Original Article

Yonago Acta Medica 2017;60:47–51

Factors Affecting Intention to Undergo Dementia Screening
Shinya Takeda,* Maki Ota† and Toshiatsu Taniguchi‡*Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan, †Division of
Neuropsychiatry, Department of Brain and Neurosciences, School of Medicine, Tottori University Faculty of Medicine, Yonago 6838503, Japan and ‡Department of Psychology, Fukuyama University, Fukuyama 729-0292, Japan

ABSTRACT

population by 2050.1 Increased age is a risk factor for
dementia.2 Therefore, as the world’s population ages, thenumber of people suffering from dementia is expected torise. In Japan, it was reported the prevalence of dementia
in the elderly population aged 65 years and older is 11.0.3
Although there is no definitive treatment for dementia, treatment with anti-dementia drugs such as donepezil tends to be more effective in the early stages of thedisease. In addition, amyloid β-targeted curative therapy
to prevent the progression of dementia of the Alzheimer type is being developed, and early diagnosis may
become even more important for effective treatment.
Because the progression of dementia leads to a decreasein the activities of daily living (ADL) and an increase in
the need for nursing care, suffering and distress experienced by the patient, the burden on the family members,
and significant economic burden on the healthcare system also increase. Early detection of dementia is thus a
key public health imperative not only in Japan but also
in other parts of the world.
Ability to detect mild dementia is necessary for its
early detection; however, signs of mild dementia arelikely to be overlooked in primary care settings.4 Inadequate knowledge and awareness pertaining to dementia
among family caregivers and healthcare professionals
such as doctors is believed to be a key underlying reason. Thus, screening tests for mild dementia are being
developed. The 7-Minute Screen was developed primarily as a screening tool for Alzheimer’s disease (AD). It
is a preliminary test of four cognitive functions; timeorientation, memory, visuospatial cognition, and speech
production. The tool has a reported sensitivity of 90%
and a specificity of 92% for mild AD.5 The Montreal
Cognitive Assessment comprises tasks that assess various cognitive functions, including memory, language,
executive function, working memory, visuospatial cognition, conceptual thinking, and orientation. It has a sensitivity of 90% and a specificity of 87% for mild cognitive

BackgroundIn the present study, we focused on themain perception-related factors that affect people’s intention to undergo dementia screening.
Methods The 344 subjects that answered all the survey questions were included in the analysis. Data on thefollowing variables were collected: Basic attributes suchas age, sex, years of education, and number of people in
the household; degree of intention to undergo dementia
screening; degree of awareness of the seriousness ofthe consequences of dementia; degree of awareness thatthe person may someday develop dementia; degree ofawareness of their ability to prevent dementia; availability of social support; degree of knowledge of lifestyle
habits that can prevent dementia; role in the communityand purpose in life.
Results There were 110 people in the strong intention
group and 234 people in the weak intention group. On
univariate analysis, awareness of seriousness, awareness of morbidity, preventability, and knowledge ofpreventative lifestyle were statistically significant at asignificance level of 5%, and these variables tended to behigher in the strong intention group as compared to thatin the weak intention group. These were entered in thelogistic regression analysis as the explanatory variables,
and intention to undergo screening was entered as theobjective variable. The results indicated that awarenessof seriousness and knowledge of preventative lifestyle
had significant influence on intention to undergo screening.
Conclusion The above results suggested that to increase the intention to undergo dementia screening,
psychoeducation that encourages people to understandthe serious consequences of dementia, efforts to spreadawareness of the risk factors for dementia, and promotion of lifestyle factors that are preventative may be effective.
Key words dementia screening; intention to undergo
dementia screening; predictive factor

Corresponding author: Shinya Takeda, PhD
takedas@med.tottori-u.ac.jp
Received 2016 November 24
Accepted 2017 January 26
Abbreviations: AD, Alzheimer’s disease; ADL, activities of dailylivingPopulation aging is a phenomenon seen not only in Japan but also in other parts of the world. According toa United Nations report, people aged ≥ 60 years willaccount for an estimated one-fifth of the total world47

S. Takeda et al.

impairment.6 The Takeda Three Colors Combination
Test is a simple test of visuospatial cognition and recent
memory that can be completed in 1 min. Its reported
sensitivity and specificity for detection of mild AD are
85% and 87%, respectively.7 In addition, it has a sensitivity of 76% for very mild AD.8 The Memory Impairment
Screen is reproduction task, which employs the use offour words. It has been reported to have a sensitivity of
87% and a specificity of 96% for mild AD.9
Although the development of effective screening
tests for mild dementia continues, some municipalities in Japan are concurrently implementing dementia
screening initiatives. However, the coverage of thesescreening initiatives has remained low. Galvin et al.
reported that the self-perceived benefits of screening aswell as people’s sense of self-efficacy and their knowledge of dementia were associated with people’s intention
to undergo screening tests for dementia.10 However, they
did not observe any significant correlation between thepeople’s perception of social support and their intention
to be screened. The factors that affect people’s intention
to undergo dementia screening have not been sufficiently investigated in Japan. Beck reported that perception
is a direct motivator that induces behavior.11 Thus, elucidation of the perceptual factors that increase people’s
intention to undergo dementia screening can help devise
interventions to modify those perceptions for improving
the rate of dementia screening. Therefore, in the present
study, we focused on the main perception-related factors that affect people’s intention to undergo dementia
screening.

selected people registered as members of the above associations. Inclusion criteria were men and women aged
≥ 60 years. Exclusion criteria were as follows: i) known
cases of dementia requiring regular visits to medical
facilities; ii) those who underwent a memory loss test at
a medical facility or elsewhere within the previous year
and iii) those who had appointments to undergo memory loss testing in an outpatient setting or to undergo acomprehensive medical evaluation of the brain. Survey
forms were returned by 431 people, who corresponded
to a response rate of 86.2%. Of these, 344 people [74men, 270 women; mean age (SD): 71.6 (± 6.7) years] had
answered all the survey questions and therefore were included in the analysis.
Methods

Data on the following variables were collected: Basic attributes such as age, sex, years of education, andnumber of people in the household; degree of intention
to undergo dementia screening (intention to undergo
screening); degree of awareness of the seriousness of theconsequences of dementia (awareness of seriousness);
degree of awareness that the person may someday develop dementia (awareness of morbidity); degree of awareness of their ability to prevent dementia (preventability);
availability of social support (includes three items: social
support); degree of knowledge of lifestyle habits that can
prevent dementia (knowledge of preventative lifestyle);role in the community and role and purpose in life (role/
purpose). The survey questions are shown in Table 1.
The survey was based on the Health Belief Model12 andthe method reported by Galvin et al.10 The social support
section was the only part that comprised 3 items. Allother sections comprised 1 item each. Items from “intention to undergo screening” to “social support” were rated on a 4-step scale as follows: “No” (0 points), “Probablynot” (1 point), “Perhaps” (2 points), and “Yes” (3 points).
For “knowledge of preventative lifestyle,” the choices
were: “Not at all” (0 points), “Not very much” (1 point),

SUBJECTS AND METHODS
Subjects

Members of the Hachinohe Medical Cooperative Association, Kagawa Medical Cooperative Association,
and Kochi Medical Cooperative Association comprised
the study population. Survey forms were sent by post
between June 2015 and January 2016 to 500 randomly
Table 1. Questions
1

If there is a dementia screening conducted in your community during this fiscal year, would you undergo screening?

2

If you developed dementia, do you think the consequences would be serious (would it be a problem)?

3

Do you think that you may develop dementia someday?

4

Do you think that it is possible to prevent dementia?

5

Is there someone who can help you when you have such a problem?

6

Is there someone who takes care of you when you are sick in bed?

7

Is there someone who will listen to you talking about your worries and problems?

8

Do you know about lifestyle habits that can help prevent dementia?

9

Do you feel you play a role in your family and community and a purpose for living?

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Intention to undergo dementia screening
Table 2. Differences between the strong intention and weak intention groups

Age
Sex
Male
FemaleYears of education
Household
Living together
Solitary life
Awareness of seriousness
Awareness of morbidity
Preventability
Social support
Knowledge of preventative lifestyle
Role/purpose

The strong intention group(N = 110)

The weak intention group(N = 234)

Statistic (P)71.4 ± 6.9

71.7 ± 6.7

t = 0.5 (P = 0.643)

1892
12.3 ± 2.1

56178
12.6 ± 2.1

χ2 = 2.5 (P = 0.111)

85
25
3 (3-3)2 (2-3)2 (2-2)6 (6-8)2 (2-3)2 (2-3)18549
3 (2-3)2 (2-2)2 (2-2)6 (6-7)
2 (2-2)2 (2-3)“Somewhat” (2 points), and “Very well” (3 points). For“role/purpose,” the choices were “Not at all” (0 points),“Not very much” (1 point), “Somewhat” (2 points), and“Very much” (3 points).

t = 1.3 (P = 0.189)
χ2 = 0.1 (P = 0.707)
P = 0.001
P = 0.001
P = 0.015
P = 0.311
P = 0.011
P = 0.624

jects in the study, and that there will be no negative repercussions of either providing consent to participate orof refusal to provide consent. Those who returned completed survey forms were deemed to have consented toparticipate in the study. This study was conducted withthe approval of the Institutional Review Board at the
Tottori University Faculty of Medicine (No. 1601A135).

Statistical analysis

For the items related to intention to undergo screening,those who answered “Yes” were placed in the strong intention to undergo screening (strong intention) group andthose who answered “No,” “Probably not,” and “Perhaps”
were placed in the weak intention to undergo screening(weak intention) group. We used the t-test, the chi-square
test, and the Mann-Whitney U test to assess differences
between the strong intention and weak intention groups
with respect to age, sex, and years of education of the respondent, number of people in the household, awarenessof seriousness, awareness of morbidity, preventability,
social support, knowledge of preventative lifestyle, androle/purpose. Variables that showed significant differences (P < 0.05) in the univariate analysis were entered
as explanatory variables in the logistic regression modelwith the intention to undergo screening as the objective
variable. For variables that showed significant differences, responses of 0 to 2 points were designated as 0 and
those of 3 points were designated as 1 as a dummy variable. Data analysis was performed using the IBM SPSS(version 22.0) software (IBM, Armonk, NY).

RESULTS
There were 110 people (32%) in the strong intention
group and 234 people (68%) in the weak intention group.
Attributes of the study population disaggregated bystudy group are shown in Table 2. On univariate analysis, awareness of seriousness, awareness of morbidity,
preventability, and knowledge of preventative lifestyle
were statistically significant at a significance level of 5%,
and these variables tended to be higher in the strong intention group as compared to that in the weak intention
group.
These were entered in the logistic regression analysis as the explanatory variables, and intention to undergo
screening was entered as the objective variable. The results indicated that awareness of seriousness [odds ratio(OR): 5.7, 95% confidence interval (CI): 3.0–11.0] andknowledge of preventative lifestyle (OR: 2.0, 95% CI:
1.2–3.4) had significant influence on intention to undergo
screening.

Ethical considerations

DISCUSSION

In addition to a written description of the purpose of thisstudy, written explanations were provided about the factthat the data collected through the course of this study
will be rendered anonymous prior to analysis, that only
those who provide consent would be registered as sub-Based on the results of this study, 32% of the total number of subjects showed a strong intention to undergo
dementia screening. Because no previous studies haveinvestigated the percentage of people who intend toundergo dementia screening, it is impossible to conduct
49

S. Takeda et al.

a relative assessment of this result. However, we believe this is not a high figure; our study calls for further
research into possible ways to increase the dementia
screening rate.
Univariate analysis indicated that people who hada strong intention to undergo dementia screening weremore likely to perceive dementia as a serious illness
and to believe themselves to be at a risk of developing dementia in future as compared to the people who
showed a weak intention to undergo dementia screening.
The Health Belief Model emphasizes that subjectively
perceived benefits associated with a sense of threat of
disease and the related behaviors instigate preventative
health behaviors.12 The subjective threat of disease isdetermined by the subjective possibility of morbidity
expressed as “a personal estimation regarding the possibility of developing a disease” and a subjective sense of
the severity of the disease expressed as “an estimationof the degree to which participation in social activities
will be negatively affected as a result of the disease.”
The fact that those with a stronger intention to undergo
screening showed an increased awareness of the severityof the disease and possibility of morbidity than thosewith a weaker intention to undergo screening is supported by the theory presented by Stretcher & Rosenstock.12
Meanwhile, those with a stronger intention to undergo
screening were more likely to believe that dementia
could be prevented than those who had a weaker intention to undergo screening. According to the Health Belief Model, higher level of awareness of the benefits of
preventative health behaviors is more likely to motivate
people for engaging in preventative health behaviors.
Awareness of the benefit of preventative health behaviors is influenced by a subjective sense of expectation
involved in benefits expressed as “what degree of benefit
can I anticipate by engaging in a certain behavior thatwill allow me to avoid developing a disease?” Perceptionof preventability expressed as “dementia can be prevented” is an indication of subjective benefit, and we believe
it is for this reason that those with a strong intention toundergo screening had higher scores than those with aweak intention to undergo screening.
Logistic regression analysis indicated that the intention to undergo dementia screening was significantly related to awareness of the seriousness of the disease andknowledge of preventative lifestyle. Those who perceived
dementia as a disease with serious consequences had a
6-fold stronger intention to undergo dementia screening
than those who were not as strongly convinced about theserious consequences. The results of this study also indicated that awareness of morbidity, which showed a significant association on univariate analysis, did not affectthe intention to undergo dementia screening. Stretcher& Rosenstock reported that awareness of the seriousnessof the disease was a more powerful predictive factor for
subsequent behavior modification than awareness of themorbidity of any given disease. In the present study also
the awareness of the seriousness of a disease appeared tohave a greater influence on preventative health behavior
as compared to merely the awareness of the morbidity
owing to dementia. In addition, in the present study,
those who were well aware of the lifestyle habits that
could prevent dementia had a 2-fold stronger intention
to undergo dementia screening than those who were
not so well aware of these lifestyle habits. According toBandura’s social learning model, the expectation that acertain behavior will lead to a desired result increases
the motivation to engage in the behavior in question.13
Thus, knowledge of lifestyle habits that can prevent dementia induces an expectation of a desired result, i.e.,prevention of dementia is likely to affect the intention
to undergo dementia screening. The result that awareness of social support does not affect the intention toundergo dementia screening is consistent with findings
reported by Galvin et al.10 Honda14 investigated factorsthat influence the participation of Japanese Americans
in colorectal cancer screening. Among the various formsof social support, emotional support was reported to bea particularly important factor associated with increased
participation in colorectal cancer screening. The resultsof the present study contradict those reported by Honda.
In Japan, there are many people who consider dementia
as a “disease that causes trouble to others,” and this may
be the reason why social support did not appear to affectthe intention to undergo dementia screening.
The above results suggested that to increase the intention to undergo dementia screening, psychoeducationthat encourages people to understand the serious consequences of dementia, efforts to spread awareness of
the risk factors for dementia, and promotion of lifestylefactors that are preventative may be effective. Empiricalinvestigation of how to increase awareness of the seriousness of dementia through these efforts and whether
increasing people’s knowledge of preventative habits
actually increases the number of people who undergo
dementia screening are required in future.
Finally, some limitations of the present study are
acknowledged. The survey was administered to people
living in three different regions. Inter-regional differences with respect to the awareness of dementia-related issues may have influenced our results. Moreover,survey respondents who were members of health carecooperatives are likely to be more interested in healththan the general population; therefore, the findings may
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Intention to undergo dementia screening

not be entirely representative of the general population.
To eliminate such regional and selection biases, it is necessary to recruit subjects more widely and to examine
the factors that affect the intention to undergo dementia
screening after adjusting for potential differences in the
degree of awareness of dementia in the region.

5 Solomon PR, Hirschoff A, Kelly B, Relin M, Brush M,
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K, Lewis FM, Rimer BK, editors. Health behavior and healtheducation. San Francisco: Jossey-Bass; 1997. p. 41-59.
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Acknowledgments: The authors would like to express their deep
appreciation to Ms. Yoshiko Oshima of the Hachinohe Medical
Cooperative Association, Ms. Yuka Ogura of the Kagawa Medical
Cooperative Association, and Mr. Ken Takahashi of the Kochi
Medical Cooperative association as well as all the participants
who cooperated in this survey. This work was supported by
MEXT KAKENHI (26380928).
The authors declare no conflict of interest.

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