Perceptions of Alzheimer's Disease Among Cognitively Healthy, Community-Dwelling Older Adults: A Metaphor Study

Alzheimer's disease prevalence has risen. Although public perceptions of AD may influence attitudes toward cognitive decline and help-seeking behaviours, little is known about how cognitively healthy older adults conceptualise the disease. This study explored older adults' metaphorical perceptions of Alzheimer's disease.

This qualitative study employed a phenomenological design using metaphor analysis. Participants were 196 cognitively healthy, community-dwelling older adults. Data were collected using a researcher-developed questionnaire including sociodemographic questions and the prompt, 'Alzheimer's disease is like … because …' Content analysis was used to identify and categorise metaphors.

A total of 196 valid metaphors were identified and organised into four categories: Change and Loss, Hopelessness, Care Dependency and No Return Journey. Participants predominantly described Alzheimer's disease through metaphors reflecting memory and identity loss, helplessness, dependence on care and irreversible cognitive decline, indicating predominantly negative perceptions of the disease among cognitively healthy older adults.

The findings suggest that cognitively healthy older adults understand Alzheimer's disease not only as a biomedical condition but also through culturally shared metaphorical meanings centred on loss, dependency and irreversibility. These perceptions may shape attitudes toward dementia before clinical diagnosis and highlight the importance of community-based educational initiatives that address both factual knowledge and stigma surrounding Alzheimer's disease.