .09). As expected, there was no association between the perceived personal dementia risk at the first occasion and the reported family history at the second occasion (r = .02, p = .76). There were no self-contained effects of the two variables family history and dementia worry over the two measurements when including all paths in the model (rs < .13, ps > .08). The cross-lagged path from dementia worry on perception of personal risk reached significance: Reporting more dementia worry at the first occasion was connected to having a higher perceived personal dementia risk 2 years later (r = .30, p < .001). The reverse path was not statistically significant (r = �.05; p = .47).
Discussion
Previous research on dementia worry found that a family history of dementia and personal dementia risk perception are associated with a higher level of dementia worry. The findings of the present cross-lagged path analysis did not reveal comparable effects of family history of dementia or any other predictor on changes of dementia worry over 2 years. The current research suggests that the perceived personal dementia risk may increase over time when expressing stronger worry about getting the disease at an earlier timepoint. We are unaware of any prior longitudinal research on the associations of dementia worry and risk
Table 2. Measurement scores at both measurement occasions (N = 129)
t1 t2
Measure M (SD) Frequency (%) M (SD) Frequency (%)
Dementia worry 10.5 (5.0) 10.0 (4.7)
Perception of personal risk 2.1 (0.9) 2.2 (0.9)
Family history of dementia 51.9 (N = 67) 62.0 (N = 80)
3 Following the findings of Bowen et al. (2019), who observed a quadratic relationship of dementia worry and age, we also tested this association, but no quadratic relationship was found in our study (r2 = .02, p = .23).
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perception over time. For example, Cutler and Brăgaru (2015, 2017) examined a large, representative sample aged 50+ years up to 20 years in order to examine predictors of dementia worry, which, however, was assessed once as a single item only at the last measurement occasion. In our research, we observed that the autoregression of dementia worry was moderate to high. Therefore, any interpretation of predictors should take the stability of dementia worry intoaccount.Thisimpliesthateffectsofpredictorsassessed at earlier occasions may not be transferred directly to the prediction of change of dementia worry.
In our study, dementia worry and perceived personal dementia risk were found to be weakly to moderately inter- related; they appear to reflect distinct concepts of self- perceptions toward dementia. While mean levels of the two constructs did not change much across 2 years, there were differences with respect to their stability: While the stability of dementia worry was moderate to strong, percep- tion of personal risk was found to be less stable.
The moderate stability of dementia worry suggests that this construct may also reflect a part of a stable disposition
to worry. This agrees with the findings of Price et al. (2007), whoobservedthatageneraldispositionofanxietywasasso- ciated with disease-specific worry. Likewise, in previous research dementia worry was found to be correlated with generalized anxiety (Bowen et al., 2019; French et al., 2012; Kessler, Südhof, et al., 2014). According to the state-trait-theory of Spielberger et al. (1983), dementia worry may reflect a dispositional trait rather than a tempo- rary state.
In contrast, the rank order in personal dementia risk per- ception was found to change over 2 years. While there were no mean-level changes in perception of personal risk, the relative positions of individuals in the sample varied over time and showed weak to moderate rank-order stability. The perceived personal dementia risk may be associated with other influencing factors like subjective health (Maxfield & Greenberg, 2020), generalized anxiety (Kinzer & Suhr, 2016), or depression (Suhr & Kinkela, 2007), which were not assessed in the current study. It should further be examined which processes lead to the perception of per- sonal dementia risk.
Table 3. Intercorrelations
1 2 3 4 5 6 7 8 9 10
Measure
1. Dementia worry t1 1
2. Dementia worry t2 .69** 1
3. Pers. risk perception t1 .49** .30** 1
4. Pers. risk perception t2 .53** .54** .56** 1
5. Family history t1 .38** .36** .27** .34** 1
6. Family history t2 .35** .32** .22* .34** .65** 1
Sociodemographics
7. Age t2 .14 .15 .03 .05 .10 .19* 1
8. Sex (female) t2 .12 .05 .01 .05 .00 �.01 �.06 1 9. Relationship status t2 .00 �.03 .01 .03 �.04 .11 .26** .06 1
10. Level of education t2 �.02 �.01 .02 .02 .03 �.06 �.15 �.07 �.07 11. Net income t2 .01 �.06 �.09 �.08 �.06 .06 .19* �.09 .39** .12
Note. **p < .01, *p < .05.
Figure 1. Fully saturated cross-lagged path model for dementia worry, personal dementia risk perception and family history of dementia. Note. Significant paths are in bold, **p < .001.
� 2020 Hogrefe GeroPsych (2020)
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In the cross-sectional analysis, dementia worry was sig- nificantlycorrelatedwithperceivedpersonaldementiarisk. Thisfindingwasinlinewithpreviousresearch(Bowenetal., 2019; Maxfield & Greenberg, 2020). In the examination of the cross-lagged paths, we found only a lagged effect of dementia worry on the perception of personal risk, while the reverse path did not prove to be statistically significant. Increased personal dementia risk perception was associ- ated with prior dementia worry. To date, not much is known about the lagged connection between the two variables. One possible explanation could be that people worrying about a specific disease tend to be generally more preoccu- pied with it and subsequently may be moreattentive to their own risk of getting the disease, which therefore may be per- ceived as being more prevalent. Furthermore, dementia worry may reflect a relatively stable personality disposition that also shows long-term consequences in behavior and cognition. It may thus reflect an important factor in the pro- cess of determining one’s own risk of developing dementia.
Contrary to previous studies (DiLorenzo et al., 2006; Hiraki et al., 2009), family history had no lagged effect on perception of personal risk. Hence, having a relative with dementia does not seem to contribute to personal dementia risk perception. Besides, previous findings were cross- sectional, giving no reliable information about lagged associations.
Furthermore, on a bivariate level, family history is signif- icantly linked to dementia worry both cross-sectionally and longitudinally. These connections vanish in the cross- lagged path model when perceived personal dementia risk is included, which could be interpreted as a mediation effect. This can be integrated in the previous findings of DiLorenzo et al. (2006), indicating a mediator role of per- ceived personal disease risk between having a family his- tory of the disease and disease specific worry. To conclude, a family history of dementia appears not to be the best direct indicator for dementia worry or a higher per- sonal dementia risk perception, but still appears to be an important factor on a bivariate or cross-sectional examination.
Our study showed no significant association between dementia worry and risk factors for dementia such as age and sex. This agrees with previous research, where no dif- ference between men and women was found (e.g., Cutler & Brăgaru, 2015; Kinzer & Suhr, 2016), and where age was not related to dementia worry (e.g., Kinzer & Suhr, 2016; Maxfield & Greenberg, 2020). Regarding age and sex,studiesondementiaworryhavegeneratedinconsistent findings. It remains to be further examined under which conditions associations do occur, which might also be because of differences in methods used or sample composition.
Limitations and Future Research
Several caveats should be considered when interpreting the findings of the present research. The first caveat concerns the selective sample with a high percentage of female, young people with higher education and a family history of dementia. Hence, the results may not be representative. Furthermore, selectivity could have concealed potential effects of sociodemographics on the outcome variables. Moreover, our sample was relatively small. A rule of thumb suggests the necessity of a ratio of 25:1 (at least 10:1) sub- jects to observed variables in cross-lagged path analyses (Nachtigall et al., 2003). Here, we reached a proportion of over 20:1 and thus still lie below the optimal sample size. So, the findings may lack accuracy or stability. Neverthe- less, because we used a stricter level of significance (p < .01) to minimize possible incidental findings, our results should be confirmed in a larger sample. A fruitful further research would be to examine a large-scale and representa- tive sample. Besides aselective sample, a selective drop-out after the first occasion could have occurred, potentially fur- ther affecting the generalizability of the results. An analysis of sample selectivity resulted in a significant difference in having a family history of dementia, indicating that people having a relative with dementia contributed a second time in the study. This could have shaped the outcomes and should be considered in other studies.
A second caveat refers to the imprecise assessment of the objective risk factor family history of dementia in the cur- rent study. The family history was indicated as having a rel- ative with dementia. We did not assess whether relatives were genetically related or in-laws. Such an unexpected absence of effects of family-related experience with dementia on changes in self-perceptions toward dementia may be associated with opposing effects of two underlying and confounding aspects in our measure, that is, (a) per- sonal genetic risks may trigger higher dementia worry, while (b) exposure to nongenetically related family mem- bers with dementia may have low or no effects. Previous studies found that dementia worry, when compared to per- sons without exposure to dementia, was higher among persons with a “nongenetic” history of dementia, such as through friends, nongenetically related relatives or a care context (Cantegreil-Kallen & Pin, 2012; Low & Anstey, 2009; Suhr & Kinkela, 2007). However, genetically related relatives of people with dementia expressed the high- est levels of worry (Kinzer & Suhr, 2016; Maxfield & Greenberg, 2020). Some research suggests that close rela- tives and friends of dementia patients often must deal with the grief of such a loss (Kessler et al., 2012). Consequently, the emotional bond to a person with dementia might be driving the experience of dementia worry. Further research
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is required to better acknowledge the possible differential effects of genetic vulnerability, personal experience and family history on dementia worry and perception of personal risk. Future research may also examine the effects of length of exposure with dementia on self-perceptions toward dementia. For example, upon receiving a diagnosis, there may be a spike in dementia related emotions and cognitions. Over time, relatives and caregivers might accommodatetothissituationandthusexpresslessdemen- tia worry over time.
Anothercaveatisthemeasurementofperceivedpersonal dementia risk, which appeared to be related but distinct from dementia worry, although it was assessed by a single item. A broader assessment covering more items would allow further differentiation of the construct and may shed light on the connecting processes between dementia worry and personal dementia risk perception.
The present research is among the first to assess demen- tiaworryandperceivedpersonaldementiariskatmorethan one occasion in order to get information about the possible longitudinal course. Nevertheless, even with two measure- ment occasions, a few questions regarding change and sta- bility of self-perceptions toward dementia remain open. As a result, future research should include repeated measure- ments to examine the variability of the variables. Longer study intervals than 2 years may be used to test the time lag needed to better understand change sensitivity of dementia worry and the currently used instruments.
Besides family history, other influencing factors such as dementia literacy could be included in analyses to find out more about possible underlying processes. Previous research highlighted that misconceptions of risk factors and consequences of dementia might increase dementia worry (Kessler et al., 2012), and that people may as well dif- ferentiate between Alzheimer’s disease and dementia (Maxfield & Greenberg, 2020). Likewise, other possible consequences of dementia worry and personal dementia risk perception like health behavior or psychological well- being should be examined to clarify the impact of the con- cerning concepts. As indicated by the mid-term stability of dementia worry, the relatedness to personality disposi- tions should be investigated as already other studies have pointed out (Bowen et al., 2019; Cutler & Brăgaru, 2015, 2017). A study by Kessler, Tempel et al. (2014) assessed a short personality inventory that was not yet included in fur- ther evaluation. Hence, the relationship still needs to be examined.
Regarding dementia worry being a part of personality, practical implications may need a change of perspective. A stable construct is not easily susceptive to change, so pos- sible effects of interventions modifying dementia worry could be limited. In contrast, perceived personal dementia
risk contains more variability to be successfully addressed by specific interventions to change, and, therefore, should be focused on by future studies.
Conclusion
In conclusion, dementia worry and personal dementia risk perception were found to be moderately associated yet distinct constructs, particularly with regard to their predictability and variability over 2 years. Dementia worry appeared to possess a moderate to strong stability, whereas the perceived personal dementia risk was more sensitive to change. Based on the 2-year cross-lagged path model, including the bivariate correlated risk factor of having a family history of dementia, no distinct lagged effects were found apart from the influence of dementia worry on the perceived personal dementia risk over time. Since the present study is among the first to measure dementia worry and perceived personal dementia risk on more than one occasion, further longitudinal research will contribute to improved understanding of change and stability in self- perceptions toward dementia. This may also pave the floor for promising avenues to intervention research on dementia worry.
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History Received March 16, 2020 Accepted August 5, 2020 Published online September 8, 2020
Conflict of Interest The authors declare no conflict of interest.
Funding Work on this article was supported by grants of the Volkswagen Foundation (Az 86 759 & Az 93 273) and of the Theo and Friedl Schöller Stiftung to Frieder R. Lang.
ORCID Frieder R. Lang
https://orcid.org/0000-0002-2660-1619
Frieder R. Lang Institute of Psychogerontology Friedrich-Alexander-University Erlangen-Nürnberg Kobergerstrasse 62 90408 Nuremberg Germany [email protected]
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