Are knowledge and interpersonal contact cures for Alzheimer’s stigma? Data from caregivers offer clues.

Research on caregivers suggests interpersonal contact with persons with Alzheimer's disease (AD) and higher disease-oriented knowledge may heighten AD stigma, though these same mechanisms are often employed in anti-stigma campaigns. If we better understand associations among caregiver experience, interpersonal contact, AD knowledge and AD stigma, we can develop improved ways of reducing stigma and avoid unintended consequences. In a factorial design experiment, 2,371 participants read a vignette describing a fictional person; the vignette varied on clinical symptom stage, AD biomarker result, and treatment availability. Multivariable analyses assessed effects of caregiver experience, interpersonal contact, and different domains of disease-oriented knowledge on modified Family Stigma in Alzheimer's Disease Scale (FS-ADS) outcomes. Interaction analyses tested how clinical features may modify those associations. AD caregiver experience was associated with higher reactions on 6 of 7 FS-ADS domains. Disease-oriented knowledge, independent of content domain, did not substantially affect those associations. However, knowledge of caregiving, treatment, and life impact associated with lower FS-ADS scores, and knowledge about disease course and risk factors associated with higher reactions on FS-ADS domains. Knowledge of treatment modified reactions to symptoms and treatment availability. Knowledge of disease course modified reactions to a biomarker result. AD caregiver experience and interpersonal contact did not modify associations between clinical characteristics and FS-ADS domains. Distinct associations among different domains of AD knowledge and stigma outcomes should be considered when developing anti-stigma campaigns. Failure to do so risks worsening rather than alleviating AD stigma.