Acta Neurologica Belgica

https://doi.org/10.1007/s13760-018-1040-7

ORIGINAL ARTICLE

Perception and attitude of the general population towards Alzheimer’s

disease in Jeddah, Saudi Arabia
Hussein Algahtani1   · Bader Shirah2 · Asim Alhazmi3 · Abid Alshareef3 · Mohammed Bajunaid3 · Ahmad Samman4

Received: 29 September 2018 / Accepted: 30 October 2018

© Belgian Neurological Society 2018

Abstract
There are many conflicting beliefs about Alzheimer’s disease in the general population. Conducting a study on public aware-
ness, attitude, and knowledge towards Alzheimer’s disease is useful in decreasing discrimination and stigmatization. This
study aims to determine the public perception and attitude towards Alzheimer’s disease in Jeddah, Saudi Arabia. In addition,
we aim to identify the religious and cultural beliefs about the causes and treatment of Alzheimer’s disease in Saudi Arabia.
This is a cross-sectional study that was conducted in malls and public places in Jeddah, Saudi Arabia. The instrument used
in this study was a self-administered questionnaire that consists of 40 items. A total of 32 questions were included into the
survey, which was subdivided into four sources of information that include general information about Alzheimer’s disease,
information about Alzheimer’s disease in the society, general information about persons with Alzheimer’s disease, and infor-
mation about the care of persons with Alzheimer’s disease. In addition, eight questions were used to collect information about
the demographic profile of the participants. A total of 1698 individuals participated in the study. 1511 participants (89%)
had heard about Alzheimer’s disease before. Around 46% of the participants think that the cause of Alzheimer’s disease is a
brain disease and 44.9% think that is a normal part of aging. Approximately, 30% of the participants believe that Alzheimer’s
disease is treated with medications and 24.6% believe that there is no treatment. Around 30% of the participant think that
the society treats persons with Alzheimer’s disease with stigmatization. More than half of the participants (56.2%) think that
persons with Alzheimer’s disease should not be admitted to the nursing home. The results of the present study suggest that the
perception of the general public of Alzheimer’s disease is lagging behind. Many wrong beliefs were identified in the general
public regarding the causes and management. The findings of our study suggest that more information about Alzheimer’s
disease would be valuable and beneficial for everyone. Awareness campaigns and public education are needed to increase
the knowledge of the general public regarding several aspects of the disease including prevention, causes, and management.
Dissemination of information about Alzheimer’s disease should be of high priority. Increased awareness will lead to earlier
detection of Alzheimer’s disease and other dementia cases and appropriate care and management of those persons.

Keywords  Perception · Attitude · Alzheimer’s disease · Saudi Arabia

Introduction

Alzheimer’s disease is a neurodegenerative disorder char-

* Hussein Algahtani
halgahtani@hotmail.com acterized by severe cognitive impairment in at least two
cognitive domains such as memory impairment, impaired
1
King Abdulaziz Medical City, King Saud bin Abdulaziz reasoning and handling of complex tasks, impaired visu-
University for Health Sciences, P.O. Box 12723, ospatial abilities, or impaired language functions [1]. It is
Jeddah 21483, Saudi Arabia
a gradually and slowly progressive disorder that eventually
2
King Abdullah International Medical Research Center, King affects the ability to perform the simplest tasks including
Saud bin Abdulaziz University for Health Sciences, Jeddah,
Saudi Arabia activities of daily living [2]. The most common risk factor
3 for Alzheimer’s disease is aging. Other risk factors include
King Saud bin Abdulaziz University for Health Sciences,
Jeddah, Saudi Arabia genetic susceptibility, cardiovascular diseases, smoking,
4 obesity, and traumatic head injury [3].
Ibn Sina National College, Jeddah, Saudi Arabia

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Alzheimer’s disease is a major challenge worldwide [4].
The studies evaluating the prevalence of Alzheimer’s disease
in the Gulf region and Arab countries are scarce. There are
no published studies about the epidemiology of Alzheimer’s
disease in Saudi Arabia [5]. According to the Saudi Alzhei-
mer’s Disease Association, there are 130 thousand persons
affected by Alzheimer’s disease in Saudi Arabia, which rep-
resents approximately 0.4% of the Saudi population [6]. This
number is expected to increase due to shifting of the age of
the population towards elderly [7].
There are many conflicting beliefs about Alzheimer’s
disease [8]. Conducting a study on public awareness, atti-
tude, and knowledge towards Alzheimer’s disease is useful
in decreasing discrimination and stigmatization. Raising the
public perception about Alzheimer’s disease is considered
important to diagnose the patient in a timely manner with
subsequent initiation of symptomatic treatment, care accept-
ance, psychosocial support, and reduction of stress among
caregivers with a lower rate of hospitalization among per-
sons with Alzheimer’s disease [9]. By identifying misunder-
standing and misconception in the population, campaigns
can be targeted, and cross-cultural comparison can improve
management strategy [10]. The perception of the illness and
patients affects how the public interacts with them. Moreo-
ver, if an illness is perceived unrealistically, the public may
show less sympathy not only for the patient but also for the
families and caregivers [11].
This study aims to determine the public perception and
attitude towards Alzheimer’s disease in Jeddah, Saudi Ara-
bia. In addition, we aim to identify the religious and cultural
beliefs about the causes and treatment of Alzheimer’s dis-
ease in Saudi Arabia.
Methods
This is a cross-sectional study that was conducted in malls
and public places in Jeddah, Saudi Arabia. This study uti-
lized the stratified random sampling technique (probability
sampling technique) in the selection of respondents from
Jeddah, Saudi Arabia, that was based on the set eligibility
criteria. The set inclusion criteria include all Arabic-speak-
ing males and females of the general population that are
above the age of 18 years. The set exclusion criteria include
any male or female aged less than 18 years and persons who
are diagnosed with Alzheimer’s disease at any age. Data
collection started in January 2018 and was completed in
June 2018.
The instrument used in this study was a self-adminis-
tered questionnaire that consists of 40 items. Development
of this instrument included an initial preparatory phase, a
pilot study phase, and a final revision phase. In the prepara-
tory phase, we conducted a thorough literature search and
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Acta Neurologica Belgica
revised published studies concerning the perception and atti-
tude towards Alzheimer’s disease in the general population
worldwide. We then designed a questionnaire to evaluate the
perception and attitude. The questionnaire was prepared in
a simple and clear Arabic language. The questionnaire was
subjected to internal revision to check its validity. Next, we
conducted a pilot study on 15 persons to check the reliability
of the questionnaire. Any confusion or misunderstanding
identified in the questions were modified appropriately. The
final revision was then used in the primary study.
A total of 32 questions were included into the survey,
which was subdivided into 4 sources of information that
include general information about Alzheimer’s disease,
information about Alzheimer’s disease in the society, general
information about persons with Alzheimer’s disease, and
information about the care of persons with Alzheimer’s dis-
ease. In addition, eight questions were used to collect infor-
mation about the demographic profile of the participants.
All numerical values obtained from each item of the ques-
tionnaires as well as the demographic data were computed
and presented by frequency and percentage. Descriptive sta-
tistics such as means, median, and standard deviation were
used to summarize quantitative variables like age, etc. All
data collected were entered and analyzed using IBM Sta-
tistical Package for the Social Sciences (SPSS) version 23.
All questionnaires were anonymous, and confidentiality
of information was ensured. Instructions to complete the
questionnaire and confidentiality issues were explained on
the cover page of each questionnaire. Completion of the
questionnaire was considered as a consent to participate
in the study. This study was approved by the Institutional
Review Board (IRB) of King Abdullah International Medi-
cal Research Center (KAIMRC).
Results
Demographic profile
A total of 1698 individuals participated in the study. The
majority of the participants were between the ages of 21
and 40 (55.9%). The sex distribution showed that 852
participants were males representing 50.2% while 846
(49.8%) were females. The majority of the participants
were Saudi nationals (75.1%). More than 90% of partici-
pants were inhabitants of Jeddah city while the remaining
were visitors. Around 75% of the participants live with
their families. More than 60% of the participants had a
monthly income of less than 10,000 Saudi Riyal. Seven
hundred eighty-three participants (46.1%) were single
while 646 (38%) were married. The majority of the par-
ticipants were bachelor’s degree holders (33.6%) and high
Acta Neurologica Belgica

school graduates (30%). The detailed demographic data of General information about Alzheimer’s disease
the participants are shown in Table 1.
1511 participants (89%) heard about Alzheimer’s disease
before, and 1397 (82.3%) think that Alzheimer’s disease
causes memory loss. In addition, 786 participants (46%)
think that Alzheimer’s disease causes hand tremor while 494
(29.1%) did not know the answer to this question (Table 2).
Table 1  Demographic profile of the participants More than 60% of the participants believe that Alzhei-
Item Frequency % mer’s disease affects the elders while 23.2% believe that it
affects all ages. Around 46% of the participants think that the
Gender
cause of Alzheimer’s disease is a brain disease and 44.9%
 Male 852 50.2
think that is a normal part of aging. The main sources of
 Female 846 49.8
information for the participants about Alzheimer’s disease
Age range
were the internet (37.1%), the television (33.6%), and the
 18–20 365 21.5
relatives and friends (28.8%). Approximately, 30% of the
 21–30 565 33.3
participants believe that Alzheimer’s disease is treated with
 31–40 384 22.6
medications, 24.6% believe that there is no treatment, and
 41–50 195 11.5
17.5% believe that it can be treated by the recitation of
 51–60 64 3.8
Quran (Table 3).
 More than 60 125 7.3
Educational attainment
Information about Alzheimer’s disease in the society
 Uneducated 54 3.2
 Less than secondary 289 17.0
1080 participants (63.6%) said that they do not have any
 Secondary 509 30.0
family member or a friend who has Alzheimer’s disease
 Bachelor 570 33.6
and 1223 (72%) said that they would not hide the reality of
 Masters 138 8.1
Alzheimer’s disease in a family member. In addition, 864
 Ph.D. 47 2.8
(50.9%) think that Alzheimer’s disease causes great psy-
 Unclassified 91 5.4
chological and social stress. Seven hundred seventy-seven
Nationality
participants (45.8%) think that the persons with Alzheimer’s
 Saudi 1276 75.1
disease are a burden on the family. Around thirty percent of
 Non-Saudi 362 21.3
the participants think that the society stigmatizes persons
 Unclassified 60 3.5
with Alzheimer’s disease. More than 60% of the participants
Living condition
think that persons with Alzheimer’s disease should not be
 Alone 327 19.3
isolated from the society. About 55% of the respondents
 With family 1265 74.5
think that it is possible to go to a public place with persons
 Other 20 1.2
with Alzheimer’s disease. However, 24.1% do not know the
 Unclassified 86 5.0
answer (Table 4).
Monthly income
 Less than 5000 SR 626 36.9
General information about persons with Alzheimer’s
 5000–10,000 SR 411 24.2
disease
 10,000–15,000 SR 275 16.2
 15,000–20,000 SR 127 7.5
752 participants (44.3%) think that the lifespan of persons
 More than 20,000 SR 58 3.4
with Alzheimer’s disease is like others while 537 (31.6%)
 Unclassified 201 11.8
think that it is not like others. About 65% of the participants
Residential area
think that persons with Alzheimer’s disease cannot drive
 Jeddah city 1601 94.3
the car without any risk and 23.8% think that persons with
 Other 97 5.7
Alzheimer’s disease cannot play sports. More than 50% of
Marital status
the participants think that persons with Alzheimer’s disease
 Single 783 46.1
cannot take the decision by themselves in health matters
 Married 646 38.0
and cannot act by themselves in their financial matters.
 Divorced 111 6.5
Around 800 participants (48.2%) think that persons with
 Widowed 77 4.5
Alzheimer’s disease cannot shop and buy by themselves and
 Unclassified 81 4.8
that they are prone to fall when the disease progresses. Six

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Table 2  General information about Alzheimer’s disease

Questions Yes % No % Don’t know %

1 Did you ever hear about Alzheimer’s disease before? 1511 89.0 104 6.1 83 4.9
2 Do you think that Alzheimer’s disease causes memory loss? 1397 82.3 150 8.8 151 8.9
3 Do you think that Alzheimer’s disease causes hand tremor? 786 46.3 418 24.6 494 29.1

hundred eighty-four participants (40.3%) think that persons

with Alzheimer’s disease remember events that are distant
Table 3  General information about Alzheimer’s disease multiple and not nearby while 490 (28.9%) think that they remember
choice questions events that are nearby and not distant. More than 50% of
Item Frequency %
the participants think that the mental abilities of persons
with Alzheimer’s disease are not like others. Five hundred
Do you know certain age for Alzheimer’s disease? ninety-one participants (34.8%) believe that persons with
 Affects all ages 394 23.2 Alzheimer’s disease think that society will steal from them
 Children 128 7.5 or harm them while 528 (31.1%) believe that they do not.
 Young 57 3.4 More than 40% of the participants think that persons with
 Elders 1070 63.0 Alzheimer’s disease have depression and anxiety and that
 I don’t know 49 2.9 they need psychotherapy (Table 5).
What are the causes of Alzheimer’s disease?
 Punishment from God 89 5.2 Information about the care of persons
 Evil eye or magic 118 7.0 with Alzheimer’s disease
 Brain disease 794 46.8
 Madness 124 7.3 916 participants (53.9%) think it is better to alert persons
 Mental retardation 133 7.8 with Alzheimer’s disease that they are repeating the same
 Genetic disease 208 12.3 question and 1070 (63%) think that persons with Alzhei-
 Psychological disease 167 9.9 mer’s disease should be given simple instructions easy to
 Head injury 142 8.4 understand. In addition, 674 participants (53.9%) think that
 Normal part of aging 762 44.9 the use of notes and modern equipment does not lead to
 I don’t know 126 7.4 deterioration of the situation while 424 (25%) think that they
 Other 14 0.8 lead to deterioration of the situation. Also, 814 participants
What are your main sources of information about Alzheimer’s (47.9%) said that they do not know how to deal with persons
disease?
with Alzheimer’s disease and 1226 (72.2%) think that per-
 Personal experience 173 10.2
sons with Alzheimer’s disease need monitoring throughout
 Relatives and friends 489 28.8
the day. More than half of the participants (56.2%) think that
 Television 570 33.6
persons with Alzheimer’s disease should not be admitted to
 Internet 630 37.1
the nursing home (Table 6).
 School or university 204 12.0
 Books, magazines and newspapers 158 9.3
 Physician 107 6.3
Discussion
 Other 97 5.7
How to treat persons with Alzheimer’s disease?
This is the first comprehensive study to assess the perception
 There is no treatment 417 24.6
and attitude of the general population towards Alzheimer’s
 With medications 516 30.4
disease in Saudi Arabia. To the best of our knowledge, the
 Surgery 245 14.4
perception of Alzheimer’s disease in Saudi Arabia has not
 With the recitation of Quran 297 17.5
been assessed previously. Our study targeted the general
 Herbal therapy 91 5.4
public with the majority of the participants being between
 Traditional cauterization 14 0.8
the ages 21 and 40 (55.9%). The age of the Saudi popula-
 Electric shock 28 1.7
tion is shifting towards elderly with 6.5% of the population
 With yoga and meditation 118 7.0
being above the age of 60 in 2016, which is expected to
 I don’t know 358 21.1
exceed 25% in year 2050 [7]. This may suggest an invest-
 Other 24 1.4
ment in education and awareness of common diseases such

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Table 4  Information about Alzheimer’s disease in the society

Questions Yes % No % Don’t know %

1 Is there any family member or friend who is suffering from Alzheimer’s disease? 483 28.4 1080 63.6 135 8.0
2 Would you hide the reality of Alzheimer’s disease in a family member? 272 16.0 1223 72.0 203 12.0
3 Do you think Alzheimer’s disease causes great psychological and social stress? 864 50.9 400 23.6 434 25.5
4 Do you think that persons with Alzheimer’s disease are a burden on the family? 777 45.8 631 37.2 290 17.0
5 Do you think the society stigmatizes persons with Alzheimer’s disease? 534 31.4 689 40.6 475 28.0
6 Do you think that persons with Alzheimer’s disease should be isolated from the society? 359 21.1 1044 61.5 295 17.4
7 Is it possible to go to a public place with persons with Alzheimer’s disease? 927 54.6 362 21.3 409 24.1

Table 5  General information about persons with Alzheimer’s disease

Questions Yes % No % Don’t know %

1 Do you think that the lifespan of persons with Alzheimer’s disease is like others? 752 44.3 537 31.6 409 24.1
2 Can persons with Alzheimer’s disease drive the car without any risk? 309 18.2 1111 65.4 278 16.4
3 Do you think that persons with Alzheimer’s disease can play sports? 1019 60.0 404 23.8 275 16.2
4 Do you think that persons with Alzheimer’s disease can decide by themselves in health 329 19.4 978 57.6 391 23.0
matters?
5 Do you think that persons with Alzheimer’s disease can act by themselves in their financial 297 17.5 984 58.0 417 24.6
matters?
6 Do you think that persons with Alzheimer’s disease can shop and buy by themselves? 512 30.1 798 47.0 388 22.9
7 Do you think that persons with Alzheimer’s disease are prone to fall when the disease 818 48.2 363 21.4 517 30.4
progresses?
8 Do you think that persons with Alzheimer’s disease remember events that are nearby and 490 28.9 684 40.3 524 30.8
not distant?
9 Do you think that the mental abilities of persons with Alzheimer’s disease are like others? 365 21.5 945 55.7 388 22.8
10 Do you think that persons with Alzheimer’s disease have depression and anxiety? 733 43.2 441 26.0 524 30.8
11 Do you think that persons with Alzheimer’s disease think that society will steal from them 591 34.8 528 31.1 579 34.1
or harm them?
12 Do you think persons with Alzheimer’s disease need psychotherapy? 711 41.9 453 26.7 534 31.4

Table 6  Information about care of persons with Alzheimer’s disease

Questions Yes % No % Don’t know %

1 Do you think it is better to alert persons with Alzheimer’s disease that they are repeating the 916 53.9 453 26.7 329 19.4
same question?
2 Do you think that persons with Alzheimer’s disease should be given simple instructions easy 1070 63.0 355 20.9 273 16.1
to understand?
3 Do you think that the use of notes and modern equipment leads to deterioration of the situa- 424 25.0 674 39.7 600 35.3
tion?
4 Do you know how to deal with persons with Alzheimer’s disease? 435 25.6 814 47.9 449 26.5
5 Do you think persons with Alzheimer’s disease need monitoring throughout the day? 1226 72.2 283 16.7 189 11.1
6 Do you think persons with Alzheimer’s disease should be admitted to the nursing home? 486 28.6 955 56.2 257 15.2

as Alzheimer’s disease and other dementias in this age group
and other age groups is worthwhile.
During the past few years, significant scientific progress
has been made in the understanding of cognition and demen-
tia, including Alzheimer’s disease. Advances have been
made in the understanding of the causes and risk factors
including genetics [12]. However, this was not reflected in
our study since the majority of the participants did not dem-
onstrate adequate knowledge about different aspects of the
disease and its treatment. It would be expected that educa-
tion of the general public is associated with better knowledge
of Alzheimer’s disease and favorable outcomes. Despite that
approximately 60% of the participants in our study were
bachelor’s degree holders and high school graduates, they

13

demonstrated low knowledge, which is probably due to poor
educational materials available in the internet and television
in the Arabic language and lack of awareness campaigns. In
addition, there is a need in services to be provided including
counseling, patient self-help groups, and psycho-education
groups.
Persons with Alzheimer’s disease typically show symp-
toms of impaired memory and decision-making abilities
in addition to other issues with their behavior and verbal
abilities [13]. Memory loss was selected by more than 80%
of the participants of this study. Although up to one-third
of patients with Alzheimer’s disease manifest parkinsonian
features including resting tremor, the classical Alzheimer’s
disease patients usually do not have a resting tremor, espe-
cially in the early phase of the disease [14]. In our study,
46% of the participants thought that Alzheimer’s disease
causes hand tremor, which is incorrect. This demonstrated a
clear knowledge issue regarding the symptoms of the disease
and suggests a very weak health literacy.
Although Alzheimer’s disease is known to be a disease
of the elderly, around 33% of the participants in our study
believe that Alzheimer’s disease may affect children and
young adults. One of the most common misconceptions
about Alzheimer’s disease is that its symptoms represent a
normal part of aging, which was thought by around 45% of
the participant of this study. The distinction between nor-
mal memory loss and Alzheimer’s disease remains unclear
among the general public of Saudi Arabia. These results are
similar to other international studies with racial differences
which indicates the need for raising awareness of Alzhei-
mer’s disease at the national and international level. Other
misconceptions include associating Alzheimer’s disease
with insanity or madness and in some cases people perceive
Alzheimer’s disease as a punishment from God, which was
also shown in a minority of our study population. In addi-
tion, the influence of cultural beliefs and religion was rela-
tively strong since 17.5% of the study population believed
that the disease can be treated with the recitation of Quran,
the Islamic holy book. Culture contributes significantly to
shaping the health beliefs and attitudes of individuals. Cul-
tural stigma and misconceptions about Alzheimer’s disease
may be a major reason for the delay in diagnosis and treat-
ment [15].
Saudi Arabia has witnessed a tremendous transition from
being a third world country to become one among the group
20 (G20) countries. Several changes were seen in the Saudi
community in the past few years including the spread of the
internet and social media with less interest in paper-based
knowledge sources including books, magazines, and news-
papers [16]. This was reflected in our study since the major
sources of information were the internet and television. In
addition, healthcare has improved significantly with the
presence of more than 500 hospitals in Saudi Arabia [17].
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Acta Neurologica Belgica
Despite this fact, only 6.3% of knowledge about Alzheimer’s
disease was received from physicians. This indicates that
physicians and hospitals still have a long way to go regarding
their contribution to the education of the society. Personal
experience and word of mouth from the relatives and friends
still contributes a lot to the knowledge of the community
regarding Alzheimer’s disease.
Over the past two decades, several new treatments have
been developed that slow the progression and alter the
symptoms of Alzheimer’s disease. In addition, several novel
therapies are currently being investigated and will add to the
treatment options in the near future [18]. In our study, only
30% of the participants believe that Alzheimer’s disease can
be treated with medications. The rest of the sample believe
that there is no treatment or other modalities such as surgical
or alternative medicine can be of help in the management
of patients with Alzheimer’s disease. Among the shocking
results in this sample was the perception of treatment of
Alzheimer’s disease with herbal therapy, electric shock, and
traditional cauterization.
Although 28.4% of the sample in our study have experi-
ence with Alzheimer’s disease in a family member or friend
and 63.6% do not have this experience, significant stigmati-
zation exists regardless of the experience with the disease in
the family. Around half of the participants of this study think
that Alzheimer’s disease causes great psychological and
social stress and that persons with Alzheimer’s disease are
a burden on the family. However, 56.2% of the participants
think that persons with Alzheimer’s disease should not be
admitted to the nursing home, which is probably influenced
by social and religious reasons.
The impact of stigmatization is magnified by the fact that
stigma is attached not only to the individual with mental
illness but also to the individual’s family [19]. In our study,
around forty percent of the participant think that the society
does not treat persons with Alzheimer’s disease with stigma-
tization while 31.4% think that the society treats them with
stigmatization, which indicates an urgent need for public
education to avoid such stigmatization. More than 60% of
the participants think that persons with Alzheimer’s disease
should not be isolated from the society and 54.6% think that
it is possible to go to a public place with persons with Alz-
heimer’s disease, which indicated an openness from a large
proportion of the society regarding persons with Alzheimer’s
disease, but the proportion needs to be increased.
Impairments in driving ability and decision-making
abilities such as medical decision-making and financial
management may be present even in early Alzheimer’s
disease. A lack of knowledge or misunderstanding about
Alzheimer’s disease may hinder the general public or their
patients from seeking help at an early stage. In addition,
it may prevent caregivers from planning upcoming social
and financial challenges [20]. This was clearly reflected in
Acta Neurologica Belgica
our study regarding social and financial activities such as
driving a car, playing sports, dealing with financial matters,
and shopping. It is important to realize that certain patients
with Alzheimer’s disease may retain for a certain period of
time the ability to drive or to decide by themselves, at least
regarding their medical treatment options. In this condition,
they should be given the chance to decide for themselves
regarding these issues.
In a study done by Barnes et al. [21] on the relationship
between the pathology and memory complaints, they found
that memory complaints were associated with the pathol-
ogy both with or without a clinically diagnosed Alzheimer’s
disease. In our study, 21.5% of the participants think that the
mental abilities of persons with Alzheimer’s disease are like
others and 40.3% do not think that Alzheimer’s disease does
not affect recent memory more than remote memory. These
findings reveal that the study sample considers Alzheimer’s
disease as a disease of memory. However, more work needs
to be done in regards to the dissemination of knowledge also
about other common forms of dementia.
Persons with Alzheimer’s disease experience a wide
range of behavioral disturbances such as affective symptoms,
aggression, agitation, and psychosis. These disturbances are
associated with increased caregiver burden, more use of psy-
chotropic medications, faster cognitive decline, and earlier
institutionalization. Given the nature of these behavioral
disturbances and the limited availability of pharmacologi-
cal interventions and their negative side effects, behavio-
ral interventions and environmental modifications may be
among the most helpful strategies for managing undesired
behaviors [22]. Around one-third of the sample do not know
whether Alzheimer’s patients have psychiatric symptoms or
need psychotherapy.
Activities of daily living become challenging when Alz-
heimer’s disease progresses, which affects the patients, their
families, and caregivers. Caregivers have more responsibili-
ties and duties including providing continuous medical care,
attending to the daily needs and requirements of the patient,
monitoring patient’s behaviors, seeking and dealing with
healthcare providers, and negotiating medications. Primary
caregivers experience an increase in visiting their doctors, a
decline in health and weight, and an increased rate of anxiety
and depression [23]. The majority of the participants in our
study think that persons with Alzheimer’s disease should be
given simple instructions easy to understand and that they
need monitoring throughout the day. A major proportion
said that they do not know how to deal with persons with
Alzheimer’s disease.
Adding ‘‘don’t know’’ response option in our questionnaire
allowed us to identify some knowledge gaps in the public. A
good proportion of the participants were uncertain about sev-
eral items about Alzheimer’s disease and persons with Alzhei-
mer’s disease. In particular, lack of knowledge about available
treatment for Alzheimer’s disease may lead to delay in seeking
appropriate treatment and improving the quality of life.
Our study is one of a few studies that have investigated
the level of knowledge of Alzheimer’s disease in the gen-
eral public. It revealed gaps in knowledge about Alzheimer’s
disease among the Saudi general public in particular in the
areas of patient care and treatment. It would be interesting
to compare the results of our study with those coming from
the Gulf region and the Middle East. However, to the best of
our knowledge and upon a meticulous literature review, we
found no research published from these countries. There is a
need for educational interventions to be planned for the general
public to raise awareness of Alzheimer’s disease. In addition,
the identity of the person with dementia and attitudes towards
that is underrepresented. In spite of some limitations to our
study, we believe that the results from this study advance our
understanding of knowledge and perception of dementia and
Alzheimer’s disease.
Conclusion
The results of the present study suggest that the perception of
the general public of Alzheimer’s disease is lagging behind.
Many wrong beliefs were identified in the general public
regarding the causes and management. The findings of our
study suggest that more information about Alzheimer’s dis-
ease would be valuable and beneficial for everyone. Aware-
ness campaigns and public education are needed to increase
the knowledge of the general public regarding several aspects
of the disease including prevention, causes, and management.
Dissemination of information about Alzheimer’s disease
should be of high priority. Increased awareness will lead to
earlier detection of Alzheimer’s disease and other dementia
cases and appropriate care and management of those persons.
Compliance with ethical standards 
Conflict of interest  The authors declare that they have no conflicts of
interest.
Informed consent  Completion of the questionnaire was considered as
a consent to participate in the study.
Ethical approval  This study was approved by the Institutional Review
Board (IRB) of King Abdullah International Medical Research Center
(KAIMRC).
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