Introduction

As global aging intensifies, the prevalence of Alzheimer’s disease (AD) and related cognitive disorders is also gradually increasing. In 2017, there were approximately 50 million dementia patients worldwide [1]. By 2020, the number of dementia patients globally exceeded 55 million, with the majority of this growth coming from developing countries [2]. It is estimated that this figure will grow to over 131 million by 2050 [3].

According to a national cross-sectional study conducted in 2020, the prevalence of dementia among people aged 60 and above in China is 6.0%, with AD accounting for approximately 65% of these cases [4]. The “World Dementia Report” (2021) released by the World Health Organization (WHO) indicates that China has the largest number of dementia patients in the world [5]. The Chinese government and society are paying increasing attention to Alzheimer’s disease and related cognitive impairments. In 2021, the Alzheimer’s Disease Prevention and Control Association of China released the “Strategic Action Plan for China to Address AD,” proposing systematically carrying out universal science popularization education to enhance public awareness and participation. In 2023, the National Health Commission of China issued the “Notice on Implementing the Dementia Prevention and Promotion Action (2023-2025),” explicitly stating the need to intensify the promotion of scientific knowledge on dementia prevention and control, and continuously improve public awareness of dementia prevention and control knowledge, to create a favorable atmosphere in the whole society for caring for elderly people with dementia. In January 2025, the “National Action Plan for Addressing Dementia in Later Life (2024-2030)”, jointly issued by 15 departments including the National Health Commission of China, stated that by 2030, scientific knowledge on dementia prevention and control will be popularized, with the public awareness rate of dementia prevention and control knowledge reaching 80% or above. Targeted science popularization and health education are essential to achieve this expected goal, and the premise for this is to understand the current level of public awareness and attitudes toward dementia.

Numerous studies have examined knowledge and attitudes towards AD among specific groups. For instance, Wang conducted a cross-sectional survey among community health professionals in Changsha, China [6]. Similarly, Qiu investigated the knowledge of dementia among community doctors from all provinces across China [7]. Wang also carried out similar research among nursing and medical students at four universities in China [8]. Additionally, Yang assessed the current levels of knowledge, attitudes, and health behaviors regarding AD among residents in communities in Tianjin, China, and identified the factors associated with these attributes [9]. Furthermore, Zuo’s research aims to investigate and classify the level of knowledge about AD among nursing staff in the eastern China region, and to identify the factors that influence their knowledge level of AD [10]. Overall, the majority of studies have been conducted on groups with a medical background, while there have been fewer studies targeting the general adult population [6–10]. Moreover, due to differences in economic development levels, education levels, regional cultures, and sample representativeness across various regions in China, the results of the aforementioned studies have limited targeted guidance for the Jiulongpo District in Chongqing.

Understanding the public’s knowledge level of AD helps to assess the effectiveness of current health education efforts and guide the design of future intervention measures, thereby increasing people’s willingness to undergo early screening and diagnosis [11, 12]. At the same time, understanding the public’s attitudes toward AD is crucial for implementing socio-psychological treatment measures [13]. Therefore, it is essential to conduct regional research on the knowledge and attitudes of residents towards AD, to develop more targeted prevention and control measures, and thereby enhance the public’s awareness and friendliness towards dementia.

Methods

Results

Sociodemographic characteristics of the residents and differences in ADKS and DAS scores

As shown in Table 1, the age distribution of the participants is relatively even. The gender distribution showed that more than half (64.24%) of the respondents were female. 68.21% of people live in cities. In terms of education, 25.26% were non-literate or had completed primary school, 20.04% had completed junior high school, 13.22% had completed high school, and 41.48% had received higher education. Furthermore, the majority of participants (81.79%) were married. The proportion of unemployed individuals is the smallest (7.05%), while medical and health personnel account for the largest share (21.81%). 5.51% of participants had family members with ADRD. 3.82% reported having experience in caring for individuals with ADRD. 14.46% of participants had attended ADRD knowledge training.

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Table 1. The sociodemographic characteristics of the residents and their relationship with ADKS and DAS scores (N = 1362).

https://doi.org/10.1371/journal.pone.0327346.t001

There were no significant differences in ADKS scores between participants with family members having ADRD and those with ADRD caregiving experience (p > 0.05), but there were significant differences with all other variables (p < 0.05). Significant differences were found in DAS scores among participants of different ages, types of residence, education levels, marital statuses, occupations, monthly incomes, family members with ADRD, and experience of ADRD knowledge training (p < 0.05). However, there were no significant differences in DAS scores based on gender and ADRD caregiving experience (p > 0.05).

The scoring situation of residents on the ADKS

Table 2 describes the ADKS scale. The average ADKS score for participants was 17.67, with a score rate of 58.90%. The percentage of correct answers for ADKS items ranged from 16.01% to 89.72%. The scoring rate for the “risk factors” domain is 54.50%, with the lowest score rate (16.96%) for the incorrect statement “Scientific evidence has proven that mental exercise can prevent the onset of AD.” The scoring rate for the “symptoms” domain is 52.25%, with the lowest score rate of only 18.58% for the incorrect statement “Tremors or shaking of the hands or arms are common symptoms in patients with AD.” The accuracy rate for the “disease course” dimension was 70.50%, and only 29.81% of respondents knew that the item “In rare cases, AD patients can recover” was incorrect. The correct response rate for the “assessment and judgment” section was 66.25%, with 17.11% of people correctly answering the statement: “If sudden memory impairment and confusion occur, it is likely due to AD.” The “treatment management” dimension had a scoring rate of 68.75%, with only 29.88% of residents correctly answering that the statement “Using reminder notes may lead to further decline in the abilities of people with AD” is incorrect. The scoring rate for the “life impact” aspect was 53.67%, with the lowest score rate for the item “Most AD patients live in nursing homes,” which only 33.41% of participants correctly identified as incorrect. The accuracy rate for the “care” section was 43.40%, with the lowest score rate being only 16.01% for the item stating, “When a person with AD repeatedly asks the same question or tells the same story, it is helpful to remind them that they are repeating themselves.” This indicates that only 16.01% of residents understand that this statement is incorrect.

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Table 2. The correct response rate for ADKS items (N = 1362).

https://doi.org/10.1371/journal.pone.0327346.t002

The scoring situation of residents on the DAS

Table 3 presents the frequency and percentage of respondents’ answers to the 20 items of the DAS. The average score for the DAS was 81.72 (out of 140, SD = 11.19), with a score rate of 58.37%. In the domain of “Knowledge about Dementia”, the average score was 38.78 (out of 63, SD = 10.64), yielding a scoring rate of 61.56%. Only one item in this domain had an average score below 4, which was “People with ADRD can also enjoy life”, with an average score of 3.97. The subdomain of “Positive Social Comfort” had an average score of 19.26 (out of 35, SD = 6.11), resulting in a score rate of 55.03%. All items in this subdomain scored below 4, with relatively lower scores for “I feel comfortable when I am with someone who has ADRD” and “I feel comfortable having physical contact with someone who has ADRD”, averaging 3.82 and 3.81, respectively. The subdomain of “Negative Social Comfort” achieved an average score of 23.68 (out of 42, SD = 6.77), with a score rate of 56.38%. In this domain, four items (Item 8, Item 9, Item 16, and Item 17) had average scores below 4, among which Item 16 (I feel frustrated because I don’t know how to help someone with ADRD) had a relatively lower average score of 3.78.

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Table 3. The scoring situation of the DAS (N = 1362).

https://doi.org/10.1371/journal.pone.0327346.t003

Multiple linear regression analysis of residents’ ADKS scores

The results, as shown in Table 4, indicate that all nine variables are factors influencing the ADKS scores of the surveyed residents (p < 0.05). Specifically, women have an ADKS score that is 0.353 higher than that of men (p < 0.05). Residents aged 18–39 have significantly higher ADKS scores compared to those aged 40 and above (p < 0.001). Residents living in townships have significantly lower ADKS scores than those living in cities (p < 0.05). The ADKS scores of residents with higher education or above are significantly higher than those of residents with other levels of education (p < 0.001). The ADKS scores of unmarried residents are higher than those of residents with other marital statuses (p < 0.05). The ADKS scores of healthcare personnel were significantly higher than those of residents in other occupations (p < 0.05). Residents with a monthly income of less than 999 RMB have lower ADKS scores than those with higher incomes (p < 0.05). Individuals with experience in ADRD knowledge training have significantly higher ADKS scores than those without such experience (p < 0.001).

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Table 4. Multiple linear regression analysis of ADKS.

https://doi.org/10.1371/journal.pone.0327346.t004

Multiple linear regression analysis of residents’ DAS scores

The results are shown in Table 5, indicating that all nine variables are factors influencing the attitudes of respondents toward dementia (p < 0.05). Residents aged 40–64 and ≥65 had significantly lower DAS scores than those aged 18–39 (p < 0.05). Residents living in townships had significantly lower DAS scores than those living in cities (p < 0.001). Residents who had received higher education or above had significantly higher DAS scores than those with other educational backgrounds (p < 0.05). Married and widowed residents had significantly lower DAS scores than unmarried residents (p < 0.05). The DAS scores of farmers, retirees, and other workers were significantly lower than those of healthcare personnel (p < 0.05). Residents with a monthly income of 3000–5999 RMB had higher DAS scores than those with a monthly income of less than 999 RMB (p < 0.05). Residents with family members suffering from ADRD had lower DAS scores than those without such family members (p < 0.05). Individuals with training experience in ADRD knowledge had significantly higher DAS scores than those without such experience (p < 0.001).

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Table 5. Multiple linear regression analysis of DAS.

https://doi.org/10.1371/journal.pone.0327346.t005

Discussion

In current research, the knowledge level of AD among residents in Jiulongpo District is relatively low. The scores obtained in this study are slightly inferior to those from a research project that surveyed representative cities and villages in the east, west, south, and north of China [13]. And also fall below the results of another study targeting the adult population in Zhuhai, China [19]. Notably, residents had particular difficulties recognizing AD symptoms and understanding caregiving needs, which highlights a critical gap in public awareness. This aligns with the results of surveys conducted by Sun et al. in Zhuhai, China [19], and Ma et al. in Jiaxing, China [20]. In summary, residents in Jiulongpo District have a relatively low level of understanding of AD, and there is significant room for improvement in each subdomain. Therefore, in the future, efforts should be intensified to promote AD knowledge and training programs in this region, with particular emphasis on the common symptoms of ADRD and the care of ADRD patients.

The survey found that the DAS scale scores of the interviewed residents were at a moderate level. Compared to the findings of Deng et al.‘s study [21], the residents participating in this study had a more positive attitude towards dementia and dementia patients. However, when compared to the results of Lu et al.’s study [13], Abdalrahim et al.’s research [22], and Aljezawi’s investigation [23], the residents’ perceptions and attitudes toward dementia patients appeared to be slightly more pessimistic. The low scores in the subdomain of “Positive social comfort” subdomian suggested that the surveyed residents may hold negative attitudes towards social interactions with dementia patients or feel anxious, uneasy, or lack confidence when facing them. Additionally, the low scores observed in the “Negative social comfort” subdomain could indicate that individuals experience more negative emotions or feelings of discomfort when interacting with dementia patients. Overall, the DAS scores of the surveyed residents were at a moderate level, leaving significant room for improvement. In the future, efforts can be made to cultivate a friendly attitude toward dementia by enhancing the public’s skills for positive interactions with dementia patients [24].

Interestingly, this study did not find significant differences in residents’ knowledge about Alzheimer’s Disease (AD) based on whether they had family members with AD or caregiving experience. Similarly, no significant differences were observed in their attitudes towards AD concerning whether they had caregiving experience. The findings of Dong et al. were consistent with this [25]. However, there is currently a lack of additional research to elucidate the reasons behind these observations. This study suggests that a possible reason is that although a few residents had family members with ADRD, they did not participate in their care, thus having little understanding of the disease. Those who had experience in caring for ADRD patients may not have received professional care training from specialized institutions or personnel and lacked social support [26]. As a result, they may have experienced significant psychological stress and emotional burdens during the caregiving process [26, 27], making it difficult for them to concentrate on learning and understanding ADRD-related knowledge. Furthermore, caregivers with heavy caregiving burdens may also experience associated stigma [28], which could lead to them not holding a more positive attitude towards ADRD patients. This survey recommends the following measures: through health education and training, family members should be equipped with basic knowledge about ADRD, including disease progression, treatment methods, and daily care skills [29]. Provide ADRD caregivers with knowledge and skill training related to ADRD care, while also offering psychological counseling to caregivers and providing them with more emotional support and social resources [30].

Our analysis also revealed that healthcare workers, urban residents, and individuals with prior dementia knowledge training exhibited better knowledge and more positive attitudes. Studies by scholars such as Zhao [31] and Wang [32] also showed that individuals with training in dementia-related knowledge had more knowledge about dementia and higher dementia attitude scores. Based on the evidence, educational and medical resources are relatively scarce in rural areas [33], while urban areas are richer in resources and have more diverse channels for accessing health information [34], making it easier for urban residents to access accurate information about ADRD and develop more favorable attitudes. Educational level is an important predictor of increased AD knowledge and favorable attitudes. Residents with higher education tend to exhibit better knowledge levels and more positive attitudes towards AD. Individuals who have received higher levels of education may develop a better understanding of complex health issues [19], which in turn helps to improve their awareness of AD and foster a more favorable attitude towards dementia [35–37]. We recommend that health education efforts should focus on rural areas, particularly on developing promotional materials tailored for residents with lower educational levels. These materials should primarily consist of easy-to-understand, engaging, and informative brochures and educational videos to improve the knowledge and attitudes of this population.

An unexpected finding was that residents with family members suffering from dementia displayed more negative attitudes. Direct caregiving or witnessing a family member with ADRD may impose psychological pressure or negative emotions on residents, leading them to hold a more negative attitude towards dementia. Therefore, for families with ADRD patients, psychological support and caregiving skills training should be provided to alleviate the caregiving burden and reduce social prejudices, helping them better cope with this challenge. This not only contributes to improving the mental health of family members and caregivers but also enhances the quality of care and life for ADRD patients, achieving a win-win outcome.

This study also has several limitations that need to be considered. Firstly, it employed a cross-sectional survey design, which means it cannot determine causality but only establish associations between variables at a specific point in time. Secondly, the questionnaire design did not control for all potential confounding factors that could influence the results, such as smoking, alcohol consumption, and lifestyle. Thirdly, the survey results were based on subjective responses from participants, which may have been influenced by social desirability, leading to more positive answers and potential information bias. These limitations need to be improved in future research.

Conclusion

Adult residents in Jiulongpo District, Chongqing, have limited understanding of AD, particularly in terms of its symptoms and care, which may hinder early detection and management control of dementia. Additionally, their scores on the DAS are at a moderate level, indicating significant room for improvement. We recommend incorporating dementia-related knowledge and fostering a friendly attitude towards it into the education system. Furthermore, efforts should be intensified to conduct public health education on the prevention, early identification, and care of ADRD, cultivating a friendly attitude towards dementia patients, and enhancing support for caregivers. These measures will not only improve the public’s ability to identify dementia early but also reduce social prejudices and promote social harmony. Such initiatives are of great significance in addressing the increasingly severe public health challenge posed by dementia.

Supporting information

Acknowledgments

We thank all the participants, all staff participating in this project, the field investigation staff.