Hindawi Publishing Corporation International Journal of Alzheimers Disease Volume 2012, Article ID 903645, 9 pages doi:10.

1155/2012/903645

Research Article The Impact of Experience with a Family Member with Alzheimers Disease on Views about the Disease across Five Countries
Robert J. Blendon,1 John M. Benson,1 Elizabeth M. Wikler,2 Kathleen J. Weldon,1 Jean Georges,3 Matthew Baumgart,4 and Beth A. Kallmyer5
1 Department 2 Program

of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA in Health Policy, Harvard University, Cambridge, MA 02138, USA 3 Alzheimer Europe, 145 Route de Thionville, 2611 Luxembourg, Luxembourg 4 Government Aairs, Alzheimers Association, Washington, DC 20005, USA 5 Constituent Services, Alzheimers Association, Chicago, IL 60613, USA Correspondence should be addressed to John M. Benson, jmbenson@hsph.harvard.edu Received 27 April 2012; Accepted 13 July 2012 Academic Editor: Ricardo Nitrini Copyright 2012 Robert J. Blendon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The objective of this paper is to understand how the publics beliefs in ve countries may change as more families have direct experience with Alzheimers disease. The data are derived from a questionnaire survey conducted by telephone (landline and cell) with 2678 randomly selected adults in France, Germany, Poland, Spain, and the United States. The paper analyzes the beliefs and anticipated behavior of those in each country who report having had a family member with Alzheimers disease versus those who do not. In one or more countries, dierences were found between the two groups in their concern about getting Alzheimers disease, knowledge that the disease is fatal, awareness of certain symptoms, and support for increased public spending. The results suggest that as more people have experience with a family member who has Alzheimers disease, the public will generally become more concerned about Alzheimers disease and more likely to recognize that Alzheimers disease is a fatal disease. The ndings suggest that other beliefs may only be aected if there are future major educational campaigns about the disease. The publics in individual countries, with diering cultures and health systems, are likely to respond in dierent ways as more families have experience with Alzheimers disease.

1. Introduction
Prevalence rates for Alzheimers disease in Europe and the United States are estimated as some of the highest in the world, growing rapidly with the aging demographic shift [14]. Alzheimers disease is one of the leading causes of death in these countries, and the costs imposed by it are substantial in terms of caregiving demands, lost productivity, and strains on health care systems [5]. Among scientists, health professionals, and policymakers, interest in the disease has grown in recent years due to the growing demands for care by patients and a number of important research ndings, including the identication of additional genetic risk factors and the release of new diagnostic guidelines

[6, 7]. This complements other recent scientic developments in potential drug therapies, diagnostic procedures [8], and other research on potential risk factors, such as dietary choices, chronic disease, and medication usage [9, 10]. Single-country surveys have looked at public attitudes and beliefs about Alzheimers disease [11, 12]. However, little is known about how levels of awareness and beliefs vary across Europe and the United States, with their dierent cultures and health systems. To ll this information void, Alzheimer Europe and the Harvard School of Public Health conducted a ve-country international poll to assess public understanding about Alzheimers disease [13, 14]. The poll involved random samples of the public in France, Germany, Poland, Spain, and the US. It is important to look at attitudes

2
Table 1 France Germany Poland Spain US Interview dates February 714, 2011 February 719, 2011 February 710, 2011 February 813, 2011 February 727, 2011 Total interviews 529 499 509 502 639

International Journal of Alzheimers Disease

Margin of error (percentage points) 4.3 4.4 4.3 4.4 3.9

and beliefs across countries because results from a single country may not be generalizable to other countries that have dierent values and experiences with Alzheimers disease. The multicountry poll focused primarily on eight broad issues. These included (1) the relative public concern about the disease when compared to other serious national health problems, (2) the publics willingness to see a physician to obtain a diagnosis if they were exhibiting symptoms possibly associated with the disease, (3) public beliefs about whether an eective treatment to slow the progression of the disease was currently available, (4) public beliefs about whether a reliable test was currently available that will determine if a person who is suering from some confusion and memory loss is in the early stages of Alzheimers disease, (5) the publics interest in future early diagnostic testing for the disease, should such a test become available, (6) public beliefs about whether Alzheimers disease is a fatal disease, (7) the level of public awareness of common symptoms that were associated with the disease, and (8) public attitudes about government spending on Alzheimers research and care. The focus of this paper is an analysis of the beliefs and anticipated behavior of those in each country who report that they have had a family member with Alzheimers disease versus those who say they have not. If the experience of having a family member with Alzheimers disease aects beliefs and behaviors, overall public attitudes and understanding of the disease might be expected to change as the number of people with experience grows as a result of anticipated demographic shifts. Therefore, understanding the dierences in perspective between those who have had a family member with the disease and those who have not is important in predicting possible changes in public beliefs and behaviors in each country. We present the major ndings of the ve-country poll in this comparative context and suggest implications of the possible changes in public response in the years ahead.

of random cell phone numbers across the country among adults age 18 and older. The average length of interview was 12 minutes. Table 1 shows interview dates, samples sizes, and margins of error at the 95% condence level for each country. The eldwork was conducted for Alzheimer Europe and the Harvard School of Public Health by TNS, an independent research company based in London, with branches in each of the ve countries surveyed. TNS is one of the largest survey research companies internationally and also currently conducts the Eurobarometer surveys of adults in European Union countries for the European Commission. The interviews were conducted in the language of each country. In the US, interviews were conducted in both English and Spanish.

2.3. Poststratication Weighting. Nonresponse in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for dierent subgroups of the population. To compensate for these known biases, the sample data are weighted to reect the actual composition of the adult population in the surveyed countries, calculated on the basis of census data from each country, according to race/ethnicity (US only), age, gender, and region. The sample data are also weighted by telephone status (landline, cell). Other techniques, such as callbacks staggered over times of days and days of weeks and systematic respondent selection within households, are used to help ensure that the sample in each country is representative. The data presented in this paper are weighted percentages. After weighting, the sample for each country reects the demographic composition of the adult population of that country as presented in its census. The results for each country are generalizable to the adult population of that country.

2. Methods
2.1. Source of Data. The data are derived from a February 2011 survey by Alzheimer Europe and the Harvard School of Public Health with nationally representative random samples of adults age 18 and older in France, Germany, Poland, Spain, and the United States [13]. 2.2. Study Design. In each of the ve countries, interviews were conducted of both landline telephone numbers using random-digit dialing and cell phone numbers using a list

2.4. Statistical Analysis. Data analysis comprises descriptive statistics to ascertain public attitudes on each of the measures. Percentages and condence intervals (at the 95% condence level) are shown for the responses to each survey item of those who report that they have had a family member with Alzheimers disease versus those who say they have not in each country. The survey found that the publics reported experience with a family member with Alzheimers disease varied substantially across the ve countries. The proportion ranged from 19% in Poland to 30% in France, 33% in Spain, 34% in Germany, and 42% in the US.

International Journal of Alzheimers Disease Table 2 presents comparative data for those with and without experience for the rst six issues discussed above. Table 3 shows comparative data between these two groups on public perceptions of common symptoms associated with Alzheimers disease. Table 4 presents comparative data between these two groups on attitudes about government spending related to Alzheimers disease. We highlight only those dierences within each country that are statistically signicant (P < 0.05). 2.5. Limitations. The poll could not identify whether national dierences in the proportion of respondents reporting family experience with Alzheimers disease were related to variation in the incidence of the disease, cultural or historical factors that might inuence the use of Alzheimers disease as a diagnostic term, or dierences in public education about the disease in individual countries that might play a role in awareness of the disease. Those with family experience with Alzheimers disease may have received educational support during this experience, which may aect dierences in awareness between the experienced and nonexperienced groups.

3 the early stages of Alzheimers disease. Only in one country did experience with a family member alter beliefs about the current availability of a reliable test. Belief increased from 44% with no family experience to 56% among those with direct experience in Spain. In all other countries, there was no signicant dierence between the two groups. 3.5. Interest in Future Early Diagnostic Testing for the Disease, Should Such a Test Become Available. There is substantial public interest in early diagnostic testing. There was no dierence in any country based on personal experience with a family member in the proportion that said they were very likely to take a diagnostic test without symptoms. 3.6. Beliefs about Whether Alzheimer Is a Fatal Disease. Large numbers do not believe Alzheimer is a fatal disease. Experience with a family member increased the belief that Alzheimer was a fatal disease in three countriesFrance, Poland, and Spain. It did not in Germany and the US. 3.7. Awareness of Common Symptoms That Were Associated with Alzheimers Disease. There is general agreement on some symptoms of Alzheimers disease, disagreement on others. As shown in Table 3, experience with a family member does not change perceptions of most symptoms across countries. Experience with Alzheimers disease had no impact on beliefs about three symptomshallucinations, problems with pain, and diculty managing and paying bills. In three or more countries, experience with a family member aected beliefs about confusion and disorientation, diculty managing daily tasks, and anger and violence. In each of these cases, experience with a family member increased the belief that these were common symptoms of the disease. In Poland, beliefs about two other symptoms were aected by family experience with the disease. Those who had experience with a family member were more likely than those without experience to believe wandering and getting lost was a common symptom. On the other hand, those who had experience with a family member were less likely than those without experience to believe that diculty remembering things in their life from years before was a common symptom. In the US, the belief that diculty remembering things in their life from the day before was a common symptom was increased by experience with a family member. 3.8. Attitudes about Government Spending on Alzheimers Research and Care. As shown in Table 4, majorities of the public in all ve countries favor increased government spending on research on new treatments for Alzheimers disease and on caring for people who have the disease. In two countriesGermany and Polandthose who had experience with a family member were more likely than those without family experience to favor increased government spending on research on new treatments. Only in Poland, those with family experience were also more likely to favor

3. Results
3.1. Relative Public Concern about Alzheimers Disease When Compared to Other Serious National Health Problems. Alzheimers disease is ranked as a major concern in many countries. In three of the countries, Germany, Poland, and the US, those with personal family experience were more likely than those without experience to choose Alzheimers disease as the disease they were most afraid of getting. Experience did not signicantly aect views in France and Spain (Table 2). 3.2. Willingness to See a Physician to Obtain a Diagnosis If They Were Exhibiting Symptoms Possibly Associated with the Disease. Most report that they would see a doctor for diagnosis if they had symptoms. There were no dierences in any country in those who would seek a physician assessment with signs of possible Alzheimers disease based on experience with having a family member who had the disease. 3.3. Beliefs about Whether an Eective Treatment to Slow the Progression of the Disease Was Currently Available. Many believe an eective treatment to slow the progression of the disease and make symptoms less severe is currently available. In all ve countries, experience with a family member did not lead to dierent beliefs about the current availability of an eective treatment. 3.4. Beliefs about Whether a Reliable Test Was Currently Available That Will Determine If a Person Who Is Suering from Some Confusion and Memory Loss Is in the Early Stages of Alzheimers Disease. A substantial portion of the public in all ve countries believes a reliable test is available to determine if a person suering from confusion and memory loss is in

Table 2: Attitudes and beliefs about Alzheimers disease, by experience with a family member. Total % (CI 95%) No, have not % (CI 95%) Yes, have ever had family member with AD % (CI 95%) P value (family member versus no family member)

27 (2331) 23 (1927) 12 (915) 24 (2028) 22 (1825)

30 (2237) 31 (2338) 24 (1533) 29 (2136) 27 (2133)

26 (2131) 19 (1424) 9 (613) 21 (1626) 18 (1422)

0.428 0.015 0.004 0.082 0.014

88 (8591) 90 (8793) 85 (8289) 95 (9398) 89 (8692)

92 (8797) 89 (8494) 89 (8296) 93 (8897) 86 (8191)

87 (8391) 91 (8794) 85 (8089) 97 (9599) 91 (8894)

0.116 0.637 0.271 0.126 0.106

40 (3544) 42 (3747) 63 (5867) 27 (2331) 46 (4251)

45 (3753) 45 (3753) 64 (5375) 29 (2236) 48 (4154)

38 (3343) 40 (3446) 63 (5768) 26 (2131) 46 (4051)

0.183 0.360 0.826 0.510 0.699

Attitude or belief Country (unweighted n for total sample; those who have had a family member with AD; those who have not) Choose Alzheimers disease from list of seven diseases as the one they are most afraid of getting France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) If exhibiting confusion and memory loss, you would go to a doctor to determine if cause was Alzheimers disease France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Believe an eective treatment currently available to slow the progression of the disease and make symptoms less severe France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Believe reliable test currently available to determine if a person suering from confusion and memory loss is in the early stages of Alzheimers disease France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Very likely to get diagnostic test if, in the future, one became available that would tell people before they had symptoms whether they will get Alzheimers disease 50 (4655) 43 (3948) 38 (3443) 48 (4353) 59 (5563) 52 (4460) 48 (3956) 33 (2344) 56 (4865) 59 (5265) 49 (4455) 41 (3547) 40 (3445) 44 (3850) 60 (5465) 0.636 0.216 0.291 0.014 0.840

International Journal of Alzheimers Disease

International Journal of Alzheimers Disease

Table 2: Continued. Total % (CI 95%) 26 (2230) 23 (1927) 30 (2534) 39 (3443) 29 (2633) 44 (4049) 33 (2837) 34 (3039) 42 (3746) 61 (5765) 53 (4461) 35 (2743) 45 (3356) 51 (4359) 60 (5467) Yes, have ever had family member with AD % (CI 95%) 27 (2034) 28 (2136) 35 (2546) 43 (3552) 31 (2538) No, have not % (CI 95%) 26 (2131) 21 (1626) 28 (2333) 36 (3042) 28 (2333) 41 (3647) 31 (2637) 32 (2737) 37 (3143) 61 (5667) P value (family member versus no family member) 0.838 0.090 0.227 0.159 0.420 0.023 0.477 0.046 0.007 0.806

Attitude or belief Country (unweighted n for total sample; those who have had a family member with AD; those who have not) France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Believe Alzheimers is a fatal disease France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379)

Source: [13].

Table 3: Perceptions of common symptoms of Alzheimers disease, by experience with a family member.

Total % (CI 95%) No, have not % (CI 95%)

Yes, have ever had family member with AD % (CI 95%)

P value (family member versus no family member)

24 (2028) 34 (2939) 26 (2230) 40 (3545) 40 (3645) 23 (1927) 22 (1726) 21 (1725) 24 (2028) 25 (2129) 80 (7683) 73 (6877) 73 (6978) 80 (7684) 84 (8087) 91 (8994) 92 (8994) 86 (8390) 96 (9498) 92 (9094) 83 (7986) 86 (8389) 85 (8188) 88 (8491) 88 (8591) 46 (4251) 40 (3545) 35 (3140) 48 (4353) 53 (4958) 86 (8092) 92 (8796) 93 (8898) 91 (8696) 92 (8896) 55 (4763) 47 (3855) 49 (3360) 56 (4865) 59 (5266) 95 (9299) 93 (8997) 93 (8798) 97 (9599) 96 (9398) 83 (7789) 77 (7085) 80 (7089) 82 (7688) 85 (8090) 79 (7483) 71 (6576) 72 (6777) 79 (7484) 82 (7887) 90 (8693) 91 (8795) 85 (8189) 96 (9398) 90 (8693) 82 (7786) 83 (7988) 83 (7987) 86 (8290) 85 (8189) 42 (3748) 37 (3143) 32 (2237) 44 (3850) 49 (4455) 20 (1326) 26 (1834) 28 (1838) 20 (1427) 25 (1930) 24 (1929) 19 (1425) 20 (1624) 26 (2031) 25 (2130)

23 (1630) 34 (2642) 34 (2344) 44 (3653) 39 (3245)

24 (1929) 34 (2840) 24 (2029) 38 (3244) 42 (3647)

0.910 0.911 0.119 0.185 0.459 0.283 0.160 0.142 0.196 0.865 0.297 0.152 0.160 0.434 0.405 0.027 0.433 0.024 0.403 0.004 0.247 0.014 0.002 0.171 0.015 0.013 0.061 0.010 0.023 0.030

Perceive each of the following to be a common symptom of Alzheimers disease Country (unweighted n for total sample; those who have had a family member with AD; those who have not) Hallucinations or hearing voices France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Pain France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Diculty managing and paying bills France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Confusion and disorientation France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Diculty managing daily tasks France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Anger and violence France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379)

International Journal of Alzheimers Disease

Table 3: Continued.

International Journal of Alzheimers Disease

Total % (CI 95%) No, have not % (CI 95%)

Yes, have ever had family member with AD % (CI 95%)

P value (family member versus no family member)

92 (9095) 89 (8592) 88 (8491) 95 (9397) 91 (8994)

95 (9299) 91 (8796) 94 (8699) 97 (9499) 92 (8995)

91 (8894) 87 (8392) 86 (8290) 94 (9197) 91 (8794)

0.072 0.205 0.018 0.197 0.555

47 (4251) 44 (3949) 58 (5463) 76 (7280) 68 (6471)

44 (3652) 47 (3855) 48 (3659) 70 (6378) 64 (5770)

48 (4354) 43 (3749) 61 (5666) 79 (7484) 70 (6575)

0.405 0.450 0.039 0.056 0.120

Perceive each of the following to be a common symptom of Alzheimers disease Country (unweighted n for total sample; those who have had a family member with AD; those who have not) Wandering and getting lost France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Diculty remembering things in their life from years before France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Diculty remembering things in their life from the day before France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) 94 (9296) 87 (8490) 80 (7684) 91 (8894) 91 (8994) 94 (8998) 89 (8494) 85 (7893) 91 (8796) 95 (9297) 94 (9297) 86 (8290) 79 (7584) 91 (8795) 89 (8693)

0.804 0.411 0.179 0.955 0.020

Source: [13].

International Journal of Alzheimers Disease

Table 4: Attitudes about government spending on Alzheimers research and care, by experience with a family member.

Attitude about spending Country (unweighted n for total sample; those who have had a family member with AD; those who have not) Favor increased government spending on research on new treatments for Alzheimers disease France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379) Favor increased government spending on caring for people with Alzheimers disease France (n = 529; 166; 363) Germany (n = 499; 177; 317) Poland (n = 509; 92; 410) Spain (n = 502; 172; 328) US (n = 639; 257; 379)
Source: [13].

Total % (CI 95%)

Yes, have ever had family member with AD % (CI 95%)

No, have not % (CI 95%)

P value (family member versus no family member)

83 (7986) 68 (6373) 75 (7079) 83 (7987) 67 (6371)

84 (7891) 75 (6883) 85 (7694) 87 (8193) 66 (6073)

82 (7786) 65 (5971) 72 (6777) 82 (7786) 68 (6273)

0.497 0.032 0.013 0.212 0.758

85 (8188) 69 (6473) 71 (6776) 79 (7583) 60 (5664)

83 (7790) 73 (6581) 86 (7794) 82 (7689) 64 (5770)

85 (8189) 67 (6173) 68 (6373) 77 (7182) 57 (5163)

0.599 0.288 0.006 0.187 0.129

increased spending on caring for people with Alzheimers disease.

4. Discussion
Obviously, many things could change in the coming years. A single reliable test or a new, eective form of treatment could be found, or certain lifestyle changes could be scientically recognized as being eective. But in the absence of such developments, one would expect certain changes of attitude and belief to occur as more people have experience with a family member who has Alzheimers disease. The results suggest that, in general, the public will become more concerned about Alzheimers disease and more likely to recognize that Alzheimer is a fatal disease, although most beliefs about the disease are unlikely to change. One of the rationales for this study is that the publics in individual countries, with diering cultures and health systems, are likely to respond in dierent ways as more families have experience with Alzheimers disease. What do the survey ndings mean for the future in each of the ve countries? For France, we would expect that as the number of people who have experience with a family member who has Alzheimers disease grows, changes in public attitudes and beliefs would change in three areas. A larger proportion of the French public would believe that Alzheimer is a fatal disease. In addition, more would perceive anger and violence and confusion and disorientation to be common symptoms of the disease.

For Germany, as the proportion of those who have family experience with Alzheimers disease grows, we would expect changes in three areas. A larger proportion of the German public would choose Alzheimer as the disease they are most afraid of getting. In addition, more would perceive that diculty managing daily tasks is to be a common symptom of the disease. A larger proportion would also favor increase of government spending on new treatments for the disease. Poland starts out as the country with the smallest proportion of the population reporting family experience with Alzheimers disease among the ve countries in the survey. As that proportion grows in the future, we would expect changes in public attitudes and beliefs in nine areas. A larger proportion of the Polish public would choose Alzheimer as the disease they are most afraid of getting, believe that Alzheimer is a fatal disease, and perceive the following to be common symptoms of the disease: confusion and disorientation, diculty managing daily tasks, anger and violence, and wandering and getting lost. If the pattern persists, one would also expect a smaller proportion to perceive diculty remembering things from their life from years before to be a common symptom. In addition, a larger proportion would be expected to favor increased government spending on research on new treatments for Alzheimers disease and on caring for people who have the disease. For Spain, as the proportion of those who have family experience with Alzheimers disease grows, we would expect changes in public attitudes and beliefs in three areas. A larger proportion of the Spanish public would believe that a reliable test is available to determine if a person suering from confusion and memory loss is in the early stages of

International Journal of Alzheimers Disease Alzheimers disease, believe that Alzheimer is a fatal disease, and perceive anger and confusion to be a common symptom of the disease. The United States starts out as the country with the largest proportion of the population reporting family experience with Alzheimers disease among the ve countries in the survey. As that proportion grows in the future, we would expect changes in public attitudes and beliefs in ve areas. A larger proportion of the US public would choose Alzheimer as the disease they are most afraid of getting and perceive the following to be common symptoms of the disease: confusion and disorientation, diculty managing daily tasks, anger and violence, and diculty remembering things in their life from the day before. Looking across the ve countries, the growing proportion of people who have family experience with Alzheimers disease is likely to have its greatest impact in Poland. Overall, however, the survey results indicate that most of the publics attitudes and beliefs about Alzheimer in these ve countries may not be aected by wider family experience with the disease. These ndings show the importance of major educational campaigns about Alzheimers disease, its diagnosis, treatment, and symptoms. In the absence of such educational eorts, many public attitudes and beliefs are unlikely to change signicantly in the future. In addition, without such an educational campaign, some beliefs that are factually incorrect are likely to remain in the publics mind. These ndings are important to each country because they show the possibilities of what widespread educational campaigns could do. Improved public education may contribute to a reduction of personal and social burden in various, for example, helping people plan for the future. The results also suggest that educational campaigns could have a dierent focus in each country depending on the current level of knowledge, awareness, and beliefs. With Alzheimers disease and other forms of dementia becoming a growing global problem [15], these ndings suggest that conducting surveys of the public in other countries could provide useful information for health professionals and policy makers dealing with Alzheimers disease and other forms of dementia in their own country in the future.

9
17, no. 2, pp. 252259, 2010, http://onlinelibrary.wiley.com/ doi/10.1111/j.1468-1331.x/pdf. Communication from the Commission to the European Parliament and the Council on a European initiative on Alzheimers disease and other dementias, 2009, http://ec.europa.eu/health/ph information/dissemination/ documents/com2009 380 en.pdf. R. Brookmeyer, E. Johnson, K. Ziegler-Graham, and H. M. Arrighi, Forecasting the global burden of Alzheimers disease, Alzheimers and Dementia, vol. 3, no. 3, pp. 186191, 2007. A. Wimo and M. Prince, World Alzheimer Report 2010: The Global Economic Impact of Dementia, Alzheimers Disease International, London, UK, 2010, http://www.alz.co.uk/ research/les/WorldAlzheimerReport2010.pdf. National Institutes of Health, New genetic risk factors for Alzheimers disease, NIH Research Matters, 2011, http://www .nih.gov/researchmatters/april2011/04112011alzheimers.htm. C. R. Jack Jr., M. S. Albert, D. S. Knopman et al., Introduction to the recommendations from the National Institute on AgingAlzheimers Association workgroups on diagnostic guidelines for Alzheimers disease, Alzheimers and Dementia, vol. 7, no. 3, pp. 257262, 2011, http://download .journals.elsevierhealth.com/pdfs/journals/1552-5260/PIIS1552526011001002.pdf. R. C. Petersen, Alzheimers disease: progress in prediction, The Lancet Neurology, vol. 9, no. 1, pp. 45, 2010. M. L. Daviglus, C. C. Bell, W. Berrettini et al., National Institutes of Health State-of-the-Science Conference statement: preventing Alzheimers disease and cognitive decline, NIH Consensus and State-of-the-Science Statements, vol. 27, no. 4, pp. 130, 2010, http://consensus.nih.gov/2010/docs/alz/ ALZ Final Statement.pdf. D. E. Barnes and K. Yae, The projected eect of risk factor reduction on Alzheimers disease prevalence, The Lancet Neurology, vol. 10, no. 9, pp. 819828, 2011. Institut National de Pr vention et dEducation pour la Sant , e e Connaissances, perceptions et comportements du grand public vis-` -vis de la maladie dAlzheimer, 2008, http://alzheimer a .inpes.fr/pdf/fr/rapport-detaille-grd-public.pdf. MetLife Foundation, What America thinks: MetLife Foundation Alzheimers survey, 2011, http://www.metlife.com/ assets/cao/contributions/foundation/alzheimers-2011.pdf. Alzheimer Europe/Harvard School of Public Health, FiveCountry Alzheimers Disease Survey, 2011. Alzheimer Europe, The Value of Knowing: Findings of Alzheimer Europes Five Country Survey of Public Perceptions of Alzheimers Disease and Views on the Value of Diagnosis, Alzheimer Europe, Luxembourg, 2011. World Health Organization and Alzheimers Disease International, Dementia: A Public Health Priority, Geneva, Switzerland, 2012, http://whqlibdoc.who.int/publications/ 2012/9789241564458 eng.pdf.

[3]

[4]

[5]

[6]

[7]

[8] [9]

[10]

[11]

[12]

[13] [14]

Acknowledgment
The survey was supported by a grant to Alzheimer Europe from Bayer AG. Bayer was not involved in the design of the survey, the data collection, the analysis or interpretation of the ndings, or the preparation of the paper.
[15]

References
[1] Alzheimers Association, W. Thies, and L. Bleiler, 2011 Alzheimers disease facts and gures, Alzheimers and Dementia, vol. 7, no. 2, pp. 208244, 2011, http://download .journals.elsevierhealth.com/pdfs/journals/1552-5260/PIIS1552526011000367.pdf. [2] T. Mura, J. F. Dartigues, and C. Berr, How many dementia cases in France and Europe? Alternative projections and scenarios 20102050, European Journal of Neurology, vol.