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. Author manuscript; available in PMC: 2025 Mar 1.
Published in final edited form as: Aging Ment Health. 2023 Oct 24;28(3):396–407. doi: 10.1080/13607863.2023.2268050

Perceptions, beliefs, attitudes, and knowledge of US Latino adults pertaining to dementia and brain health: A Systematic Review

Sophia W Light 1, Francesca Tomasino 1, Annie Wescott 2, Alissa Bernstein Sideman 3,4,5, Alyssa Vela 6, Katherine L Possin 4,7, Frank J Penedo 8, Michael S Wolf 1
PMCID: PMC10983845  NIHMSID: NIHMS1980617  PMID: 37874117

Abstract

Objectives:

Latinos in the US are 1.5 times more likely to develop Alzheimer’s Disease and Related Dementias (ADRD) than non-Latino Whites. This systematic review aims to summarize current understanding of the perceptions, knowledge, beliefs, and attitudes about ADRD and brain health of Latinos to inform public health efforts addressing disparities.

Methods:

Searches were completed across 6 databases (Medline, PsycINFO, WoS, LILACS, ProQUEST, CINAHL). Studies were required to capture attitudes and/or knowledge of ADRD or brain health among US-based Latino adults who were not cognitively impaired and were not caregivers or healthcare providers. Results were synthesized narratively.

Results:

5,528 unique records were identified. Following de-duplication and screening, 24 articles met the inclusion criteria for this review. Overall, knowledge about brain health and ADRD among Latinos is quite mixed. A consistent finding was that participants recognized memory loss as a symptom of cognitive impairment, but demonstrated limited recognition of other signs of impairment. The studies also highlighted variable knowledge of protective factors for maintaining brain health.

Conclusions:

Opportunities exist to increase knowledge of ADRD signs and symptoms, and awareness of risk and protective factors. Given the heterogeneity of Latinos in the US, more research is warranted to better elucidate nuances in conceptualizations of brain health and aging among diverse Latino subgroups.

Keywords: dementia, Alzheimer Disease, disparities, Hispanic or Latino, systematic review

Introduction

By 2050, cases of Alzheimer’s disease and related dementias (ADRD) in the United States (US) are expected to reach 14 million (Alzheimer’s Association, 2022). Given the influence of various social determinants of health (Brindis et al., 2018; Yaffe, 2018), individuals of Latin American descent living in the US (hereafter referred to as Latinos) are currently 1.5 times more likely to develop ADRD than non-Latino Whites (Alzheimer’s Association, 2022; Matthews et al., 2019), and they are expected to experience the steepest increase in incidence over the coming decades (González et al., 2019; The Truth About Aging and Dementia | CDC, 2019).

To inform public health efforts addressing this profound disparity, several calls to action have asserted the need to better understand the knowledge, beliefs, and attitudes about cognitive aging in the general public of middle-aged and older adults, particularly among diverse social and ethnic groups (Anderson et al., 2009; Centers for Disease Control and Prevention & Alzheimer’s Association, 2020). Reduced knowledge of ADRD may be one factor contributing to disparities in disease burden. With reduced knowledge, individuals may not engage in risk prevention, help seeking, early intervention, and research (Connell et al., 2007; Milani et al., 2020). The way persons think about and interpret events, including cognitive aging and decline, can determine their emotional and behavioral responses (Ayalon, 2013). In addition to individuals’ own knowledge and beliefs, attitudes and perceptions that are commonly held within a sociocultural group can influence health behaviors (J. N. Laditka et al., 2011).

To date, much of the published work on individuals’ perceptions of cognitive aging and ADRD either is based on studies with a small number of minoritized racial/ethnic groups or is focused on the knowledge and perceptions of caregivers of people living with ADRD (PLWD). For instance, a 2015 systematic review identified 40 articles that explored the general public’s knowledge and understanding of ADRD. This review revealed a fair to moderate level of knowledge and understanding, with a common misconception that dementia is a normal part of aging (Cahill et al., 2015). Specifically among Latinos, several studies explored beliefs and attitudes of caregivers of PLWD, and highlighted a tendency to value caregiving at home, reciprocity, and familism – the belief that the family supersedes the needs of the individual (Apesoa-Varano et al., 2015; C. Arévalo-Flechas et al., 2014; Mahoney et al., 2005; Rote et al., 2019). While understanding these belief systems is important, it is critical to understand how the general public of middle-aged and older adults – those without specialized training or exposure to ADRD – think about and conceptualize cognitive aging, ADRD, and brain health, or the preservation of optimal brain integrity and cognitive function in the absence of overt neurological disorders (Perales et al., 2020; Wang et al., 2020). This information can identify gaps in knowledge and misperceptions that may impact engagement in protective behaviors and practices, as well as access to timely diagnosis and care that also likely contribute to existing disparities. This systematic review thus aims to understand the established literature on perceptions, knowledge, beliefs, and attitudes about ADRD and brain health in adults of Latin American descent living in the US.

Methods

This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The review protocol was registered on PROSPERO (CRD42022360583).

Inclusion Criteria

In order to minimize bias, we established explicit inclusion criteria, followed by an exhaustive literature search. Eligible studies included individuals who: (a) were ≥18 years old, (b) currently living in the US, and (c) descend from one or more Latin American countries (i.e., identify as Latino/Hispanic/Latinx/Latin American; or are from any Spanish-speaking country in Central or South America; or whose family is from any Spanish-speaking country in Central or South America). Studies were included if they reported: attitudes, beliefs, or perceptions about brain health and/or dementia, and/or knowledge of brain health and/or dementia. If studies only included a portion of Latino individuals, they had to provide analysis of the differences in knowledge or beliefs by race/ethnicity.

Studies were excluded if they solely focused on: (a) participants with a diagnosis of dementia or mild cognitive impairment, (b) healthcare professionals or students, care staff or caregivers, or other specialist groups, or (c) exploratory evaluation of perceptions after an intervention. These exclusion criteria were developed in order to exclude groups whose attitudes and knowledge are likely to have been influenced by their highly relevant personal and professional experiences or interventions targeting issues of salience to PLWD. Abstracts, letters to editors, conference proceedings, books, book chapters, and reports that did not collect primary data were excluded from the report because we sought to include novel empirical data only. Theses and dissertations that included full manuscripts reporting on original data were included for comprehensiveness.

Search Strategy

A data specialist (AW) searched for relevant studies on select databases (Medline, PsycINFO, WoS, LILACS, ProQUEST, CINAHL) and registers (Cochrane Central Register of Controlled Trials), utilizing various iterations of syntax and combinations of MeSH terms and text words. The key terms used in the search were: (a) brain health or dementia (including Alzheimer’s disease and other dementias, as well as cognitive or neurocognitive function), (b) Hispanic or Latino (including Latine, Latinx, and specific Latin American nationalities; hereafter: Latino), and (c) knowledge or perceptions (Table 1). Only indiviudals from Spanish-speaking countries were included, based on the government definition of Hispanic/Latino as including those of “Spanish culture or origin” (Lopez et al., 2022). All search results were downloaded, and duplicates were identified and deleted. The remaining documents were uploaded into Rayyan software (Ouzzani, Hammady, Fedorowicz, & Elmagarmid, 2016) for title and abstract screening. Two reviewers (SWL, FT) independently reviewed titles and abstracts of the first 100 records for inclusion and exclusion criteria, and discussed inconsistencies until consensus was obtained. Then both researchers each independently screened all titles and abstracts for inclusion, and disagreements were resolved upon discussion. If necessary, a third researcher was consulted to make the final decision.

Table 1.

Search terms used for search strategy.

Brain Health/Dementia Hispanic or Latino Knowledge/Perception
dementia*
demencia
amentia*
CADASIL
Alzheimer*
Creutzfeldt-Jakob
Huntington*
Lewy-Bod*
cognit* within 2 words of disorder*/defect*/deficit*/decline*/deteriorate*/disabilit*/dysfunction/disfunction*/impaired/impairment*/interference*
neurocognit* within 2 words of disorder*/defect*/deficit*/decline*/deteriorate*/disabilit*/dysfunction/disfunction*/impaired/impairment*/interference*
frontotemporal within 2 words of
disorder*/defect*/deficit*/decline*/deteriorate*/disabilit*/dysfunction/disfunction*/impaired/impairment*/interference*		 AND Hispanic*
Puerto Rican*
Latin
Latino*
Latina*
Latine*
Latinx
Spanish-speaker*
Spanish-speaking
Argentinean*
Belizean*
Bolivian*
Chilean*
Colombian*
Cuban*
Costa-Rican*
Cuban*
Dominican*
Ecuadoran*
Guatemalan*
Haitian*
Honduran*
Mexican*
Panamanian*
Paraguayan*
Peruvian*
Salvadoran*
Uruguayan*
Venezuelan*		 AND attitude*
belief*
perception*
knowledge
opinion*
understanding
literacy
view*
viewpoint*
stigma*
information
associations
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NOTE: Within a column, OR terms were used

Full texts of potentially eligible records were obtained by the data specialist. Two researchers (SWL, FT) independently applied the full inclusion and exclusion criteria to determine full text eligibility. Decisions were tracked using an excel spreadsheet. Consensus was reached by discussion. There was good agreement between researchers (κ=0.95). Data extracted from study documents included study design, inclusion criteria, sample size, participant demographics, ethical approvals reported, response rate, non-response bias, outcomes and their measurements, and findings. One researcher (SWL) extracted data, and a second researcher (FT) independently extracted a portion of the data to ensure consistency. When necessary, disagreements were resolved with a third party and recorded in an excel spreadsheet.

The outcomes of interest were (a) attitudes, beliefs, or perceptions about brain health and/or dementia, and (b) knowledge of brain health and/or dementia. Given that this review included both quantitative and qualitative studies, the validated Mixed Methods Appraisal Tool (MMAT)(Hong et al., 2018) was utilized by two independent reviewers for quality assessment of relevant papers. The MMAT is comprised of two screening items for all research types, followed by five apraisal items for each type of study design (i.e., qualitative, quantitative randomized controlled trials, quantitative non-randomized, quantitative description, miexed methods). Reviewers independently evaluated selected articles by responding to each item with a “yes” if the item was addressed, “no” if the item was not addressed, or “can’t tell” if it was unclear whether the item was addressed.

Descriptive data were reported for all studies, and relevant information was synthesized narratively. The following tools and techniques were utilized, as described by Popay et al.: for building preliminary synthesis, textual descriptions, tabulation, groupings and clusterings, and thematic analysis; for exploring relationships within and between studies, concept triangulation and consideration for variability in outcomes, study design, and study population; and for assessing robustness of findings, critical reflection (Popay et al., 2006). Descriptive data was summarized and described as either (a) attitudes, beliefs, and perceptions, or (b) knowledge. Themes within these two domains were identified inductively following reading and re-reading of the original sources and discussions between the review team.

Results

Number of Studies Included

A total of 5,528 articles were identified, of which 2,459 studies were duplicates. Following title and abstract screening, the remaining 3,069 studies were reduced to 41 studies that investigated topics relevant to this report and that had full manuscript text available (note: of 50 resources sought, 9 were unattainable due to being more duplicates or having only abstracts available). After further scrutiny in the full text review phase, another 17 studies were excluded. Six were excluded because they were published in formats incompatible with the specific criteria identified (i.e., reports that did not collect primary data). Eleven covered topics that were not fully relevant (e.g., 5 did not discuss results pertaining to Latinos, 4 only included specialty groups such as caregivers or healthcare providers, 1 did not discuss knowledge or perceptions, and 1 did not discuss brain health or dementia). Our review is therefore based on 24 works. (Figure 1)

Figure 1.

Figure 1.

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

*Databases include Medline, PsycINFO, WoS, LILACS, ProQUEST, CINAHL; Registers include Cochrane Central Register of Controlled Trials

**No automation tools were used.

Background of Studies Reviewed

Of the included studies, 13 utilized a qualitative study design, 10 used quantitative descriptive methodology, and 1 was a mixed methods study that included both quantitative and qualitative methods (Table 2). Whereas quantitative studies provided valuable information pertaining to knowledge of Alzheimer’s disease and related dementias (ADRD), qualitative studies elucidated more in-depth understandings of the experiences and beliefs of individuals regarding brain health and dementia. Of note, only six studies were specifically tailored to individuals who identified as Latino (Cabrera et al., 2021; Cuevas & Zuñiga, 2021; Light et al., 2022; Rodriguez & Gatz, 2011; Sharkey et al., 2009; Weiner-Light et al., 2021); the remaining studies included between 2.5% and 50% Latino individuals. The reviewed studies that only included a portion of Latino individuals did provide analysis of differences in knowledge or beliefs by race/ethnicity.

Table 2.

Summary of studies included in the systematic review (N=24)

Study Study Design Sample Size (N) Inclusion Criteria Age: Mean (SD) Female Gender: N (%) Latino Ethnicity: N (%) Response Rate (%) Outcomes and their measurements
Ayalon & Arean (2004) Quantitative 193 ≥ 55 years, speak English or Spanish 67.45 (6.7) 74 (38.3%) 37 (19.2%) Not Reported Knowledge of AD: 17 true-false questions (nature, consequence, cure)
Ayalon (2013) Quantitative 1230 ≥ 50 years and their spouse of any age. The Health and Retirement Study 30.7% over age 75 709 (57.6%) 120 (9.8%) “representative of US population” Not Reported Concerns, knowledge, and beliefs about AD. 13 questions: true-false and Likert scale
Cabrera, et al. (2021) Qualitative 29 40–60 years old, native Spanish speakers. Puerto Ricans or Mexicans living in the Grand Rapids area. range: 39–60 20 (69.0%) 29 (100%) Not Reported Semi-structured focus group discussion guide: (a) knowledge, attitudes, beliefs concerns around AD and its prevention, and resources available for its care; (b) perceptions and attitudes around care related to AD; (c) ethical issues related to Latinos and AD.
Carpenter, et al. (2011) Quantitative 763 Community-dwelling older adults without cognitive impairment (n = 89), professionals involved in dementia research and service provision (n = 75), senior center staff (n =61), caregivers of people with dementia (n = 54), and undergraduate students (n = 484). 36.08 (22.55) 532 (70.0%) 89 (12%) Not Reported Knowledge of AD: ADKS (etiology, risk factors, assessment and diagnosis, symptomatology, course, treatment and management, and caregiving)
Chung, et al. (2009) Quantitative Descriptive 778 ≥ 50 years and their spouse of any age. The Health and Retirement Study 68 (31–96); 87.2% >50 y.o. 414 (53.2%) 47 (6.0%) Not Reported Perceived risk of AD. 2–3 questions based on hypothetical scenario.
Connell, et al. (2007) Quantitative 1176 ≥ 35 years old, English-speaking 55.1 (13.2) 593 (50.4%) 303 (25.8%) 31.90% Knowledge and beliefs about AD, (2) concern about AD and other prevalent chronic diseases, and (3) self-reported lifestyle changes to reduce the risk of AD and other diseases. 10 Likert scale questions.
Cuevas & Zuniga (2021) Qualitative 30 50–70 years old, identify as Latinx, have Type 2 Diabetes Mellitus for at least 2 years 66 (4.3) Not Reported 30 (100%) Not Reported Perspectives on cognitive health. 11 open-ended questions (terms for cognition; cognitive concerns; cognitively stimulating activities; modifiable health factors; terms, concerns, and knowledge specific to ethnicity; the effect of cognitive changes on diabetes self-management)
Edwards, et al. (2000) Quantitative 527 ≥ 60 years old, community dwelling older adults 74 (8) 321 (61%) 26 (5%) 63% Misconceptions of AD. 3 Likert scale questions.
Friedman, et al. (2011) Qualitative 396 ≥ 50 years old, community dwelling, did not report cognitive impairment. The Healthy Brain Study: 42 focus groups (2 with Latinos) 71.0 (9.3) 297 (74.9%) 10 (2.5%) Not Reported 9-item focus group discussion guide. Perceptions about the roles of mental exercise, social activity, and positive attitude in maintaining cognitive health.
Friedman, et al. (2013) Quantitative 4728 ≥ 18 years old 46.4 (18–99) 2435 (51.5%) 633 (13.4%) 72.70% Perceptions related to beliefs and communication practices about lifestyle behaviors beneficial for overall health and for maintaining cognitive functioning. 5 multiple choice questions.
Karlawish, et al. (2011) Qualitative Free-listing 120 Four groups defined by their self-identified ethnicity and caregiver status: Latino or non-Latino Whites who were either caregivers or noncaregivers (1 group of 30 Latino noncaregivers) 60.0 (12.1) 93 (77.5%) 60 (50%) Not Reported Perceptions and knowledge of AD. 4 free-listing exercises (symptoms, causes)
Laditka, et al. (2009) Qualitative 396 ≥ 50 years old, community dwelling, did not report cognitive impairment. The Healthy Brain Study: 42 focus groups (2 with Latinos) 71.0 (9.3) 297 (74.9%) 10 (2.5%) Not Reported 9-item focus group discussion guide. Perspectives about aging well, in context of cognitive health.
Laditka, et al. (2011) Qualitative 396 ≥ 50 years old, community dwelling, did not report cognitive impairment. The Healthy Brain Study: 42 focus groups (2 with Latinos) 71.0 (9.3) 297 (74.9%) 10 (2.5%) Not Reported 9-item focus group discussion guide. Concerns about cognitive function and memory.
Laditka, et al. (2013) Qualitative 396 ≥ 50 years old, community dwelling, did not report cognitive impairment. The Healthy Brain Study: 42 focus groups (2 with Latinos) 71.0 (9.3) 297 (74.9%) 10 (2.5%) Not Reported 9-item focus group discussion guide. Perceptions of others who currently experience cognitive impairment, or did so in the past.
Light, et al. (2022) Qualitative 30 ≥ 60 years old, first-generation Latin American immigrants, monolingual Spanish-speakers. Global Brain Health Initiative project. 76.37 (7.7) 30 (66.7%) 30 (100%) Not Reported Semi-structured interview guide. Knowledge, perspectives, and attitudes about the brain, brain health, and aging, and where that knowledge was acquired.
Milani, et al. (2020) Quantitative 842 ≥ 50 years old 62.4 (8.3) 525 (62.3%) 104 (12.4%) Not Reported Knowledge of AD: Abbreviated ADKS (risk factors, assessment and diagnosis, symptoms, life course, and treatment and management)
Nadeau, et al. (2017)
[Master’s Thesis] 		Quantitative 86 Born between 1946 and 1964, with the ability to read and understand the English language Not Reported 55 (64.0%) 4 (4.7%) Not Reported Knowledge of AD: ADKS (etiology, risk factors, assessment and diagnosis, symptomatology, course, treatment and management, and caregiving)
Roberts, et al. (2015) Qualitative 75 ≥ 55 years old. 6 focus groups (two with 22 Latinos; one group was done in Spanish). 55–78 45 (60%) 22 (29.3%) Not Reported Semi-structured interview guide. Attitudes and beliefs related to cognitive illness, culture, and aging.
Rodriguez & Gatz (2011)
[Master’s Thesis] 		Mixed Methods 40 ≥ 18 years old, self-identified Hispanic/Latino race/ethnicity, speak English and/or Spanish, and had the ability to travel to the Senior Services Division of the International Institute of Los Angeles. 47.75 (14.75) 29 (72.5%) 40 (100%) Not Reported Knowledge of AD: ADKS (etiology, risk factors, assessment and diagnosis, symptomatology, course, treatment and management, and caregiving)
Sharkey, et al. (2009) Qualitative 33 Mexican American colonia residents, ≥55 years old, Spanish as preferred language 39.4% 50–64 y.o.; 36.4% 75+ y.o. 25 (75.8%) 30 (90.9%) Not Reported 9-item focus group discussion guide (from The Healthy Brain Study). Perspectives on cognitive health, and how they may be motivated to improve lifestyle behaviors to maintain it.
Van Liew, et al. (2014) Quantitative 974 ≥18 years or older in Balboa Park, San Diego; understand written and spoken English 30% 18–30 y.o.; 31% 31–50 y.o.; 28.6% 51–65 y.o.; 10.4% 66+ y.o 511 (52.5%) 113 (11.6%) Not Reported Concern and perceived risk of AD. 10 Likert scale questions in response to vignette.
Weiner-Light, et al. (2021) Qualitative 30 ≥ 60 years old, first-generation Latin American immigrants, monolingual Spanish-speakers. Global Brain Health Initiative project. 76.37 (7.73) 30 (66.7%) 30 (100%) Not Reported Semi-structured interview guide. Knowledge, perspectives, and attitudes about the brain, brain health, and aging, and where that knowledge was acquired.
Wilcox, et al. (2009) Qualitative 396 ≥ 50 years old, community dwelling, did not report cognitive impairment. The Healthy Brain Study: 42 focus groups (2 with Latinos) 71.0 (9.3) 297 (74.9%) 10 (2.5%) Not Reported 9-item focus group discussion guide. Awareness and attitudes about several topics related to brain health, brain disorders, and the behaviors that have been associated with maintaining brain health.
Williams, et al. (2010) Qualitative 119 Attended a memory screening event, English-speaking or bilingual English-Spanish adults 68.81 (11.49) 95 (79.8%) 33 (27.7%) Not Reported 5 item structured interview guide. Perspectives on screening and intentions to pursue diagnostic testing if they had positive screening results.
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ADKS = Alzheimer’s disease knowledge scale

N = number of participants

SD = Standard deviation

Five papers leveraged data from the Healthy Brain Study (Friedman et al., 2011; J. N. Laditka et al., 2011; S. B. Laditka et al., 2009, 2013; Wilcox et al., 2009), and an additional study utilized the same interview guide (Sharkey et al., 2009). Two other papers leveraged data from the same Global Brain Health Initiative investigation (Light et al., 2022; Weiner-Light et al., 2021). Two more papers leveraged data from the Health and Retirement Study (Ayalon, 2013; Chung et al., 2009). Two studies found on ProQuest were thesis documents and thus not published in peer-reviewed publications (Nadeau & White, 2017; Rodriguez & Gatz, 2011); we chose to include these studies in an effort to be as comprehensive as possible.

Sample Size

Sample sizes ranged considerably. Eight studies included small samples (n < 100), of which 6 were qualitative peer-reviewed papers, and the other two were thesis projects (1 quantitative, 1 mixed methods). Nine studies reported medium sample sizes (e.g., n = 100–600). Three had medium-large samples (e.g., n = 600–900). Another three studies included large samples (e.g., n = 900–1,999) and one had a very large sample (e.g., n ≥ 2,000).

Age Profile

Data on participant ages varied. Mean age was available for 18 of the studies. Of those, average age ranged from 36 to 76 years. Five studies only reported age ranges (50 to 64 years, 39 to 60 years, 55 to 78 years, 50 to ≥66 years, or 18 to ≥75 years). The majority of studies (n = 18) had minimum age requirements: three had a minimum age requirement of 18 years old, one of 35 years old, one of 40 years old, nine of 50 years old, one of 52 years old, two of 55 years old, and one of 60 years old.

Quality Assessment Overview

Instruments Used to Assess Knowledge and Beliefs.

Of the studies involving quantitative methods, the majority (n = 7) developed their own instruments to collect data on knowledge and/or beliefs, typically leveraging either true/false responses, multiple choice or Likert scales, or a vignette or hypothetical prompt. Four studies utilized the validated Alzheimer’s Disease Knowledge Scale (ADKS)(Carpenter et al., 2009), though one of these used an abbreviated version of the ADKS.

Of the studies involving qualitative methods, the majority leveraged structured interview guides for focus groups (n = 9), while four used semi-structured guides for one-on-one interviews, and one study (Karlawish et al., 2011) utilized free-listing exercises.

Probability Versus Nonprobability Sampling.

All included reports utilized nonprobability sampling (e.g., convenience sampling). One paper used a random number sequence to implement random selection within a convenience sampling method (Van Liew et al., 2014).

Response Rates.

Only three of the studies (all quantitative) provided information on response rates. Of these, response rates ranged from 32% to 73% (Connell et al., 2007; Edwards et al., 2000; Friedman, 2013). Among the qualitative studies, several reported unbalanced participation of the different ethnic groups under study (e.g., fewer Latino focus groups than other ethnic groups (Friedman et al., 2011; J. N. Laditka et al., 2011; S. B. Laditka et al., 2009, 2013), fewer Puerto Rican participants than Mexican-American participants (Cabrera et al., 2021)).

Because the MMAT was designed to appraise quantitative, qualitative, and mixed methods research, the authors discourage the calculation of an overall score from the ratings of each criterion; rather, the authors suggest providing a more detailed presentation of the ratings of each criterion to better inform the quality of the included studies. Across all but one of the quantitative studies, at least one item was marked as “can’t tell” on the MMAT tool, indicating the need for manuscripts to be more explicit about methods used (see Supplemental Material).

Results on Dementia Knowledge

In the eight studies investigating dementia knowledge, six reported that knowledge among Latinos was lower compared to non-Latino Whites in at least one domain (Ayalon, 2013; Ayalon & Areán, 2004; Carpenter et al., 2011; Connell et al., 2007; Nadeau & White, 2017; Rodriguez & Gatz, 2011). Of those studies that utilized the ADKS, total mean scores for Latinos were 17.6 or 19.74 (out of 30), compared to 21.9 for non-Latinos, which represented a statistically significant difference (p<.001) (Carpenter et al., 2011; Rodriguez & Gatz, 2011).

Common misconceptions included misunderstanding the difference between normal memory loss and AD (Ayalon, 2013; Connell et al., 2007), uncertainty about curability and treatment options (Ayalon, 2013; Ayalon & Areán, 2004), under- or over-estimation of various risk factors for ADRD (Rodriguez & Gatz, 2011), and limited knowledge of the course of the disease including independence and safety considerations (Ayalon, 2013; Rodriguez & Gatz, 2011). It is important to note that two of these studies are thesis papers and therefore are not peer-reviewed, have small sample sizes, and may have other methodological limitations (Nadeau & White, 2017; Rodriguez & Gatz, 2011). Additionally, data from one of the studies showed that Latinos had a lower mean ADKS score compared to non-Latinos, but these differences were not described in the manuscript, nor were professionals or specialists separated from the general public (Carpenter et al., 2011).

In some studies, few differences were identified by ethnic group (Connell et al., 2007; Edwards et al., 2000; Nadeau & White, 2017). For instance, a national survey of individuals aged 55 and older demonstrated that for non-Latino White, Black, and Latino participants alike, approximately half of participants answered knowledge questions pertaining to life espectancy, treatment, and prevention for AD correctly (Connell et al., 2007); a survey of people aged 60 and older in Northwest Indiana found that for both Latino and non-Latino White participants, a large percentage of the sample responded incorrectly or “unsure” to questions about prevention, cause, and cure for AD (Edwards et al., 2000); and in Southern California, no significant differences on ADKS scores were found between non-Latino White, Latino, Black, Asian, and “Mixed” participants between 52 and 70 years old (Nadeau & White, 2017). In one national study, the majority of Latino adults demonstrated accurate knowledge of genes as a risk factor for AD, despite misperceptions about patients’ decision-making abilities, availability of preventative drugs, and safety of driving with AD (Ayalon, 2013).

Importantly, only one of the studies focused on knowledge was completed within the past five years (Milani et al., 2020). In contrast to the previously described studies, this most recent investigation reported that Latinos demonstrated knowledge that was either comparable to or higher than their non-Latino White counterparts. Specifically, Milani, et al. (2020) reported that Florida-based Latinos performed better than other ethnic groups on knowledge domains of life impact, risk factors, and course of disease. Latinos were more likely to know that people with AD are prone to depression, and to recognize cholesterol and high blood pressure as risk factors. The authors noted that 62.5% of the Latinos included in their sample were recruited from Miami, of which the majority were born in Cuba and Colombia, and they reported the lowest food insecurity (used as a proxy for socioeconomic status) compared to all other ethnic groups in the study, and significantly higher levels of education compared to non-Latino Black participants (Milani et al., 2020).

Aside from race/ethnicity, several correlates of knowledge were identified, including education level (Ayalon, 2013; Ayalon & Areán, 2004; Edwards et al., 2000; Milani et al., 2020; Rodriguez & Gatz, 2011), speaking English versus Spanish (Rodriguez & Gatz, 2011), having a family member with ADRD (Carpenter et al., 2011), being recruited in an urban versus rural settings (Milani et al., 2020), female gender (Milani et al., 2020), and reporting no food insecurity (Milani et al., 2020).

Results on Dementia Beliefs and Perceptions

Concern/Perceived Risk:

Regarding aging, participants acknowledged concern about being alone and becoming dependent (Sharkey et al., 2009) or being a burden (Cabrera et al., 2021; S. B. Laditka et al., 2013). In contrast, one study demonstrated that Latinos in Southern California’s Inland Empire (encompassing Riverside and San Bernardino Counties) were more accepting of aging compared to non-Latinos who felt disappointed and fearful (Roberts et al., 2015). (Table 3)

Table 3.

Summary of Beliefs and Perceptions

Perception Category Summary of Themes
Concern/Perceived Risk Concern about being alone, becoming independent, being a burden
Acceptance of aging
Mixed concern about cognitive impairment
Signs and Symptoms Consistently recognize memory loss, forgetfulness as signs of ADRD
Difficulty distinguishing between normal and non-normative memory loss
Acceptance of memory difficulties as part of natural course of aging
Disorientation, confusion, communication difficulties, loss of independence, aggressive behaviors, personality changes, physical limitations, social isolation, “losing the soul” variably identified as additional signs
Brain health as maintaining independence, memory function, emotion regulation, orientation, conversational skills, physical health, the ability to work, the ability to stay active, longevity
Etiology/Risk Factors Consistently identified genetics as cause of ADRD
Variably attribute ADRD to stress, family problems, depression, God’s will
Prevention Mixed recognition of protective lifestyle factors
Often recognize physical activity, mental exercise, diet, staying positive, limiting stress, accepting one’s age, distracting oneself, social engagement, community engagement, going to church, increasing educational attainment, managing medical conditions, prayer and connecting to God, sleep, and limiting substance use variably identified as protective factors
Treatment Limited knowledge of medical treatments for ADRD
Tendency to be open to seeking medical help for ADRD
Preference for family-centered care
Frequently reported barriers to care, such as cost, insurance, discrimination, limited language concordance
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Specific to cognitive impairment concerns, findings were mixed. In two studies, including a national sample and one based in South Florida, Latinos were less concerned than non-Latino White and Black participants about having a problem with their memories (Friedman, 2013; Williams et al., 2010). Utilizing vignettes, Van Liew et al. (2014) reported that, compared to non-Latino White participants, English-speaking Latinos in the San Diego, CA region rated a condition as more severe, the need for medical assistance as stronger, and the likelihood of hiring a home care aide as higher for a cognitively healthy individual compared to someone with AD (Van Liew et al., 2014). In contrast, all ethnic groups in another study of older community-dwelling adults living in diverse geographic regions expressed worry and fear about their memories and abilities to think (S. B. Laditka et al., 2013).

One study of Florida-based adults aged 50 and older reported that all ethnic groups expressed a wish to know their chances of developing AD and that Latinos were most likely to believe that they will develop AD (Ayalon, 2013). Another national study demonstrated that when self-rated longevity expectation was included as a covariate, Latinos had a lower perceived risk of developing AD within 10 years than did non-Latino Whites (Chung et al., 2009). More recently, both Mexican-American and Puerto Rican participants in Grand Rapids, Michigan expressed openness to diagnostic testing, with stated reasons including concern about a family history of AD and being able to prepare loved ones (Cabrera et al., 2021). One national study of English-speaking adults ages 35 years and older demonstrated that in all ethnic groups, about 25% of respondents were concerned about developing AD, but they were more concerned about developing cancer, diabetes, and heart disease (Connell et al., 2007). Another study similarly described Southern California Latino participants’ concerns about lack of awareness of ADRD within their communities, as providers are more focused on other chronic conditions (Roberts et al., 2015).

One national study showed that, among adult community members age 55 years and older, more Latino respondents reported feeling “very knowledgeable” about AD and well-prepared to manage a family member’s diagnosis compared to their non-Latino White counterparts (Connell et al., 2007). Latinos in this study also demonstrated more optimism about future AD research and the potential for a cure to be found (Connell et al., 2007).

Signs and Symptoms.

Across studies, participants were able to identify various signs of ADRD. By far the most frequently endorsed sign was memory loss or forgetfulness (Cabrera et al., 2021; Karlawish et al., 2011; S. B. Laditka et al., 2013; Roberts et al., 2015; Rodriguez & Gatz, 2011). Many of the studies noted that respondents had a difficult time distinguishing between normal memory difficulties and non-normative memory loss, and that they often normalized or accepted memory difficulties as part of the natural course of aging (Cabrera et al., 2021; Cuevas & Zuñiga, 2021; J. N. Laditka et al., 2011; Roberts et al., 2015; Rodriguez & Gatz, 2011). Additionally, participants variably mentioned disorientation or getting lost (Karlawish et al., 2011; Rodriguez & Gatz, 2011), confusion or recognition problems (Cabrera et al., 2021; Karlawish et al., 2011), communication difficulties (Karlawish et al., 2011; S. B. Laditka et al., 2013; Rodriguez & Gatz, 2011), loss of independence (Karlawish et al., 2011; Rodriguez & Gatz, 2011), aggressive behaviors or personality changes (Cabrera et al., 2021; Rodriguez & Gatz, 2011), physical limitations (Roberts et al., 2015), social isolation (S. B. Laditka et al., 2013), and – among older, monolingual Spanish-speaking Mexican-Americans living in low income areas of South Texas – losing the soul (Sharkey et al., 2009).

In contrast, respondents in some studies described brain health as maintaining independence (S. B. Laditka et al., 2009; Light et al., 2022; Sharkey et al., 2009), memory function (S. B. Laditka et al., 2009; Light et al., 2022; Sharkey et al., 2009), emotion regulation (Light et al., 2022), orientation (Light et al., 2022), conversational skills (S. B. Laditka et al., 2009), physical health or the absence of disease (Cuevas & Zuñiga, 2021; S. B. Laditka et al., 2009), the ability to work (Cuevas & Zuñiga, 2021; S. B. Laditka et al., 2009), the ability to stay active (Cuevas & Zuñiga, 2021), and longevity (Cuevas & Zuñiga, 2021).

Importantly, these responses were variable. In the Karlawash et al. (2011) study, when asked what words come to mind when they hear AD, non-caregiver Puerto Ricans in Philadelphia responded “I don’t know” more frequently than caregiver groups as well as the non-caregiver non-Latino White group, and only the caregiver group acknowledged behavioral and emotional changes as signs of AD (Karlawish et al., 2011). Also, in Laditka, et al. (2013)’s study, in contrast to other ethnic groups, Latino older adults did not mention slow thinking or mood and personality changes as potential signs of dementia (S. B. Laditka et al., 2013). In Cabrera et al. (2021)’s recent study, Latino middle-aged adults in Grand Rapids were not able to distinguish AD from dementia (Cabrera et al., 2021). Relatedly, when asked about brain health and healthy versus unhealthy aging, few older Latin American immigrants in the San Francisco Bay Area connected their descriptions to ADRD (Light et al., 2022).

Etiology and Risk Factors:

Respondents often identified genetics as a cause of ADRD (Ayalon, 2013; Karlawish et al., 2011; Rodriguez & Gatz, 2011). In one national study and one Philadelphia-based study, Latinos were more likely than their non-Latino White counterparts to attribute ADRD to stress, family problems, or depression (Ayalon, 2013; Karlawish et al., 2011). In a San Francisco-based study, some older Latin American immigrants attributed unhealthy brain aging to God’s will (Weiner-Light et al., 2021). Of note, in Laditka et al. (2013), while participants of other ethnicities mentioned various potential causes of ADRD, Latino participants did not mention any (S. B. Laditka et al., 2013); and in a Philadelphia-based study, non-Latino White participants, but not Latinos, noted lack of brain activity, plaque buildup, and environment as potential underlying causes (Karlawish et al., 2011).

Prevention:

There was a wide range of perspectives on ways to prevent dementia. Across studies, participants mentioned physical activity (Ayalon, 2013; Cabrera et al., 2021; Cuevas & Zuñiga, 2021; Rodriguez & Gatz, 2011; Sharkey et al., 2009), mental exercise (Friedman et al., 2011; Light et al., 2022; Rodriguez & Gatz, 2011; Sharkey et al., 2009), diet (Ayalon, 2013; Cabrera et al., 2021; Cuevas & Zuñiga, 2021; S. B. Laditka et al., 2009; Rodriguez & Gatz, 2011; Wilcox et al., 2009), staying positive or optimistic (Friedman et al., 2011; S. B. Laditka et al., 2009; Rodriguez & Gatz, 2011), limiting stress or worry (Cuevas & Zuñiga, 2021; Friedman et al., 2011; S. B. Laditka et al., 2009; Rodriguez & Gatz, 2011), accepting one’s age (S. B. Laditka et al., 2009), distracting oneself (Rodriguez & Gatz, 2011; Sharkey et al., 2009), social engagement (Cuevas & Zuñiga, 2021; Friedman et al., 2011; S. B. Laditka et al., 2009; Light et al., 2022), community engagement (Friedman et al., 2011), going to church (Weiner-Light et al., 2021), increased education attainment (Rodriguez & Gatz, 2011), management of medical conditions (Light et al., 2022), prayer and connecting to God (Friedman et al., 2011; Weiner-Light et al., 2021), sleep (Cuevas & Zuñiga, 2021), and limiting substance use (S. B. Laditka et al., 2009). One paper reported that Latinos were among the groups that most frequently cited less worry and stress as important strategies for maintaining cognitive health (Friedman et al., 2011).

Specific mentally stimulating activities mentioned were games and puzzles (Cuevas & Zuñiga, 2021; Friedman et al., 2011; Sharkey et al., 2009), singing (Sharkey et al., 2009), embroidery (Sharkey et al., 2009), listening to music (Sharkey et al., 2009), spending time with pets (Sharkey et al., 2009), reading (including the Bible)(Cuevas & Zuñiga, 2021; Friedman et al., 2011; Sharkey et al., 2009), and using memory tips (Friedman et al., 2011). Specific dietary advice included following a vegetarian diet (Cuevas & Zuñiga, 2021). Vitamins and dietary supplements were also discussed as aspects of maintaining brain health (Ayalon, 2013; Light et al., 2022; Wilcox et al., 2009).

In one study, Puerto Ricans, but not Mexican-Americans in Grand Rapids, noted preventative lifestyle factors (Cabrera et al., 2021). In another, no Latino participants in Southern California, but only non-Latino White participants mentioned protective factors (Roberts et al., 2015). In one national study, Latinos were the least likely to think that mental activity could be protective (Ayalon, 2013). In a multi-site study specifically exploring perceptions of the role of physical activity and diet in brain health, older Latinos offered fewer responses than other groups, and did not explicitly link physical activity and brain health, yet often included activities of daily living (ADLs) in their conceptualizations of brain health (Wilcox et al., 2009). Moreover, they did not mention factors related to frequency, intensity, or duration of physical activity for maintaining brain health (Wilcox et al., 2009). In terms of diet, Latinos in the same study discussed portion control as a brain health maintenance approach; as opposed to other ethnic groups, Latinos did not discuss preparation methods or specific foods one should eat (Wilcox et al., 2009).

In one national study, more Latino and Black adults than non-Latino White adults endorsed changing their behaviors in order to avoid AD (~32%); however, they were considerably more likely to change their behaviors for cancer (~71%) or diabetes (~79%) (Connell et al., 2007). In another study, participants in Texas reported that they do not do a good job of practicing the behaviors they described and that they do not receive help from healthcare providers to do so (Cuevas & Zuñiga, 2021).

Treatment:

There is some evidence that Latino adults demonstrated limited knowledge of medical treatments for ADRD (Rodriguez & Gatz, 2011). In one study, Spanish-speaking adults in East Los Angeles mentioned nutrition, vitamins, mental exercise, pets, and God’s help as treatment options for dementia (Rodriguez & Gatz, 2011).

In terms of attitudes, Latino adults tend to be open to seeking medical help in response to ADRD (Roberts et al., 2015; Rodriguez & Gatz, 2011; Williams et al., 2010). One study of older adults in South Florida suggested that Latinos were more likely than other ethnic groups to seek professional help if they screened positive for cognitive decline (~65%), and that they were the most optimistic about treatment outcomes (Williams et al., 2010). On the other hand, several studies highlighted the preference for family-centered care among Latinos (Cabrera et al., 2021; Cuevas & Zuñiga, 2021; Roberts et al., 2015; Rodriguez & Gatz, 2011). Puerto Rican participants in Philadelphia described caregivers as “attentive,” “understanding,” “loving,” and “strong” (Karlawish et al., 2011). In another study, older Latinos in Southern California additionally emphasized the role of neighbors and community in caring for elders (Roberts et al., 2015). In Cabrera, et al. (2021)’s recent paper, both Puerto Ricans and Mexican-Americans in Grand Rapids preferred family-centered care at home, as opposed to nursing homes; participants expressed concern about cost of care, and Puerto Rican participants mentioned insurance as a barrier to care (Cabrera et al., 2021). In a study exploring the meaning of cognitive health from the perspectives of Latinx adults in Texas with Type 2 Diabetes Mellitus, Cuevas & Zuniga (2021) similarly reported barriers to care, including experiences of discrimination in the healthcare system and limited language-concordant care (Cuevas & Zuñiga, 2021).

Discussion

We performed a comprehensive review of studies assessing US-based Latino adults’ knowledge and beliefs pertaining to ADRD. While identifying core findings, synthesizing data, and drawing conclusions is difficult given the lack of consistency across constructs, sampling, inclusion criteria, study design, and data collection methods, several important concepts and themes were identified.

Overall, evidence suggests that knowledge about brain health and ADRD among Latinos is quite mixed. While several quantitative studies suggest that knowledge among Latinos may be lower than that of non-Latinos, one recent study demonstrated higher knowledge among Florida-based, middle-aged and older Latinos (Milani et al., 2020). These differences may be explained by education level, socioeconomic status, exposure to ADRD, acculturation, and/or urban living. Moreover, different Latino subpopulations might have varying levels of knowledge of ADRD. For example, the Miami Latino population is distinct in that it is mostly comprised of Latinos of Cuban or South American descent (while Mexican-Americans account for the majority of Latinos in the US), and they often have higher socioeconomic status and education levels (Lopez & Dockterman, 2011; Milani et al., 2020; Noe-Bustamante et al., n.d.). In contrast, studies that included Latinos living in other regions of the US, and those that specifically included those of Puerto Rican and Mexican-American descent, demonstrated somewhat more limited knowledge and awareness of ADRD.

In qualitative studies, Latino participants shared heterogeneous understandings of signs and symptoms of ADRD, as well as indicators of brain health. Overall, participants tended to recognize memory loss as a symptom, but there is evidence of a limited ability to distinguish between normal forgetting that comes with aging, versus memory loss that is suggestive of impairment. Further, there was limited recognition of other important signs of cognitive impairment. Similar to results among the general public (Cahill et al., 2015), findings highlight the importance of increasing understanding of the difference between typical age-related forgetting and memory loss that disrupts daily life. Notably, the majority of studies specifically focused on AD. While AD is the most common form of dementia, it is worth increasing the public’s understanding of other causes of dementia (e.g., vascular dementia, Lewy body disease, frontotemporal lobar degeneration), as well as the warning signs and symptoms of all ADRD beyond memory loss (e.g., challenges in planning or problem-solving, difficulty completing familiar tasks, confusion with time or place, visuospatial difficulties, new problems with speaking or writing, poor judgment, changes in personality or behavior, etc.) (Alzheimer’s Association, 2022).

Overall, Latino participants expressed variable concern about their risk of developing ADRD; yet there is some evidence that Latinos do not view dementia or cognitive impairment as a major area of concern or vulnerability. Some studies suggest that Latinos may accept cognitive impairment as inevitable, or may view ADRD as characteristic of normal aging. This normalization of ADRD may be problematic, serving to impede access to services, deterring individuals from responding to public health promotion efforts, engaging in health behavior change, and/or screening (Ayalon, 2013; J. N. Laditka et al., 2011). Indeed, participants’ knowledge of risk factors for dementia was mixed. The majority of studies reported a general awareness of the contribution of genes to ADRD; yet aside from that, results indicated an underappreciation of other potential contributing factors, as well as an overestimation of the role of stress in the development of ADRD. Attributing ADRD to stress may be associated with blaming individuals with cognitive impairment, thus increasing stigma, and lowering the probability of seeking medical intervention (Ayalon, 2013). Therefore, further education on the role of stress in ADRD is warranted. Additionally, if individuals believe that ADRD trajectories are inevitably determined by their genes, they may be less likely to adopt behaviors associated with maintaining cognitive health (J. N. Laditka et al., 2011). Therefore, findings suggest that increasing understanding of additional risk factors for ADRD may be prudent (e.g., age, cardiovascular risk factors, education, traumatic brain injury, etc.) (Alzheimer’s Association, 2022; Livingston et al., 2020), while simultaneously emphasizing that having a family history and/or carrying specific alleles may increase risk but does not guarantee that a person will develop ADRD (Alzheimer’s Association, 2022).

Relatedly, findings demonstrated variable beliefs about protective factors for maintaining brain health. Across studies, Latino participants mentioned physical activity, mental exercise, and diet, which have all been identified as potentially modifiable lifestyle behaviors that can delay or prevent dementia (Alzheimer’s Association, 2022; Livingston et al., 2020; Yaffe, 2018). Other potential protective factors, such as limiting substance use, managing mental and physical health conditions, managing sensory deficits, and staying socially active (Alzheimer’s Association, 2022; Livingston et al., 2020; Yaffe, 2018) were either rarely or never mentioned. Results suggest the need for increasing knowledge of what individuals can do now to reduce risk and potentially delay the onset of cognitive decline. In particular, specific guidelines for physical activity and dietary recommendations may be prudent. Respondents also tended to overestimate the role of vitamins and supplements in maintaining cognitive health. Importantly, a systematic review found little to no benefit from the use of supplements or vitamins in preventing cognitive decline or ADRD (Butler et al., 2018); therefore, although this belief will likely result in little benefit, the misperception may additionally represent vulnerability to marketing of unproven “anti-aging” products, as opposed to evidence-based approaches. Finally, while educating the public on risk and protective factors may help to reduce ADRD rates, it is critical to acknowledge that many known contributors are structural and systemic in nature (Majoka & Schimming, 2021), and steps must be taken to avoid placing blame on individuals. Furthermore, given that Latinos and other minoritized groups have historically been excluded from ADRD research, more research is needed to understand the generalizability of the aforementioned protective factors to Latino individuals, as they have been endorsed based on research in predominantly non-Latino White, educated, industrialized, high socioeconomic status samples (Díaz-Santos et al., 2023).

Few studies explicitly explore participants’ understanding of treatment options for cognitive impairment; that said, awareness of treatment approaches may be limited. To date, the US Food and Drug Administration has approved several drugs for the treatment of AD (Alzheimer’s Association, 2022). The most recently approved drugs, aducanumab and lecanemab, actually address the underlying biology of AD by reducing beta-amyloid plaques in the brain (Alzheimer’s Association, 2022, 2023). These drugs are specifically indicated for people with mild cognitive impairment (MCI) or mild dementia due to AD (Alzheimer’s Association, 2022, 2023), further highlighting the importance of early detection. Due to various factors including language barriers, insurance coverage, and concerns about immigration status, Latino individuals are currently less likely to participate in clinical trials compared to other ethnic groups, impacting the generalizability of efficacious treatments and interventions (McGill, 2013; Perales et al., 2020). Increasing education and awareness could lead to increased willingness to participate in clinical trials and relevant research that are essential for quality care for diverse groups. In our review, while there was some evidence of positive attitudes among Latinos towards seeking screening and medical treatment, there were also notable perceived barriers to care (e.g., discrimination, cost, insurance, language), and a tendency towards family- and community-centered care. The tendency towards a model of care that centers around the family and community is consistent with studies among Latino caregivers (Apesoa-Varano et al., 2015; C. Arévalo-Flechas et al., 2014; Mahoney et al., 2005; Rote et al., 2019) and non-caregiver adults in Brazil (Farina et al., 2021). While this practice has many benefits, it may also lead to higher rates of caregiver burden in Latino communities (Alzheimer’s Association, 2022; Bilbrey et al., 2018; Liu et al., 2021), further underscoring the importance of early intervention (Van Liew et al., 2014). It is also worth highlighting the need for improved care for patients and family members of historically marginalized communities, who may continue to feel marginalized in healthcare settings.

Limitations

Several limitations must be noted. First, our review leveraged both qualitative and quantitative studies, in order to elaborate as much as possible on perceptions of ADRD and brain health. Among the quantitative studies, synthesis and interpretation of findings was somewhat limited due to the heterogeneity of measures used, including some measures that had not been validated. Overall there was a lack of data on response rates, which might have further informed the perspective on study quality. Additionally, deciding how best to interpret qualitative findings was challenging, as their results cannot be evaluated using the same methods as quantitative studies. Nevertheless, the rich data extrapolated from qualitative research cannot be overlooked. Second, several papers reviewed data from the same overarching studies, and two papers were masters’ theses and thus not peer reviewed. Additionally, the vast majority of the included studies were conducted over a decade ago and may no longer be accurate depictions of current perspectives. Therefore, more research is necessary to supplement the existing literature. While this paper focuses on the ‘general public of middle-aged and older adults’ – those without specialized training or exposure to ADRD, the majority of studies include older adults, who may be more conscientious about brain health than younger adults. Thus, further explorations of these themes among middle-aged adults would be valuable. Finally, only three studies explicitly explored perceptions of specific subgroups of Latinos (Cabrera et al., 2021; Karlawish et al., 2011; Sharkey et al., 2009). Latinos represent an exceptionally heterogenous group with different lived experiences, cardiovascular risk factors, acculturation levels, and genetic profiles. More research is warranted on the knowledge and beliefs of diverse Latino subgroups living in the US.

Conclusions

This review elucidates both strengths and gaps in knowledge and perceptions of ADRD and brain health among Latino adults. In particular, opportunities exist to increase knowledge of (a) the difference between normative and non-normative memory loss, (b) signs and symptoms of ADRD beyond memory loss, (c) possible courses of ADRD including safety considerations, (d) risk and protective factors, and (e) treatment options. Given the state of the extant literature, more research is warranted to better inform messaging and public health interventions aimed at increasing understanding of ADRD and brain health. Improving knowledge and awareness may address existing disparities by increasing engagement in risk prevention, help seeking, early intervention, and research.

Supplementary Material

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Footnotes

Declaration of Interest Statement

Dr. Wolf reports grants from the NIH during the conduct of the study; grants from Merck, the Gordon and Betty Moore Foundation, the NIH, and Eli Lilly outside the submitted work; and personal fees from Sanofi, Pfizer, GlaxoSmithKline, Lundbeck, Bristol Myers Squibb, and Luto outside the submitted work. Dr. Bailey reports grants from the NIH during the conduct of the study; grants from Merck, Lundbeck, Pfizer, NIH, and Eli Lilly outside the submitted work; grants and personal fees from Pfizer, Sanofi, Lundbeck, the Gordon and Betty Moore Foundation outside the submitted work; and personal fees from Sanofi, Pfizer, and Luto outside the submitted work. Authors not named here have disclosed no conflicts of interest.

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