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Knowledge about Alzheimer's disease amongNorwegian psychologists: The Alzheimer's diseaseknowledge scaleInger Hilde Nordhus a b c , Børge Sivertsen a d e & Ståle Pallesen b fa Department of Clinical Psychology , University of Bergen , Bergen , Norwayb Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital ,Bergen , Norwayc Kavli Research Center for Ageing and Dementia, Haraldsplass Deaconess Hospital ,Bergen , Norwayd Division of Mental Health, Norwegian Institute of Public Health , Bergen , Norwaye Division of Psychiatry , Helse Fonna , Norwayf Department of Psychosocial Science , University of Bergen , NorwayPublished online: 30 Nov 2011.
To cite this article: Inger Hilde Nordhus , Børge Sivertsen & Ståle Pallesen (2012) Knowledge about Alzheimer's diseaseamong Norwegian psychologists: The Alzheimer's disease knowledge scale, Aging & Mental Health, 16:4, 521-528, DOI:10.1080/13607863.2011.628973
To link to this article: http://dx.doi.org/10.1080/13607863.2011.628973
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Aging & Mental HealthVol. 16, No. 4, May 2012, 521–528
Knowledge about Alzheimer’s disease among Norwegian psychologists: The Alzheimer’s
disease knowledge scale
Inger Hilde Nordhusabc, Børge Sivertsenade* and Stale Pallesenbf
aDepartment of Clinical Psychology, University of Bergen, Bergen, Norway; bNorwegian Competence Center for SleepDisorders, Haukeland University Hospital, Bergen, Norway; cKavli Research Center for Ageing and Dementia,
Haraldsplass Deaconess Hospital, Bergen, Norway; dDivision of Mental Health, Norwegian Instituteof Public Health, Bergen, Norway; eDivision of Psychiatry, Helse Fonna, Norway; fDepartment
of Psychosocial Science, University of Bergen, Norway
(Received 6 March 2011; final version received 23 September 2011)
Professional knowledge about Alzheimer’s disease (AD) is essential in order to provide appropriate care for thosesuffering from this progressive and fatal condition. The optimizing of service provision to these patients and theirfamilies should also involve mental health professionals including clinical psychologists. In the present study,members of the Norwegian Psychological Association working in clinical practice were invited to participate in aweb-based survey measuring knowledge about AD and related disorders. Questions regarding age, gender,accreditation as clinical specialist, age group of typical patients, and experience with patients suffering fromdementia were asked in addition to the administration of the Alzheimer’s Disease Knowledge Scale (ADKS).ADKS consists of 30 true/false items covering risk factors, assessment and diagnosis, symptoms, course, lifeimpact, care giving, and treatment and management. A total of 956 clinical psychologists participated, yielding aresponse rate of 50.9%. The average mean performance score on the ADKS was 24.10 (SD¼ 2.5, range 15–30).Kuder-Richardson coefficient of reliability on the ADKS was 0.98. Multiple regression analysis showed thatbeing indirectly exposed to dementia in older family members through their own patients, together with a self-reported knowledge of one’s performance on the ADKS, significantly explained high scores on the ADKS. Withreservations based on study limitations, it is concluded that the knowledge of AD in Norwegian clinicalpsychologists is fairly good. An obvious challenge is how to strengthen this knowledge both in our professionaltraining programs in psychology as well as among those working in applied clinical settings.
Keywords: Alzheimer’s disease; knowledge; clinical psychologists; older adults
Introduction
Despite the growing number of older people in mostglobal populations relatively few psychologists workwith older adults compared with younger age groups(Gatz, 2007; Karlin, 2006; Karlin & Humphreys, 2007;Zeiss & Karlin, 2008). Notwithstanding, as thepopulation continues to age, mental health profes-sionals will increasingly encounter older persons intheir clinical work, either directly or indirectly throughtheir younger adult patients (Jane-Llopis &Gabildondo, 2008). A demand for adequate mentalhealth services to this growing age group is warrantedimplying a strengthened academic as well as clinicalpreparation for adequate assessment and treatmentprocedures (Hinrichsen, Zeiss, Karel, & Molinari,2010; Qualls, Scogin, Zweig, & Whitbourne, 2010).The dissemination of scientifically based knowledgeabout age-related changes is fundamental for studentsand professionals alike in order to develop appropriateexpectations for clinical work with older patients, and,not least to avoid biased images and stereotypes ofmental health in old age (Jackson, Cherry,Smitherman, & Hawley, 2008).
One critical component of health in later adulthoodis the distinction between normal and pathologicalcognitive ageing. As the proportion of older adults in
the population increases, a corresponding increase inrates of dementia and age-related mental illness can beexpected (Jane-Llopis & Gabilondo, 2008; Rabinset al., 2007). Early identification and screening willhave a pivotal role in facilitating early access toadequate treatment and care, and allow families toadapt to the condition and its impact.
Alzheimer’s disease (AD), constitute the majorityof dementia cases hence knowledge about this diseaseis important for clinicians. Carpenter, Balsis,Otilingam, Hanson, and Gatz (2009) recently devel-
oped the Alzheimer’s Disease Knowledge Scale in
order to reflect and quantify actual clinician knowledge
and bias regarding Alzheimer’s disease and related
disorders. The scale is followed by the respondents’
self-rating of knowledge about AD and related
disorders. The development of ADKS was based on
a highly varied pool of respondents, thus reflecting an
expected variation in the respondents’ knowledge of
and experience with dementia. The respondents
involved undergraduate students, dementia profes-
sionals, senior health care staff, dementia caregivers,
and older adults, implying that groups who knew more
about AD based on their experience or education
should score higher than those who knew less about
AD. Overall group differences generally followed the
*Corresponding author. Email: [email protected]
ISSN 1360–7863 print/ISSN 1364–6915 online
� 2012 Taylor & Francis
http://dx.doi.org/10.1080/13607863.2011.628973
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expected directions, implying that the group of demen-tia professionals achieved the highest mean perfor-mance of the ADKS. Still, Carpenter, Balsis, Otilingam,Hanson, & Gatz (2009) emphasize that further researchis needed specific to profession and setting, in order toconfirm reliability and validity of the scale, as well as toestablish norms for specific populations.
The primary objective in the present study is toexamine the knowledge base of AD using ADKS in asample of Norwegian psychologists currently engagedin active clinical practice. We expect that clinicalexperience with older patients is critical to their level ofAD knowledge. We thus presume that psychologistsrepresenting various clinical contexts and age segmentsof patients will be empirically differentiated fromdementia professionals on the ADKS, favoring thelatter group. In the present study, additional factors,such as age, gender, acquired clinical specialty, thepresence of older patients in the respondents’ clinicalpractice, including dementia patients, are examined toassess their respective contribution to variation inknowledge and understanding of Alzheimer’s disease.
Method
Participants and procedure
A web-based survey questionnaire was distributed bythe Norwegian Psychological Association (NPA) tomembers registered as currently engaged in activeclinical practice at the time of the survey. Norwegianpsychologists have six years of university training inpsychology (graduate training according to a scientific-practitioner model) and are licensed as health person-nel in pursuance to the Norwegian health legislation.Psychologists have treatment responsibilities compar-able to those of medical doctors, except for theprescription of medication. All Norwegian citizensare covered by public health insurance and themajority of clinical psychologists work in publicmental health services. According to the NorwegianPsychological Association there were 5075 licensedpsychologists in Norway at the time of the survey(population about 4.8 million), and of whom approxi-mately 85% were members of NPA. On approachingthis register, 2031 NPA members were classified asworking in public or private mental health services,comprising roughly 47% of the NPA members.Omitted from this register are clinical psychologistsworking in specialized areas like school and childwelfare authorities, child and family protection centres,and various addiction units or clinics. Psychologistspracticing clinical work will vary as regards to theirrespective clinical area and whether they have acquiredtheir clinical specialty or not (a five year post licensuretraining program based on supervised clinical workand applied courses).
The web-based survey was preceded by a brief pre-contact e-mail letter signed by NPA’s president and thefirst author (from May to August 2009), in which
recipients were invited to complete a survey with aparticular focus on knowledge about Alzheimer’sdisease. After completing the survey, the scoring keyof the scale was given. Participation was anonymous,implying that the two follow-up reminders (withapproximately 4–5 week intervals) were sent to theinitial number of potential invited participants with acomment to ignore our reminder if they already hadresponded to our request. To further increase theresponse rate, a modest monetary incentive was used inthe format of 10 gift vouchers (NOK 500/EUR 56/USD 84 each) announced in the invitation (by e-mail)letter. Those who wished to participate in the drawingof a gift voucher had to register name and e-mailaddress, however, without a linkage to the survey.Tailoring survey design methodology by highlightingthe need for multiple contacts as well as monetaryincentives, have been shown to increase response rates(e.g. Edwards et al., 2008).
Among the 2031 NPA members approached forour study, 135 persons were excluded for incompleteresponding, and 18 did not work in clinical practiceduring the survey period (6 weeks) due to maternalleave, etc. Thus, a total of 1878 respondents wereeligible, and the final overall response rate of 50.9%(N¼ 956) incorporates completed returns from theinitial and follow-up mailings to the e-mail request(and attached web-link).
Materials
The survey included a set of demographic and back-ground questions (gender and age), as well as questionsconcerning relevant clinical practice defined as:acquired clinical specialty, age range of typical patient,frequency of seeing patients with dementia/symptomsconcordant with dementia, frequency of indirectexposure to dementia patients in the role as familymember of patient (both coded 1¼never, 2¼ 1–6times/yr, 3¼ 7–11 times/yr, 4¼ 1–4 times/month, and5¼weekly or more often), and, finally, approximatepercentage of patients with dementia.
The Alzheimer’s Disease Knowledge Scale (ADKS;Carpenter et al., 2009) contains 30 true/false items toassess knowledge about Alzheimer’s disease (AD) andcovers the following issues: risk factors, assessment anddiagnosis, symptoms, course, life impact, care giving,and treatment and management. The 30 items arefollowed by a rating of self-reported knowledge aboutAD (and related disorders), on a scale from 1 (‘‘I knownothing at all’’) to 10 (‘‘I am very knowledgeable’’). Thescale takes approximately 5 to 10 minutes to complete,and is designed for use with health care professionals,students, and the general public, and has demonstratedadequate psychometric properties (Carpenter et al.,2009). A total composite score is calculated by addingtogether the scores for each item, yielding a total scorewith a range of 0 to 30 (the 30 items appear in Englishin Table 2; a Norwegian version of the scale is available
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from the authors). The Norwegian version wasadapted from English by a standard translation-backtranslation procedure.
Statistics
SPSS for Windows version 17 (SPSS, Chicago, III) wasused for the statistical analysis. Mean and standarddeviation of the total score on the ADKS werecalculated, followed by calculation of difficulty indexesand discrimination indexes, respectively for each itemof the ADKS. A total score of the ADKS wascalculated by summing the number of correctresponses. We calculated a difficulty index (p) foreach item, which represents the percentage of respon-dents who answered the item correctly. In concert withthe item difficulty index (to indicate the extent to whichthe scale items discriminate between individuals withhigh or low scores), a discrimination index (DI) wasestimated (ideally between 0.3 and 0.7). DI wascalculated by estimating the number of correctlyanswered items among the high scorers (top 27%)subtracted from the number of correctly answereditems among the low scorers (bottom 27%) divided bythe number of respondents comprising 27% of thesample (Kelley, 1939). Internal consistency of theADKS was calculated using Kuder-Richardson’sformula for dichotomously scored items.
Independent sample t-tests were used to comparemean performance in the current sample with meanperformance in the scale’s validation study. The testswere calculated manually based on the means, stan-dard deviations and sample sizes reported in thevalidations study.
Finally, a multiple linear regression analysis wasconducted, in which the number of correct answers onthe ADKS constituted the criterion variable. Predictorvariables were: sex, age, clinical speciality, and to whatdegree the psychologist works with older adults,directly or indirectly. We also checked for normalityin the variables included in the regression models.However, as the sample in the current study was large(N¼ 956), no further steps were taken to overcomethis, as the risk of problems associated with bothskewness and kurtosis are reduced with large samples(200þ), and will, according to Tabachnick and Fidell(1996), not make a substantive difference in theanalyses.
Results
Sample characteristics
The sample (N¼ 956) comprised 68.9% females, hadan average age of 42.9 years (SD¼ 11.7), with asignificant gender difference of mean 41.6 (SD¼ 11.3)for women and mean 45.9 (SD¼ 12.2) for men. Asdisplayed in Table 1 about one half (50.8%) of therespondents had acquired a clinical speciality, and themajority of the respondents (56.3%) were in the age
range of 30 to 49 years. Not surprisingly, only a smallpercentage, 3.2%, had adults 60 years and above astheir typical patient, and seldom met with patients –neither directly nor indirectly – suffering fromdementia. In terms of generalizability, there were nostatistical differences between responders and non-responders in terms of age, gender or clinical speciality.
Scale characteristics
The average total score/mean performance score onthe ADKS was 24.10 (SD¼ 2.5, range 15 –30).Compared to the samples in the original study byCarpenter et al. (2009), the sample of Norwegianclinical psychologists scored significantly higher on theADKS than both the US student sample (ADKS mean20.19 (SD¼ 3.59) (t(1438)¼ 24.07, p5 0.001), thesenior staff sample (ADKS mean 20.15 (SD¼ 4.10),(t(1015)¼ 11.41, p5 0.001), and dementia caregivers(ADKS mean 22.70 (SD¼ 4.27), (t(1008)¼ 3.82,p5 0.001). There were no difference between theNorwegian psychologist sample and US older adultssample (ADKS mean 24.10 (SD¼ 2.95),t(1043)¼ 0.000, p¼ 1.00), whereas the Norwegianpsychologist sample scored significantly lower thanthe US sample of dementia professionals (ADKS mean27.40 (SD¼ 1.89), (t (1029)¼�11.18, p5 0.001). Theaverage inter-item correlation for the ADKS,expressed by the Kuder-Richardson reliability coeffi-cient, was 0.98. Predictive validity was examined bycalculating the correlation between performance (cor-rectly answered items) on the ADKS and ratings ofself-reported knowledge about AD (1–10). The corre-lation was 0.52, p5 0.001, indicating that there is acorrespondence between respondents’ ADKS ratingsand self-reported knowledge about AD. The itemdifficulty index (p) appears in Table 2. A p-value of0.95 indicates that 95% of the respondents answeredthe item correctly (Streiner & Norman, 1995). Adifficulty index lower than 0.95 or higher than 0.05 ismore likely to discriminate among test takers; when itis below 0.05 almost everyone gets the item correct. Inthe present sample there was a range in p value from0.32–0.97. The Item difficulty index was used inconcert with the discrimination index (DI), in whicha high DI suggests that each item differentiatesadequately between respondents on their knowledgeof AD (Table 2).
Predictors of ADKS
Table 3 displays the results of the multipleregression analysis. Neither age nor gender signifi-cantly explained variance in ADKS performance.After entry of clinical characteristics these variablesexplained an additional 6.4% of the ADKS perfor-mance, F(5,567)¼ 7.821, p5 0.001. When self-ratedknowledge was entered, an additional 1.7% of thevariance in ADKS performance was explained,
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Table 1. Sample characteristics: demography and clinical experience (%, n, p-value).
CharacteristicsWomen
68.9% (n¼ 659)Men 31.1%(n¼ 297) All p-value
Age 50.00120–29 16.6 (90) 10.9 (27) 14.8 (117)30–39 38.5 (209) 30.4 (75) 35.9 (284)40–49 21.4 (116) 18.2 (45) 20.4 (161)50–59 16.0 (87) 27.9 (69) 19.7 (156)460 7.6 (300) 12.6 (31) 9.1 (72)
Certified clinical specialist (Yes) 45.5 (300) 62.5 (185) 50.8 (485) 50.001Age range of typical patient 50.0010–6 yrs 2.6 (17) 1.4 (4) 2.2 (21)7–18 yrs 31.2 (205) 18.5 (54) 27.3 (259)17–59 yrs 62.6 (410) 77.7 (227) 67.3 (637)460 yrs 3.5 (23) 2.4 (7) 3.2 (30)
Frequency of seeing patients withdementia/symptoms concordant with dementia
50.001
Never 60.6 (392) 47.8 (139) 56.6 (531)1–6 times/yr 32.0 (207) 36.8 (107) 33.5 (314)7–11 times/yr 2.5 (16) 6.5 (19) 3.7 (35)1–4 times/month 1.5 (10) 5.8 (17) 2.9 (27)Weekly or more often 3.4 (22) 3.1 (9) 3.3 (31)
Frequency of indirect exposure todementia through patients in the role of family member
50.001
Never 44.2 (288) 35.5 (105) 41.5 (393)1–6 times/yr 45.5 (295) 47.3 (140) 45.9 (435)7–11 times/yr 4.9 (32) 11.1 (33) 6.9 (65)1–4 times/month 2.3 (15) 3.7 (11) 2.7 (26)Weekly or more often 3.4 (22) 2.4 (7) 3.1 (29)Approximate percentage of patientswith dementia/symptoms concordant with dementia
2.0 (10.4) 3.6 (11.2) 2.5 (10.6) 0.066
Table 2. Item characteristics: the Alzheimer’s Disease Knowledge Scale (ADKS).
Item # Item ContentDiscrimination
indexDifficultyindex
Alpha ifitem dropped
1 People with Alzheimer’s disease are particu-larly prone to depression.
Life impact 0.30 0.96 0.97
2 It has been scientifically proven that mentalexercise can prevent a person from gettingAlzheimer’s disease.
Risk factors 0.43 0.77 0.97
3 After symptoms of Alzheimer’s disease appear,the average life expectancy is 6 to 12 years.
Course 0.48 0.54 0.97
4 When a person with Alzheimer’s diseasebecomes agitated, a medical examinationmight reveal other health problems thatcaused the agitation.
Assessmentanddiagnosis
0.47 0.86 0.98
5 People with Alzheimer’s disease do best withsimple instructions giving one step at a time.
Care giving 0.25 0.97 0.97
6 When people with Alzheimer’s disease begin tohave difficulty taking care of themselves,caregivers should take over right away.
Care giving 0.44 0.83 0.97
7 If a person with Alzheimer’s disease becomesalert and agitated at night, a good strategy isto try to make sure that the person getsplenty of physical activity during the day.
Care giving 0.51 0.63 0.98
8 In rare cases, people have recovered fromAlzheimer’s disease.
Course 0.31 0.92 0.97
9 People whose Alzheimer’s disease is not yetsevere can benefit from psychotherapy fordepression and anxiety.
Treatment andmanagement
0.34 0.86 0.97
(continued )
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F(1,566)¼ 10.397, p5 0.001. When looking at the finalstep in the regression analysis indirect exposure todementia through primary patients recorded the high-est beta value (Std. beta¼ 0.27, p5 0.001) followed byself-reported ADKS performance (Std. beta¼ 0.15,p5 0.001).
Thus, the results described above demonstrate thatNorwegian clinical psychologists have adequateknowledge of Alzheimer’s disease according to theADKS criteria. This study also provided someevidence that indirect exposure to dementia in olderadults may give a certain boost to ADKS performance,
Table 2. Continued.
Item # Item ContentDiscrimination
indexDifficultyindex
Alpha ifitem dropped
10 If trouble with memory and confused thinkingappears suddenly, it is likely due toAlzheimer’s disease.
Assessmentanddiagnosis
0.29 0.91 0.97
11 Most people with Alzheimer’s disease live innursing homes.
Life impact 0.42 0.86 0.97
12 Poor nutrition can make the symptoms ofAlzheimer’s disease worse.
Treatment andmanagement
0.44 0.88 0.97
13 People in their 30s can have Alzheimer’sdisease.
Risk factors 0.44 0.61 0.98
14 A person with Alzheimer’s disease becomesincreasingly likely to fall down as the diseasegets worse.
Course 0.54 0.49 0.98
15 When people with Alzheimer’s disease repeatthe same question or story several times, it ishelpful to remind them that they arerepeating themselves.
Care giving 0.38 0.81 0.97
16 Once people have Alzheimer’s disease, they areno longer capable of making informeddecisions about their own care.
Care giving 0.45 0.83 0.97
17 Eventually, a person with Alzheimer’s diseasewill need 24-hour supervision.
Course 0.34 0.78 0.97
18 Having high cholesterol may increase a per-son’s risk of developing Alzheimer’s disease.
Risk factors 0.53 0.36 0.98
19 Tremor or shaking of the hands or arms is acommon symptom in people withAlzheimer’s disease.
Symptoms 0.26 0.87 0.97
20 Symptoms of severe depression can be mis-taken for symptoms of Alzheimer’s disease.
Assessmentanddiagnosis
0.36 0.92 0.97
21 Alzheimer’s disease is one type of dementia. Assessmentanddiagnosis
0.25 0.97 0.97
22 Trouble handling money or paying bills is acommon early symptom of Alzheimer’sdisease.
Symptoms 0.41 0.84 0.97
23 One symptom that can occur with Alzheimer’sdisease is believing that other people arestealing one’s things.
Symptoms 0.45 0.85 0.97
24 When a person has Alzheimer’s disease, usingreminder notes is a crutch that cancontribute to decline.
Treatment andmanagement
0.29 0.93 0.97
25 Prescription drugs that prevent Alzheimer’sdisease are available.
Risk factors 0.36 0.83 0.97
26 Having high blood pressure may increase aperson’s risk of developing Alzheimer’sdisease.
Risk factors 0.57 0.32 0.97
27 Genes can only partially account for thedevelopment of Alzheimer’s disease.
Risk factors 0.28 0.97 0.97
28 It is safe for people with Alzheimer’s disease todrive, as long as they have a companion inthe car at all times.
Life impact 0.30 0.94 0.97
29 Alzheimer’s disease cannot be cured. Treatment andmanagement
0.28 0.96 0.97
30 Most people with Alzheimer’s diseaseremember recent events better than thingsthat happened in the past.
Symptoms 0.31 0.94 0.97
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together with a positive self-rating of knowledge aboutAD and related disorders. However, as indicatedabove, the predictors explained only a small amountof the variation in ADKS performance.
Discussion
The average score among Norwegian clinical psychol-ogists on ADKS was 24.01. By way of comparison,Carpenter et al. (2009) found that dementia profes-sionals demonstrated an average ADKS score of 27.40whereas undergraduate students had an average scoreof 20.19. Thus, our expectation that these groupswould be differentiated by the ADKS was supported.Considering that daily clinical work with older adultsin general, and with patients suffering from dementiain particular is sparse in our sample, we regard theresults as satisfactory. We do not know however, howthis knowledge translates into practical problemsolving when faced with an actual dementia patient.It should be noted that during the development andpsychometric testing of the scale it was emphasizedthat ADKS is not an assessment tool, but ratherreflects a general knowledge base which should besupplemented by additional modules in order todifferentiate between professional groups (Carpenteret al., 2009). For this reason, the current scale mayshow ceiling effects in certain expert groups, includingclinical psychologists. It should also be emphasizedthat Norwegian professional programs in psychologyare founded on a generalist model in which cognitiveimpairment throughout the lifespan is the topic ofrequired course reading material, if not necessarily apart of the internship practice for the majority of our
graduate students. Additionally, we should not ruleout a certain influence on knowledge from topicsdebated in health care contexts as well as in the publichealth care discourse.
The discrimination index as it appeared in thepresent sample was relatively low on most items,indicating that the items seem suitable for the purposeof discriminating at a high level of general professionalknowledge. In terms of concurrent validity, scores onthe ADKS should be different across groups withdifferent levels of knowledge about Alzheimer’sdisease. We would argue that clinical psychologistsworking with adults in general, should be familiar withclinical characteristics of dementia, which wouldenable them to refer the patient for appropriatedementia assessment when indicated. In line with theCarpenter et al. (2009), the correlation between theperformance on the ADKS and ratings of self-reportedknowledge about AD suggests an adequate predictivevalidity (0.52, p5 0.001).
By inspection of the specific items, only 6 items hada difficulty index ( p) below 0.70. The two items withthe lowest percentage of correct answers (0.36 and0.32, respectively) were related to medical risk factors,that is, high levels of cholesterol (item 18) and highblood pressure (item 26). These two items, representingoutliers in our sample, may be the ones most clearlyrelated to medicine or physiological processes, thus notcovered by the core knowledge base of most psychol-ogists. This seems also to be the case for the issue offalling as a consequence of AD (item 14, p¼ 0.49)together with the average life expectancy issue (item 3,p¼ 0.54), both items falling within the area of broadermedical issues. We would argue, however, that work-ing with older adults in general and with dementia
Table 3. Linear regression analysis of predictors for performance on ADKS (N¼ 956).
VariableUnstd.Beta
Std.Beta T p-level. R2 Change
p-levelchange
Model 1: Demography 0.005 0.255Age (years) �0.015 �0.069 �1.625 0.105Gender (1¼ female; 2¼male) 0.005 0.001 0.022 0.982
Model 2: Clinical Experience 0.064 50.001þ Certified clinical specialist(1¼ yes; 2¼ no)
�0.340 �0.068 �1.251 0.211
þ Age range of typical patient(1¼ 0–6 yrs; 2¼ 7–17 yrs; 3¼ 18–59 yrs; 4¼ 60þ yrs)
�0.068 �0.015 �0.292 0.770
þ Frequency of seeing patients withdementia/symptoms concordant with dementiaa
�0.121 �0.059 �0.823 0.411
þ Frequency of indirect exposure to dementia throughpatients in the role of family membera
0.619 0.272 4.526 0.000
þ Approximate percentage of patients withdementia/symptoms concordant with dementia (1–100)
0.010 0.044 0.835 0.404
Model 3: Self-reported Knowledge of AD 0.017 0.001þ Circle any number between 1 and 10 to indicate howmuch knowledge you think you have about Alzheimer’sdisease and related disorders
0.201 0.146 3.224 0.001
Note: a1¼ never; 2¼ 1–6 times a year; 3¼ 7–11 times a year; 4¼ 1–4 times during a month; 5¼ 1–2 times a week; 6¼ 3–4 times aweek; 7¼ daily.
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patients in particular involves the need for a bareminimum knowledge concerning medically relatedsymptoms as well as pharmacological treatmentoptions for AD. Hence, these issues should be betteraddressed in our professional psychology trainingprograms. Reversely, issues related to co-morbiditywith mental health issues such as in dementia, isobviously a well recognized topic in our sample (item 1,p¼ 0.96), a finding we would expect due to a strongemphasis on co-morbidity between somatic illness andemotional disorders in most professional psychologytraining programs. As for top performances in thepresent study, one third of the items had a p¼ 0.90 orabove, a finding that once again indicates the risk of acertain ceiling effect for the scale.
The regression analysis demonstrated that two ofthe predictors in sum explained 8.1% of the variance ofADKS performance, these being indirect exposure topatients suffering from dementia (Std. beta¼ 0.27,p5 0.001) and self-rated ADKS performance (Std.beta¼ 0.15, p5 0.001). The total explained variance isrelatively low, indicating that we might favourablyhave included a larger number of potentially relevantpredictors in our data collection. We would argue,however, that exposure to dementia in clinical practicedeservedly appears in the top spot as a plausiblepredictor of AD knowledge. The significant positiverelationship between knowledge and indirect contactwith the AD patient, points at a potential cross-learning between family care givers and professionals.Our sample has demonstrated the sparsity amongpsychologists of clinical work with older adults ingeneral and patients with dementia in particular.Unfortunately, our study also highlighted that littleappears to have changed since various surveys whichshowed that only between 1–4% of psychologistsconsidered specializing in working with older adultsor considered older patients as their primary profes-sional target (e.g. Gatz, Karel, & Wolkenstein 1991;Qualls, Segal, Norman, Niederehe, & Gallagher-Thompson, 2002; Wells, 2004). Of particular interest,however, is the fact that indirect exposure to dementiaalso has an impact on AD performance. Although at asmall-scale level, this reminds us of the extensive areaof application for which AD knowledge is relevant andin which it may develop. As a consequence, we shouldmore explicitly endorse an attitude that knowledgeabout abnormal ageing is not just a matter for thosespecializing in working professionally with olderadults. Accurate knowledge of the physical, cognitiveand psychological changes that may occur with age isimperative within an integrated model of general adulthealth care (Jackson, Cherry, Smitherman, & Hawley,2008). It goes without saying, that the boosting ofpsychology students’ exposure to older adults throughmandatory placements in age care settings withinprofessional clinical programs and curricular contentfocused on geropsychology would have a great impacton preparing future psychologists to work with olderpatients (e.g. Pachana, Helmes, & Koder, 2006).
Meanwhile, we find the ADKS as a potentially helpful
tool to assess current basic knowledge about
Alzheimer’s disease and related disorders.In closing, limitations of this study deserve men-
tion. Our sample may not be representative of theNorwegian clinical psychologist population. Still, given
that more than 50% of Norway’s NPA licensed clinical
psychologists participated in the study, substantial
deviations from our findings do not seem particularly
likely. Additional international studies would berequired, however, before attempting any broad
generalizations about AD knowledge in psychologists.
As indicated by Carpenter et al. (2009), the ADKS is
not a complete assessment tool, but rather containsrepresentative items indicating the level of general
knowledge about AD. The risk of ceiling effects in
certain expert groups, psychologists included, should
consequently not be underestimated. In order to
strengthen the utility of this scale, we believe thatsupplementary modules adapted to specific profes-
sional groups would provide added value, making it
more appropriate for use in professional training
programs and subsequent evaluation of teachingefforts. On a broader note, our findings underscore
the fact that psychologists without formal geropsy-
chology training may find that that they are providing
clinical services to older adults, either directly or as
part of support given to relatives of older personssuffering from dementia. In addition to strengthening
models of graduate clinical geropsychology training,
continuing post licensure education appears crucial in
preparing psychologists to provide clinical services toolder adults and their families. The ADKS may
usefully serve as part of a monitoring tool in the
effort to increase professional awareness among
psychologists working with older patients.
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