Applied Neuropsychology: Adult

ISSN: 2327-9095 (Print) 2327-9109 (Online) Journal homepage: http://www.tandfonline.com/loi/hapn21

Dementia worry and its relationship to dementia

exposure, psychological factors, and subjective
memory concerns

Adrianna Kinzer & Julie A. Suhr

To cite this article: Adrianna Kinzer & Julie A. Suhr (2016) Dementia worry and its relationship
to dementia exposure, psychological factors, and subjective memory concerns, Applied
Neuropsychology: Adult, 23:3, 196-204, DOI: 10.1080/23279095.2015.1030669

To link to this article: http://dx.doi.org/10.1080/23279095.2015.1030669

Published online: 23 Oct 2015.

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 APPLIED NEUROPSYCHOLOGY: ADULT
2016, VOL. 23, NO. 3, 196–204
http://dx.doi.org/10.1080/23279095.2016.1030669

Dementia worry and its relationship to dementia exposure, psychological

factors, and subjective memory concerns
Adrianna Kinzer and Julie A. Suhr
Psychology, Ohio University, Athens, Ohio

ABSTRACT KEYWORDS
With increased societal awareness of dementia, older adults show increased concern about Cognitive testing; dementia;
developing dementia, leading to misidentification of aging-related cognitive glitches as signs of dementia worry; mild
dementia. While some researchers have suggested self-reported cognitive concerns accurately cognitive impairment;
identify older adults with early signs of dementia, there is evidence that subjective cognitive self-report; subjective
cognitive decline
decline is not associated with objective cognitive performance and instead reflects psychological
factors consistent with models of health anxiety, including dementia worry. We examined the
construct of dementia worry and its relationship to subjective memory concerns in 100 older adults
(Mage ¼ 69 years) without signs of dementia, using a recently developed measure of dementia
worry. Consistent with hypotheses, dementia worry was related to exposure to dementia, having
a high number of depressive or general worry symptoms, and having more memory concerns.
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Exposure to dementia moderated the relationship of dementia worry to depression and general
worry. Furthermore, dementia worry moderated the relationship of objective memory impairment
to subjective memory ratings. The results provide further evidence of the role of psychological
factors such as dementia worry in subjective memory report and emphasize the need for objective
cognitive testing before making determinations about dementia in older adults expressing
memory concerns.

Introduction necessary for accurate diagnosis, diagnostic criteria for

mild cognitive impairment include subjective memory
Earlier diagnosis of dementia should help to slow
complaints and may lead to overfocusing on the presence
its progression by providing earlier treatment and/or
of self-reported cognitive symptoms and perceived
identifying contributing factors (such as other health
decline without a more thorough evaluation, resulting
concerns) that could be treated to help minimize decline
in misclassification and misdiagnosis (Bondi et al., 2014;
(Cutler & Hodgson, 1996). Thus, campaigns to educate
Clark et al., 2013; Edmonds, Delano-Wood, Clark, et al.,
the public about the symptoms of early dementia and
2015; Edmonds, Delano-Wood, Galasko, Salmon, & Bondi,
development of easily administered screening tools for
2014). Recently, some researchers have suggested that
dementia are beneficial. However, it is also important
analysis of subjective cognitive decline might detect the ear-
to remember that there are potential negative conse-
liest signs of dementia and thus could be used as an effec-
quences to awareness campaigns and screening tests,
tive screening tool for identifying early signs of dementia
which have a high false-positive rate. For older adults,
(Amariglio, 2013; Jessen et al., 2014; Koppara et al., 2013;
it can be difficult to separate changes that result from
Kryscio et al., 2014). However, it is important to note that
healthy aging from symptoms that result from disease
subjective cognitive decline may not be accurate in all cases.
(George, 2001). Older adults who have a great deal of
For example, Alladi, Arnold, Mitchell, Nestor, and Hodges
anxiety about potentially having dementia may pay
(2006) found that of 124 individuals presenting to a mem-
heightened attention to normal age-related cognitive
ory clinic for concerns about dementia, 18% showed no
changes and misattribute them as “symptoms” of a
evidence of cognitive impairment after careful evaluation;
disease, which could contribute to misdiagnosis of mild
they referred to these individuals as the “worried well.”
cognitive impairment or early dementia.
Jonker, Geerlings, and Schmand (2000) reviewed studies
Although guidelines for diagnosing dementia and
examining the accuracy of self-reported cognition relative
mild cognitive impairment (McKhann et al., 2011;
to actual cognitive findings and found that in studies
Petersen, 2004; Petersen et al., 1999; Winblad et al., 2004)
of community members paid to participate in research,
emphasize that evidence of actual cognitive decline is

CONTACT Julie A. Suhr suhr@ohio.edu Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701
© 2016 Taylor & Francis

subjective cognitive decline accurately predicted cognitive
decline. However, in studies including treatment seekers
presenting to clinics for treatment or evaluation, subjective
report did not predict cognitive decline. More recently,
Silva et al. (2014) and Gifford et al. (2014) demonstrated
that subjective memory complaints were not predictive
of conversion to dementia in older adults presenting to
a clinic for evaluation. In another recent study using
participants of the Alzheimer’s Disease Neuroimaging
Initiative (Edmonds, Delano-Wood, Clark, et al., 2015),
there was no relationship between subjective cognitive
complaints and objective cognitive functioning. Thus,
it is imperative that clinicians (and researchers) consider
other factors that might contribute to an older adult’s
report of cognitive changes and concerns.
One such factor might be an overfocus on everyday
cognitive changes associated with normal aging due to
worry about potentially developing dementia. Psycho-
logical models health anxiety development emphasize
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both experiential factors (such as learning about a dis-
order from public education campaigns or observing
the disorder in a family member) and premorbid
individual difference factors (anxiety, depression, con-
scientiousness, belief in negative aging stereotypes) that
can influence the development of personal anxiety that
one has a particular disease or illness (Warwick &
Salkovskis, 1990; Williams, Wasserman, & Lotto, 2003).
Consistent with health anxiety models, these “worried
well,” who are concerned about subjective declines in
cognitive functioning but who do not show objective
signs of impairment, are likely to interpret everyday cog-
nitive lapses as signs of memory decline or impairment
despite other evidence to the contrary and are more
likely to seek out other signs or symptoms and search
for the disease in their own behaviors (Cutler & Hodgson,
1996; Suhr & Kinkela, 2007). Although vigilance to one’s
symptoms could lead to early detection of disease,
hypervigilance to “symptoms” and excessive anxiety
about normal age-related cognitive changes may increase
the likelihood of misdiagnosis and inappropriate treat-
ment in that individuals may be given dementia medica-
tions with negative side effects, and opportunities for
effective treatment for other conditions contributing to
the subjective sense of cognitive decline may be missed.
One factor that may contribute to an older adult
viewing a cognitive lapse (a common occurrence in
aging) as a more serious concern is by knowing his or
her potential risk for the disorder. For example,
Lineweaver, Bondi, Galasko, and Salmon (2014) exam-
ined Apolipoprotein E status (and awareness of that sta-
tus) in a sample of older adults. Those who had an E4
allele and knew that they had an E4 allele self-reported
worse memory ability and also performed worse on
APPLIED NEUROPSYCHOLOGY: ADULT 197
cognitive tasks relative to those who had an E4 allele
but who did not know it; individuals who did not have
an E4 allele and knew that they did not have an E4 allele
reported much better cognitive abilities than did those
who did not have an E4 allele but did not know
it (although these two groups did not differ in actual
cognitive performance). Therefore, it was knowledge
of risk status rather than actual risk status that was
related to subjective cognitive reporting (and poten-
tially objective cognitive performance). An experiential
factor that might also lead to interpretation of an
everyday cognitive lapse as a sign of dementia might
be personal exposure to someone with dementia (e.g.,
having a biological family member with dementia or
serving as a caregiver for someone with dementia),
which might increase the sense of personal risk for
dementia and provide personal knowledge about
dementia symptoms and the impairment they cause,
leading to anxiety and excessive worry about “signs”
of dementia in oneself.
The construct of dementia worry has been inconsis-
tently operationalized and assessed in existing literature.
Prior studies have examined the construct of perceived
dementia threat (Cutler & Hodgson, 1996, 2001), which
focuses on whether an individual perceives himself or
herself to be at higher risk for dementia than others
based on response to a single item. Lachman, Bandura,
Weaver, and Elliott (1995) also focused on the belief
that one is personally likely to develop dementia at some
point in the future, although assessed with multiple
items. Roberts (2000) expanded the construct of
perceived dementia threat by examining not only
individuals’ perceptions of their own likelihood of
developing dementia, but also their level of concern if
they were to have dementia and their perception of
likely consequences to their functioning if they were to
have dementia. Studies based on these conceptualizations
of perceived dementia threat have shown that having
personal exposure to dementia (such as having a genetic
or nongenetic family member with dementia), being
female, and being more depressed are associated with
higher perceived dementia risk (Hodgson & Cutler,
2003; Suhr & Kinkela, 2007). Personal exposure to
dementia has also been shown to moderate the associ-
ation of other variables with perceived threat of
dementia. For example, younger age was associated with
higher perceived Alzheimer disease (AD) threat in indivi-
duals who had genetic family members with AD, while
older age was associated with higher perceived AD
threat in those without genetic family members with
AD (Hodgson & Cutler, 2003; Roberts, 2000; Roberts
et al., 2003; Suhr & Kinkela, 2007). Hodgson and Cutler
(2003) also found an association between depressive
 198 A. KINZER AND J. A. SUHR
symptoms and perceptions of AD threat in a general
sample but not in a sample of children of patients with AD.
However, existing studies have predominantly
focused only on perception of personal dementia risk.
The concept of dementia worry as conceptualized in
health anxiety models includes not just a perception
of personal dementia risk, but also ruminative thoughts
about this risk in everyday life (i.e., the tendency to fre-
quently misinterpret the cause of everyday cognitive
errors and regularly misattribute normal aging signs
as potential symptoms of dementia). Perceived threat
of dementia combined with ruminative worry about
everyday behaviors being signs and symptoms of
dementia can perpetuate a cycle of health anxiety and
symptom seeking. Suhr and Isgrigg (2011) developed a
15-item Dementia Worry Scale with items assessing
aspects of AD worry such as dismissability and controll-
ability of thoughts about developing dementia or having
dementia. Items for the scale were initially selected
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based on review of the literature on perceived dementia
threat, as well as review of the literature on symptoms
and manifestations of worry in older-adult populations.
An initial pilot study with 22 community-dwelling
women aged 50 to 93 years old who referred themselves
for dementia screening showed that higher dementia
worry was significantly associated with higher depress-
ive symptoms, more memory concerns, and higher
perceived dementia threat. In addition, consistent with
existing studies focused on perceptions of dementia
threat, dementia worry was higher among those with
dementia exposure (whether genetic or not) compared
with those without dementia exposure.
The present study provides further evaluation of the
Dementia Worry Scale developed by Suhr and Isgrigg
(2011). First, basic psychometrics of the scale were
examined to see if the scale is unidimensional and
internally consistent. Then, hypothesized relationships
of various demographic and psychological factors with
scores on the Dementia Worry Scale were examined,
based on prior research. It was expected that higher
dementia worry would be seen in women and in
those with personal exposure to dementia. It was also
expected that higher dementia worry would be associated
with higher levels of depressive and general anxiety
symptoms. Finally, it was expected that higher dementia
worry would be associated with more subjective memory
concerns and a higher perception of personal risk for
dementia. An additional goal of the study was to examine
whether personal dementia exposure moderates the
association of dementia worry with these various demo-
graphic and psychological factors, which would be
consistent with models for the development of health
anxiety generally.
The final goal of the study was to examine whether
dementia worry affects the relationship between subjec-
tive memory concerns and actual cognitive perfor-
mance. Preliminary data suggest that both perceived
dementia threat and dementia worry can be related to
inaccurate subjective cognitive report. For example,
Suhr and Kinkela (2007) found that individuals with
genetic AD exposure tended to report higher perceived
dementia threat when they performed better on cogni-
tive tests, while individuals with nongenetic or no AD
exposure had more accurate views of their cognitive
skills (i.e., they reported worse cognitive abilities
when their cognitive test scores were lower). Similarly,
Suhr and Isgrigg (2011) showed that dementia worry
moderated the relationship of subjective memory com-
plaints to actual memory performance; in those with
low dementia worry, higher memory complaints were
associated with worse memory ability, while in those
with high dementia worry, higher memory complaints
were associated with better memory ability. Thus, it was
expected that the subjective memory performance of indi-
viduals with high dementia worry would be less accurate
(i.e., less associated with actual cognitive performance).
Methods
Participants
Individuals who previously participated in studies on
cognitive impairment in older adults were recruited
for participation in the present study. These individuals
had been originally recruited from the community
based on responses to advertisements for studies
offering free memory screens for older adults. Potential
participants (N ¼ 143) received packets containing
study materials in the mail; $1 was included in each
study packet for recruited participants to keep as a
token of appreciation. One hundred of these individuals
(69.93% return rate) completed the measures and sent
them back. Six of the 143 packets (4.2%) were returned
by mail as undeliverable. A subset of 50 participants
(the first 50 respondents) received a second mailing
approximately 20 days after the first mailing, for
the purposes of test–retest analyses. Of these, 37 parti-
cipants (74% return rate) with usable data from the first
mailing completed and returned the measures.
Of the total sample of 100 participants, 28% reported
having a genetic relative with dementia, 52% reported
nongenetic exposure to dementia (having a relative by
marriage, a spouse, or a close friend with dementia or
being a caregiver to someone with dementia), and
20% reported no personal exposure to dementia. No
participants reported diagnoses of any form of dementia
or mild cognitive impairment, and none of the individuals

with concurrent neuropsychological data met diagnostic
criteria for dementia or mild cognitive impairment. All
participants were independently dwelling community
members. Nineteen percent of participants reported a
history of head injury involving loss of consciousness
lasting 1 min to 120 min (M ¼ 3.38, SD ¼ 15.55), 7%
reported history of seizures, 1% reported history of
brain tumors, 3% reported history of stroke, and
9.1% reported history of myocardial infarction.
Additionally, 45% of participants reported a history
of treatment for one or more mental health conditions,
including adjustment disorders, anxiety disorders, depres-
sion, attention-deficit hyperactive disorder, bipolar dis-
order, and/or counseling to deal with divorce/marital
issues, and 3% of participants reported that they
currently receive mental health counseling.
Demographic information was available for only 89
of the 100 participants, who had participated in a prior
study and allowed for their prior data (including
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neuropsychological screening; see Objective memory
impairment section) to be linked to the present study
(for various reasons, the other 11 individuals had either
incomplete data from a prior study or their identification
numbers could not be used to link their prior data to the
current study). For that subset of participants, 57 (64%)
were female, participant age ranged from 55 years to 90
years (M ¼ 69.22, SD ¼ 8.50), and years of education
ranged from 8 years to 27 years (M ¼ 18.13, SD ¼ 3.19).
The vast majority (more than 95%) of individuals
were Caucasian. Neuropsychological data preceded the
completion of the mailing by an average of 13 months
(SD ¼ 4.29 months; range ¼ 1–18 months).
Measures
Medical history. A medical history form was used
to assess for past and current general health status.
Participants provided self-reported history of dementia,
head injuries, seizures, brain tumors, stroke, and heart
attack; listed all medical diagnoses and current medica-
tions; and indicated the presence or absence of history
of treatment for mental health conditions.
Memory controllability inventory. Perceptions of
memory functioning and perceived dementia likelihood
were assessed with subscales of the Memory Controll-
ability Inventory (MCI; Lachman et al., 1995). The
Present Ability subscale of the MCI assesses an indivi-
dual’s degree of confidence in current memory function-
ing (i.e., lower scores mean more memory concerns).
However, for the purposes of our analysis, the items were
reverse-coded so that higher scores mean more memory
concerns. The Alzheimer’s Likelihood subscale reflects
APPLIED NEUROPSYCHOLOGY: ADULT 199
perceived likelihood of personally developing AD. These
subscales have shown adequate internal consistency and
test–retest reliability in prior studies (e.g., Lachman
et al., 1995); in the present study, internal consistency
was questionable for the Present Ability scale (a ¼ .67)
and acceptable for the Alzheimer’s Likelihood subscale
(a ¼ .70). Prior studies have shown that these subscales
relate in theoretically appropriate ways to the concepts
of present memory beliefs and concern of personal
risk for dementia (Lachman et al., 1995; Suhr &
Kinkela, 2007).
Personal exposure to dementia. To assess personal
exposure to dementia, participants were asked whether
they know or have known someone with dementia
and, if so, the nature of their relationship with that
person (how frequently they see/saw them, how
emotionally close they feel/felt to them, how related to
them they are/were genetically). Participants were also
asked to report whether they had served as caregivers
for family or friends with dementia. Dementia exposure
was coded as genetic (must have reported having a first-
or second-degree relative with dementia; N ¼ 28),
nongenetic (any other personal exposure to dementia,
including caregiving for a nonbiological relative;
N ¼ 52), or no personal exposure to dementia (N ¼ 20).
Depressed mood. Level of depressed mood was assessed
using the Geriatric Depression Scale (Yesavage et al.,
1983), a brief self-report depression scale designed for
use with older adults. Prior studies have shown good
test–retest reliability (e.g., Parmalee, Lawton, & Katz,
1989; Yesavage et al., 1983) and high internal consist-
ency (Parmalee et al., 1989; Yesavage et al., 1983); in
the present study, the measure was internally consistent
(a ¼ .89). Prior studies have suggested it is an accurate
measurement of depression in older adults (Parmalee
et al., 1989; Yesavage et al., 1983).
General worry. General worry was assessed using an
Abbreviated version of the Penn State Worry Question-
naire (PSWQ-A; Hopko et al., 2003). Crittendon and
Hopko (2006) showed that the original PSWQ can be
effectively modified for use with older adults by exclud-
ing all five of the reverse-coded items and three of the
positively worded items, resulting in the eight-item
PSWQ-A. The PSWQ-A has high internal consistency
(a ¼ .87) and adequate test–retest reliability (r ¼ .63)
when used with older adults. The measure also demon-
strates good convergent and divergent validity with
other measures of anxiety and worry (r ¼ .39–.49;
Crittendon & Hopko, 2006). Within the present sample,
internal consistency was strong (a ¼ .91).
 200 A. KINZER AND J. A. SUHR
Dementia worry. Dementia worry was assessed using
the Dementia Worry Scale, described briefly in the
Introduction; further psychometrics were gathered as
part of the present study and are reported in detail in
the Results. The original version of the scale contained
15 items rated on a 5-point scale, ranging from 1 ¼
not at all typical of me to 5 ¼ very typical of me.
Objective memory impairment. To assess for actual
memory impairment, Immediate and Delayed Memory
subscale scores from the Repeatable Battery for the
Assessment of Neuropsychological Status (RBANS;
Randolph, 2012), which was completed in a prior study,
were matched to the present study data. This measure
has strong construct validity, and, in particular, the
delayed memory tasks have shown clinical utility in
the diagnosis of many neurological conditions involving
memory impairment, including early dementia and
mild cognitive impairment. For the purposes of the
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present study, objective memory impairment was
liberally defined as scoring at or below the 16th percen-
tile based on age norms on at least two of the six
immediate and delayed memory tasks (List Learning,
Story Memory, List Recall, List Recognition, Story
Recall, and Figure Recall).
Results
Psychometric analysis of the dementia
worry scale
Examination of the correlation matrix of the Dementia
Worry Scale items in the full sample suggested that
three reverse-coded items from the original scale did
not correlate consistently with the other items, and thus,
they were removed from all further analyses. Principal
axis factoring (PAF) with Promax rotation was conduc-
ted to analyze the factor structure of the remaining
items. The scree plot suggested one main factor, and
the PAF results showed that all items loaded more than
.4 on the factor (see Table 1); therefore, all remaining
items were retained in the final scale. See Table 1 for
the 12 items remaining in the present analyses. The
internal consistency of the scale was .91. Test–retest
reliability over an average of 3 weeks was .89 (p < .001).
Total scores ranged from 15 to 60, with a mean of 25.4
(SD ¼ 9.68).
Relationship of dementia worry to gender and
personal dementia exposure
With regard to total scores on the Dementia Worry
Scale, contrary to our predictions, dementia worry was
not different between men (M ¼ 17.03, SD ¼ 6.55) and
Table 1. Factor loadings of dementia worry scale items.
Item Factor Loading
I know I shouldn’t worry about developing dementia, .81
but I just cannot help it.
I find it difficult to control my worries about .81
developing dementia.
When I can’t remember something, I find myself .72
wondering whether I have dementia.
My worries about dementia overwhelm me. .69
More often than not, I find my thoughts returning .77
to concerns that I have dementia.
When I hear about someone having dementia, .51
I start to worry about having it myself.
When I am not distracted, I find my thoughts .53
focusing on my own cognitive changes and
concerns.
Even though I know it doesn’t help to focus on it, .83
I can’t help thinking about whether or not
I have dementia.
Once I start worrying about dementia, I just cannot .54
stop.
Sometimes when trying to go to sleep, I find my .58
thoughts drift to my concerns about having
dementia.
When I forget a word that I want to say, my thoughts .66
immediately turn to dementia.
I think I probably worry more about dementia than .84
other people my same age.
women (M ¼ 18.92, SD ¼ 7.61), t(86) ¼ 1.18, d ¼ 0.27,
p ¼ .24.
Our hypothesis that personal exposure to dementia
would be related to dementia worry was partially sup-
ported. A one-way analysis of variance (ANOVA)
examined differences in dementia worry in those with
genetic exposure, nongenetic exposure, and no exposure
to dementia. Results showed significant differences
among the groups, F(2, 97) ¼ 9.16, p < .001. Follow-up
t tests showed that individuals with genetic exposure
to dementia reported significantly more dementia worry
(M ¼ 22.60, SD ¼ 9.06) than did those with no dementia
exposure (M ¼ 14.20, SD ¼ 2.55; d ¼ 1.26, p < .001),
and those with nongenetic exposure to dementia
(M ¼ 17.36, SD ¼ 6.89; d ¼ 0.65, p ¼ .002). Individuals
with nongenetic exposure to dementia scored higher
on dementia worry than did those with no dementia
exposure, although the difference was not significant
(d ¼ 0.61, p ¼ .09).
Relationship of dementia worry to depression,
general worry, memory concern, and AD
likelihood perception
Table 2 provides descriptive data for the measures of
depression, general worry, memory concern, and AD
likelihood perception for the total sample, as well as
for the three groups. As hypothesized, higher dementia
worry was related to higher depressive symptoms
(r ¼ .51, p < .001) and to higher levels of general worry
(r ¼ .53, p < .001) in the total sample. Also as predicted,
 APPLIED NEUROPSYCHOLOGY: ADULT 201

Table 2. Descriptive statistics for relevant study variables in the total sample and individual study groups.
Total sample Genetic exposure Nongenetic exposure No exposure
Mean (SD), range Mean (SD) Mean (SD) Mean (SD)
Depression 4.4 (4.9), 0–23 4.6 (.1) 4.9 (6.0) 4.0 (4.8)
General worry 16.4 (7.9), 8–40 15.5 (7.3) 19.2 (8.5) 14.8 (7.8)
Memory concern 14.3 (3.7), 7–25 15.3 (3.7) 14.2 (3.6) 13.1(3.5)
AD likelihood 2.89 (1.35), 1–7 2.7 (1.3) 3.6 (1.4) 2.3 (1.1)

higher dementia worry was also associated with higher
memory concern (r ¼ .37, p < .001) and higher belief
in personal likelihood of having AD (r ¼ .61, p < .001)
in the total sample.
Does personal exposure to dementia moderate
the relationship of dementia worry to other
variables?
Table 3 presents correlations of dementia worry to study
variables separately in the three groups. Examination of
the simple correlations suggests that, with regard to age,
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Does level of dementia worry moderate the
relationship of memory concern to actual
cognitive impairment?
As noted earlier, objective memory impairment was
defined as scoring at least 1 standard deviation below
the mean on at least two of the memory subscales
of the RBANS. This definition was used to form two
groups: those with memory impairment (N ¼ 13) and
those with no memory impairment (N ¼ 64; note that
the 16 individuals who scored low on only one of the
memory subscales were not included in this analysis).

there was no consistent relationship of age to worry in In addition, groups were divided into high and low
any group. However, in general, the relationship of dementia worry based on a mean split. Consistent with
dementia worry to depression, general worry, memory expectations, the 2 � 2 ANOVA showed a significant
concern, and personal threat of AD was only seen in Worry � Memory Impairment interaction, F(1, 77) ¼
those with personal exposure to dementia; these vari- 5.63, p ¼ .023. The main effects for impairment,
ables were not correlated in the group of individuals F(1, 77) ¼ 2.11, p ¼ .152, and dementia worry,
with no dementia exposure. An exception was memory F(1, 77) ¼ 1.31, p ¼ .26, were not significant.
concern, which was generally positively correlated with Exploration of the significant interaction showed that
worry in all groups. Given that correlations (other than in the group with objective memory impairment,
age) were similar in those with genetic and nongenetic individuals with low worry (N ¼ 5) were not different
dementia exposure, these two groups were collapsed in memory concern (M ¼ 16.5, SD ¼ 3.3) from those
for moderator analyses. who had high dementia worry (N ¼ 8; M ¼ 16.6,
Analysis of covariance models testing for the interac- SD ¼ 2.4; t < 1, d ¼ 0.03). However, in those with no
tion between group status (dementia exposure/no evidence of cognitive impairment, those with low
dementia exposure) and other psychological variables worry showed significantly lower memory concern
showed significant interaction terms for depression, (N ¼ 34; M ¼ 11.5, SD ¼ 2.6) relative to those with
F(1, 91) ¼ 7.45, p ¼ .008, general worry, F(1, 94) ¼ 10.67, high worry (N ¼ 30; M ¼ 17.1, SD ¼ 4.7; t ¼ 5.98,
p ¼ .002, and perceived AD threat, F(1, 96) ¼ 5.15, d ¼ 1.48, p < .001); in fact, the group with no
p ¼ .025, but not for memory concern, F(1, 95) ¼ 1.61, objective memory impairment but high dementia worry
p ¼ .21. As can be seen in the simple correlations reported memory concern similar to that of individuals
presented in Table 3, the nature of this interaction was with objective memory impairment but with low worry
consistent with our hypotheses, in that dementia worry (d ¼ 0.19) and individuals with objective memory
was related to depression, general worry, and perceived impairment but with high worry (d ¼ 0.16).
AD threat only in individuals with genetic and nongenetic
dementia exposure.
Discussion
Table 3. Correlations of dementia worry to study variables Overall, the present findings lend support to the validity
separately by exposure with dementia. of the Dementia Worry Scale as a measure of dementia-
Genetic Nongenetic No dementia
exposure exposure exposure specific health worry. Examination of the underlying
(N ¼ 28) r (p) (N ¼ 52) r (p) (N ¼ 20) r (p) factor structure of the Dementia Worry Scale supported
Age .19 (.36) .01 (.99) .02 (.93) a unidimensional factor structure, and the scale showed
Depression .52 (.01) .62 (<.001) .06 (.81)
General worry .53 (.004) .64 (<.001) .00 (.99) strong internal consistency and test–retest reliability
Memory concern .21 (.37) .39 (.004) .26 (.18) during a 3-week interval, suggesting that the scale has
AD perception risk .66 (<.001) .46 (<.001) .17 (.48)
adequate reliability and internal validity.
 202 A. KINZER AND J. A. SUHR
Contrary to expectations, dementia worry did not
differ between men and women in our study. This
finding is inconsistent with previous findings (Cutler
& Hodgson, 1996; Suhr & Kinkela, 2007), in which
women endorsed higher levels of perceived dementia
threat relative to men. Of note, in the present sample,
men and women also did not differ in perception of
personal risk for AD (t ¼ 1.06, p ¼ .29). Larger sample
sizes of men and women both with and without personal
dementia experience would be necessary to further
examine potential gender differences in dementia worry.
Our hypothesis regarding the relationship of dementia
worry to dementia exposure was partially supported.
Individuals who reported genetic exposure to dementia
scored higher on the Dementia Worry Scale than did
individuals who reported nongenetic exposure or no
dementia exposure. Those who reported nongenetic
exposure to dementia reported higher worry than did
those with no dementia exposure, with a medium effect
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size, but the difference was not statistically significant.
Further research should examine this issue in larger
groups and also investigate the level and intensity
of dementia exposure, including caregiver status, which
is associated with additional stressful experiences that
can affect the psychological health of caregivers and
perhaps their own worries about developing dementia
(Brodaty, Woodward, Boundy, Ames, & Balshaw, 2013;
Conde-Sala, Garre-Olmo, Turro-Garriga, Vilalta-Franch,
& López-Pousa, 2010).
The Dementia Worry Scale was correlated with
several variables that were consistent with study hypo-
theses. Specifically, individuals who scored higher on
dementia worry reported higher concern about current
memory functioning, endorsed higher beliefs that
they might personally develop dementia in the future,
reported higher levels of depressive symptoms, and
scored higher on measures of general worry. These
results are consistent with the extant literature on the
correlates of perceived dementia threat and preliminary
data on the Dementia Worry Scale. In addition,
as expected given prior research findings (e.g., Roberts
et al., 2003) and consistent with a health anxiety
model, dementia exposure appeared to moderate the
relationship of dementia worry to other constructs.
Specifically, depression and general worry were more
strongly related to dementia worry among the groups
reporting personal dementia exposure as opposed to
the group reporting no dementia exposure. Similarly,
dementia worry was related to perceived risk for
developing dementia only among individuals reporting
personal dementia exposure. These results suggest that
for individuals with exposure to dementia, anxiety and
worry about personally developing dementia are related
to psychological health and to perceptions of personal
dementia risk.
Finally, consistent with prior findings (Suhr &
Isgrigg, 2011; Suhr & Kinkela, 2007) and with health
anxiety models, the results showed a significant Worry �
Objective Memory Impairment interaction for the
prediction of subjective memory performance. Specifi-
cally, among individuals with evidence of cognitive
impairment, dementia worry did not interact with
ratings of memory concern, while for individuals
with no evidence of cognitive impairment, those with
high dementia worry had much higher memory concern
than those with low dementia worry and in fact showed
memory concern scores similar to those who actually
had objective memory impairment.
The present study was characterized by several lim-
itations, one being the nature of the sample. As already
mentioned, our study included a relatively small sample
size, suggesting the need for further research examining
larger samples. There is also a need for more hetero-
geneity in future samples regarding education and
sociodemographic characteristics. Our study was also
limited by its liberal definition of cognitive impairment
(i.e., at or below the 16th percentile based on age norms
on at least two of six memory tasks). Using such
a liberal criterion means that the individuals who were
identified as “memory-impaired” may well have been
false positives (i.e., may not actually have memory
impairment). However, defining cognitive impairment
in this way allowed us to examine subjective perception
of even mild changes in cognitive functioning. Another
limitation was that the neuropsychological data
preceded the self-report survey by about a year, and it
is possible that some individuals experienced cognitive
decline during that time period. Of note, however, all
participants were still living independently and did
not report any recent diagnoses of dementia or mild
cognitive impairment in the interim between their par-
ticipation in the two studies. Furthermore, the sample
showed minimal evidence of any cognitive impairment
at the time of the participants’ initial participation
(i.e., only 12 participants showed evidence of cognitive
impairment using a very liberal definition of impairment).
The present findings have implications for the use of
subjective memory complaints as a screening tool for
detecting dementia in its earliest stages. If individuals
who present for evaluation are worried about
developing dementia, their own reports of their memory
complaints may be inflated and inaccurate. Thus, our
results add to the concerns raised by other researchers
that including subjective complaints in the diagnostic
criteria for early dementia states (i.e., mild cognitive
impairment) could result in false-positive errors in

identifying those at risk for developing dementia (Bondi
et al., 2014; Clark et al., 2013; Edmonds, Delano-Wood,
Clark, et al., 2015; Edmonds, Delano-Wood, Galasko, et
al., 2014). Overidentification could lead to unnecessary
treatment and additional anxiety for those who already
exhibit a tendency to worry. Thus, dementia worry and
personal exposure to dementia, as well as presence of
depression or anxiety/general worry symptoms, should
be considered when determining how much confidence
to place in reports of subjective memory complaints
among individuals presenting for dementia screening.
Furthermore, the present results highlight the need for
decisions about the presence of cognitive impairment
or dementia to be informed by objective cognitive test-
ing, such as neuropsychological testing.
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