Cultural Variations In Dementia And Alzheimer's Disease

According to the World Health Organization, dementia tends to be one of the major causes of dependency and disability among older people globally. With 55 million people experiencing these diseases worldwide, and 60% of them living in low- and middle-income regions, dementia may present challenges in multiple countries and cultures around the world. The way individuals view dementia may vary depending on their location and culture. For example, one study suggested that those in the United Kingdom and China tended to emphasize the role of family in providing care for individuals with dementia, while those in the United States usually looked to nursing homes and other care facilities to care for dementia patients. Care options may vary depending on location, but often, dementia is treated with a combination of medication and multiple types of therapy. 

Are you or a loved one living with dementia?

Discuss coping strategies with a therapist

Cultural variations in dementia and Alzheimer’s disease care

While identifying the exact ways different cultures understand and care for dementia can be challenging, some researchers have investigated how different countries view these topics. In a 2019 study, 194 participants from the United States (US), United Kingdom (UK), and China were asked to complete a free association task and a justification task in response to the word “dementia.” 

Cultural differences in understanding dementia among US, UK, and Chinese participants

Their free association task generally involved selecting words and expressions that corresponded to dementia and then ranking their associations, while the justification task involved explaining these associations. The study’s results showed that US participants often associated the word dementia with terms such as “elderly,” “memory loss,” and “forgetfulness,” with a notable lack of acknowledgment of the emotional and human experience of living with dementia. Researchers stated that this could support the notion that the cognitive domain of dementia tends to be prioritized in a Western philosophical setting. 

For UK participants, several elements were shared with other groups, including words like “brain” and “deterioration.” Researchers noted that the word “emptiness” was present, suggesting that those in the UK may consider the loss of cognitive ability as a loss of autonomy, self-control, and sense of self—in general, equating dementia with the loss of “being human.” 

UK participants tended to display a more balanced representation by humanizing those with dementia and separating them from their physical and cognitive symptoms. In contrast with the potential reductionism of comparing the loss of cognitive ability to the loss of being human, this research may suggest that UK culture holds a stigmatizing attitude that could run contrary to its explicit values. 

Like those from the UK, participants from China usually associated dementia with the word “emptiness” with a biomedical-dominated core. Researchers found this to be significant due to the traditionally collectivist culture of China, which is usually considered to prioritize affect over reason. 

The words “dull” and “abnormal” were also included, which may imply a negative attitude toward those experiencing dementia. Chinese participants went on to include other elements, such as “agitated,” “slow,” and “emotional,” potentially indicating a focus on behavior. This may relate to the value that Chinese culture places on maintaining interpersonal relationships and avoiding socially inappropriate behavior—both of which may be difficult for those with dementia. 

This seems to differ from the UK participants’ tendency to highlight the internal emotions experienced by those with dementia, with the Chinese participants instead focusing on the external behaviors associated with dementia that may be observed by others. 

Differences in cultural views of dementia care

The study also mentioned how each culture viewed care, including the role played by the family and loved ones of an individual with dementia. For Chinese participants, “family” and “assistance” were usually associated, potentially indicating the emotional and material support provided by family members to those with dementia. 

However, the words “treatment” and “irreversible” may also indicate the importance placed on medical care, while the words “dependence” and “inconvenience” may highlight the potential difficulty that can accompany caregiving. 

Cultural variations in dementia care between UK and US

UK participants usually shared the element of “family” while also including the word “care,” which researchers believed was similar to “assistance.” In addition, those in the UK group also associated dementia care with “living well,” which may reinforce the previously mentioned idea that those in the UK do not simply view an individual with dementia as someone with a condition that needs to be managed.

For American participants, dementia care was typically associated with “disabled” and “nursing home.” This may indicate that the perception of dementia in the US relates less to the duty of family members and more to the concepts of segregation and dependence. Researchers believed this could suggest the US relies on residential care and may hold a stigma that could dehumanize those experiencing dementia. 

How do dementia treatments vary in different cultures? 

Dementia care and treatments can vary depending on the country where a person is being treated. For example, according to the National Institute on Aging, the US Food and Drug Administration (FDA) has approved several medications for the treatment of dementia. 

Cholinesterase inhibitors are less effective in treating Alzheimer’s disease

One category of medications approved by the FDA is cholinesterase inhibitors, which may stop acetylcholine—a brain chemical that appears to play a vital role in thinking and memory—from breaking down. However, as certain forms of dementia progress (such as Alzheimer’s disease), the brain may produce less acetylcholine, potentially making these medications less effective.

Lecanemab may slow the rate of dementia cognitive decline

Another FDA-approved medication is lecanemab, which typically targets a protein known as beta-amyloid. This protein can build up as plaque in the brains of those experiencing dementia. If treatment is successful, lecanemab may slow the rate of cognitive decline, though it may be difficult to have this medication covered by insurance. 

Memantine can regulate glutamate in the brain

In addition, a glutamate regulation medication known as memantine has also been approved by the FDA. Memantine may regulate glutamate, a brain chemical that can be toxic in excessive amounts. 

Are you or a loved one living with dementia?

Discuss coping strategies with a therapist

Mental health therapy for the treatment of dementia in the US and other cultures

In addition to these medications, several types of therapy may be used in the US and other countries. For example, the UK Alzheimer’s Society lists various types of talk therapy for the treatment of dementia:

• Life story and reminiscence therapy: Life story and reminiscence therapy may help individuals with dementia connect with their memories and create a record of important events, places, and people. This type of therapy may use a variety of prompts to stimulate these memories, many of them personal. These can include videos, objects from their home, photos of loved ones, or music that reminds them of their childhood. This process can be enjoyable and may help individuals with dementia maintain their confidence, self-esteem, and overall sense of self. 
• Cognitive rehabilitation therapy: Cognitive rehabilitation therapy often focuses on the development or maintenance of skills that may be essential for daily living. These may include using devices like a smartphone or tablet that could help them remember to complete certain tasks or reinforce skills they had previously, such as tending to their garden or cooking their own meals. Cognitive rehabilitation therapy may also help individuals improve more general skills, such as organization, planning, problem-solving, attention, and communication. 
• Cognitive stimulation therapy: Cognitive stimulation therapy (CST) is often used to help those experiencing mild to moderate dementia. A CST therapist may lead individuals or groups through activities that focus on communication, memory, concentration, and thinking. These activities may involve discussing important events in the past, shared hobbies or interests, and details about the current time and place. Research has shown that CST may lead to significant impacts on language skills, such as word-finding, naming, and comprehension, as well as improvements in quality of life, mood, concentration, and confidence. 

Online therapy for people with Alzheimer’s disease and other forms of dementia

However, in-person forms of these and other types of therapy may not be convenient or accessible for everyone. For example, an individual may not be comfortable leaving their home or have reliable transportation to commute to an in-person therapy session. In addition, it may not always be safe for those with dementia to drive or take public transportation to a therapist’s office. In these cases, it may be necessary to consider alternative options, such as online therapy.

Effectiveness of online therapy for mental health concerns

While more research may be needed on the efficacy of online therapy specifically for treating dementia, research suggests that online therapy is normally as effective as in-person therapy. This comparison was highlighted in a 2022 systematic review and meta-analysis focusing on studies pertaining to telehealth and in-person mental health treatment. Researchers found no significant differences between telehealth and face-to-face therapy when investigating various metrics, including function, working alliance, overall improvement, and client satisfaction.