Identifying deficits in the public's memory aging knowledge is a promising avenue for improving our understanding of Alzheimer's disease (AD) risk and developing effective education and intervention strategies. Yet, it is important to contextualize knowledge within culturally relevant frameworks that may not only contribute to the extent of individuals’ knowledge, but also to the reception of developed educational and intervention programs.
Objective
One prominent culture within the United States (U.S.) that has largely been neglected within AD research is the culture of honor, or those that prioritize the defense and maintenance of reputation.
Methods
Using an online sample, the present study examined 998 U.S. adults’ endorsement of honor culture norms and knowledge of normal and pathological memory aging knowledge, as well as AD specific knowledge. Hierarchical linear regression analyses (controlling for age, sex, race/ethnicity, educational attainment, and dementia experience) examined associations between honor endorsement and each type of memory aging knowledge.
Results
Greater honor endorsement was associated with worse knowledge of normal memory aging, pathological memory aging, and AD. Exploratory analyses that examined links to domains of AD knowledge revealed that greater honor endorsement was specifically linked with worse knowledge related to AD risk factors, symptoms, treatment and management, life impact, and caregiving.
Conclusions
The present research advances our understanding of deficits in the public's memory aging knowledge within the context of U.S. honor cultures and highlights a need for the developmental of culturally relevant education and intervention efforts.
AndersonLADayKLBeardRL, et al.The public’s perceptions about cognitive health and Alzheimer’s disease among the U.S. population: a national review. Gerontologist2009; 49: S3–11.
7.
AraiYAraiAZaritSH. What do we know about dementia?: a survey on knowledge about dementia in the general public of Japan. Int J Geriatr Psychiatry2008; 23: 433–438.
8.
AyalonLAreanPBornfeldH, et al.Long term care staff beliefs about evidence based practices for the management of dementia and agitation. Int J Geriatr Psychiatry2009; 24: 118–124.
9.
BondJStaveCSgangaA, et al.Inequalities in dementia care across Europe: key findings of the facing dementia survey. Int J Clin Pract2005; 59: 8–14.
10.
CahillSPierceMWernerP, et al.A systematic review of the public’s knowledge and understanding of Alzheimer’s disease and dementia. Alzheimer Dis Assoc Disord2015; 29: 255–275.
11.
CherryKEWestRLReeseCM, et al.The knowledge of memory aging questionnaire. Educ Gerontol2000; 26: 195–219.
12.
JonesCMoyleWStockwell-SmithG. Caring for older people with dementia: an exploratory study of staff knowledge and perception of training in three Australian dementia care facilities. Australas J Ageing2013; 32: 52–55.
13.
RobertsJSMcLaughlinSJConnellCM. Public beliefs and knowledge about risk and protective factors for Alzheimer’s disease. Alzheimers Dement2014; 10: S381–S389.
14.
Van PattenRTremontG. Public knowledge of late-life cognitive decline and dementia in an international sample. Dementia2020; 19: 1758–1776.
15.
CherryKEBrigmanSReese-MelanconC, et al.Memory aging knowledge and memory self-appraisal in younger and older adults. Educ Gerontol2013; 39: 168–178.
16.
CherryKEBlanchardBWalkerEJ, et al.Knowledge of memory aging across the lifespan. J Genet Psychol2014; 175: 547–553.
17.
CarpenterBDZollerSMBalsisS, et al.Demographic and contextual factors related to knowledge about Alzheimer’s disease. Am J Alzheimers Dis Dementias2011; 26: 121–126.
18.
CherryKEAllenPDBoudreauxEO, et al.Knowledge of memory aging in students, caregivers, and senior service providers. Educ Gerontol2009; 35: 541–552.
19.
AyalonLAreánPA. Knowledge of Alzheimer’s disease in four ethnic groups of older adults. Int J Geriatr Psychiatry2004; 19: 51–57.
20.
BrownRP. Honor bound: how a cultural ideal has shaped the American psyche. New York, NY: Oxford University Press, 2016.
21.
UskulAKCrossSEGünsoyC. The role of honour in interpersonal, intrapersonal and intergroup processes. Soc Personal Psychol Compass2023; 17: e12719.
22.
Rodriguez MosqueraPM. On the importance of family, morality, masculine, and feminine honor for theory and research. Soc Personal Psychol Compass2016; 10: 431–442.
23.
LeungAKYCohenD. Within- and between-culture variation: individual differences and the cultural logics of honor, face, and dignity cultures. J Pers Soc Psychol2011; 100: 507–526.
24.
O’DeaCJJardinESaucierDA. The masculinity-based model of aggressive retaliation in society (MARS). Psychol Men Masculinities2022; 23: 160–172.
25.
BossonJKVandelloJA. Precarious manhood and its links to action and aggression. Curr Dir Psychol Sci2011; 20: 82–86.
26.
VandelloJACohenD. Culture, gender, and men’s intimate partner violence. Soc Personal Psychol Compass2008; 2: 652–667.
27.
GulPCrossSEUskulAK. Implications of culture of honor theory and research for practitioners and prevention researchers. Am Psychol2021; 76: 502–515.
28.
PomerantzAGreenKMcCollumD, et al.Different dialects”: examining masculine and feminine honor across gender and ethnicity in an American context. Curr Psychol2023; 42: 22623–22636.
29.
FischerDH. Albion’s Seed: Four British Folkways in America. New York, NY: Oxford University Press, 1989.
30.
CohenD. Culture, social organization, and patterns of violence. J Pers Soc Psychol1998; 75: 408–419.
31.
LopezHNBockJEBrownR, et al.Beyond the dichotomy: creation and validation of a continuous statewide index of U.S. honor culture. Pers Soc Psychol Bull2025; 51: 2586–2600.
BockJETuckerRPBrownRP, et al.Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor. Suicide Life Threat Behav2023; 53: 692–701.
34.
BockJEBrownRPJohnsNE, et al.Is honor culture linked with depression?: examining the replicability and robustness of a disputed association at the state and individual levels. J Cross-Cult Psychol2025; 56: 948–968.
35.
OstermanLLBrownRP. Culture of honor and violence against the self. Pers Soc Psychol Bull2011; 37: 1611–1623.
36.
BrownRPImuraMMayeuxL. Honor and the stigma of mental healthcare. Pers Soc Psychol Bull2014; 40: 1119–1131.
37.
O’DeaCJChalmanSTCastro BuenoAM, et al.Conditional aggression: perceptions of male violence in response to threat and provocation. Personal Individ Differ2018; 131: 132–141.
38.
FosterSBockJECarvalloM, et al.Honor-endorsing women and relational aggression: evidence for the presence of feminine aggression norms in southern U.S. women. Personal Individ Differ2022; 194: 111668.
39.
GünsoyCFerozSKandalaftK, et al.The role of culture and masculine honor ideology in substance use and outcome expectancies. Subst Use Misuse2025; 60: 2175–2186.
40.
BockJEBrownRPGreenK. Aging with honor: examining ambivalent ageism and interpersonal risk-factors for suicide as explanations for the honor-suicide link. J Soc Clin Psychol2019; 38: 721–750.
41.
BockJETuckerRPBrownRP, et al.Factors contributing to honor-endorsing men’s suicide capability: firearm ownership, practical capability, and exposure to painful and provocative events. Suicide Life Threat Behav2021; 51: 1247–1258.
42.
FosterSCarvalloMLeeJ, et al.Honor and seeking mental health services: the roles of stigma and reputation concerns. J Cross-Cult Psychol2021; 52: 178–183.
43.
BarnesCDBrownRPTamborskiM. Living dangerously: culture of honor, risk-taking, and the nonrandomness of “accidental” deaths. Soc Psychol Personal Sci2012; 3: 100–107.
BockJEBrownRPTuckerRP, et al.To honor and defend: state- and individual-level analyses of the relationship between the U.S. culture of honor and military service. Pers Soc Psychol Bull2026; 52: 949–963.
46.
ChapmanJCDiaz-ArrastiaR. Military traumatic brain injury: a review. Alzheimers Dement2014; 10: S97–104.
47.
St. IvanyASchminkeyD. Intimate partner violence and traumatic brain injury: state of the science and next steps. Fam Community Health2016; 39: 129.
48.
MielkeMMRansomJEMandrekarJ, et al.Traumatic brain injury and risk of Alzheimer’s disease and related dementias in the population. J Alzheimers Dis2022; 88: 1049–1059.
49.
HarringtonEEBockJE. Risk factors for Alzheimer’s disease and related dementias in U.S. honor cultures. SSM Popul Health2024; 28: 101732.
50.
RosenstockIM. Historical origins of the health belief model. Health Educ Monogr1974; 2: 328–335.
51.
JanzNKBeckerMH. The health belief model: a decade later. Health Educ Q1984; 11: 1–47.
52.
AkyolMAZehirlioğluLErünalM, et al.Determining middle-aged and older adults’ health beliefs to change lifestyle and health behavior for dementia risk reduction. Am J Alzheimers Dis Demen2020; 35: 1533317519898996.
53.
JungSHGuMO. Factors influencing dementia preventive behaviors of older adults at high risk of dementia: application of extended health belief model. Res Community Public Health Nurs2024; 35: 22–36.
54.
ZakrzewskiJJDavisJDGemelliZT, et al.Understanding health beliefs and health behaviors in older adults at risk for Alzheimer’s disease. J Alzheimers Dis2024; 99: 1093–1104.
55.
LiWCZhangJBraithwaiteG, et al.Quick coherence technique facilitating commercial pilots’ psychophysiological resilience to the impact of COVID-19. Ergonomics2023; 66: 1176–1189.
56.
PipatpiboonNSripetchwandeeJ, et al.Establishing the feasibility and preliminary efficacy of a health belief model based educational training program on health belief perceptions and dementia-preventive behaviors in people with type 2 diabetes. Nurs Health Sci2024; 26: e13081.
57.
SayeghPKnightBG. Cross-cultural differences in dementia: the sociocultural health belief model. Int Psychogeriatr2013; 25: 517–530.
58.
WieseLKWilliamsCLTappenRM, et al.An updated measure for investigating basic knowledge of Alzheimer’s disease in underserved rural settings. Aging Ment Health2020; 24: 1348–1355.
59.
DouglasBDEwellPJBrauerM. Data quality in online human-subjects research: comparisons between MTurk, prolific, CloudResearch, qualtrics, and SONA. PLoS One2023; 18: e0279720.
60.
BockJEBrownRPPomerantzAL, et al.Preliminary validation of two brief measures of masculine and feminine honor endorsement. J Pers Assess2024; 106: 522–531.
61.
IJzermanHvan DijkWWGallucciM. A bumpy train ride: a field experiment on insult, honor, and emotional reactions. Emotion2007; 7: 869–875.
62.
CarpenterBDBalsisSOtilingamPG, et al.The Alzheimer’s disease knowledge scale: development and psychometric properties. Gerontologist2009; 49: 236–247.
63.
SpectorAOrrellMSchepersA, et al.A systematic review of ‘knowledge of dementia’ outcome measures. Ageing Res Rev2012; 11: 67–77.
64.
Perry-YoungLOwenGKellyS, et al.How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography. Dementia2018; 17: 34–60.
65.
WernerP. Knowledge about symptoms of Alzheimer’s disease: correlates and relationship to help-seeking behavior. Int J Geriatr Psychiatry2003; 18: 1029–1036.
66.
SmythWFieldingEBeattieE, et al.A survey-based study of knowledge of Alzheimer’s disease among health care staff. BMC Geriatr2013; 13: 2.
67.
LeeKPugaFPickeringCEZ, et al.Transitioning into the caregiver role following a diagnosis of Alzheimer’s disease or related dementia: a scoping review. Int J Nurs Stud2019; 96: 119–131.
68.
PengRXShenF. Why fall for misinformation? Role of information processing strategies, health consciousness, and overconfidence in health literacy. J Health Psychol2025; 30: 2030–2045.
69.
RappDNWithallMM. Confidence as a metacognitive contributor to and consequence of misinformation experiences. Curr Opin Psychol2024; 55: 101735.
70.
HawleyKSGarrityAWCherryKE. Knowledge of normal versus pathological memory aging among police officers. Educ Gerontol2005; 31: 1–17.
71.
GreeneJACopelandDZDeekensVM, et al.Beyond knowledge: examining digital literacy’s role in the acquisition of understanding in science. Comput Educ2018; 117: 141–159.
72.
LövdénMFratiglioniLGlymourMM, et al.Education and cognitive functioning across the life span. Psychol Sci Public Interest2020; 21: 6–41.
73.
ManlyJJByrdDTouradjiP, et al.Literacy and cognitive change among ethnically diverse elders. Int J Psychol2004; 39: 47–60.
74.
SeblovaDEngCAvila-RiegerJF, et al.High school quality is associated with cognition 58 years later. Alzheimers Dement (Amst)2023; 15: e12424.
