Dementia Knowledge among Kuwait University Students: a Descriptive Study

Dementia is a disease of cognitive decline that interferes with the person’s daily functions and behavior. However, it is not a normal part of aging. Dementia is one of the World health organization’s (WHO) public priorities as approximately 50 million people worldwide are currently living with dementia. According to WHO’s results, dementia is the seventh highest cause of death [1]. Worldwide, every three seconds, there is a new case of dementia, and the number is expected to triple to 152 million by 2050 [2]. Dementia is an umbrella term that can be categorized into various diseases. The most common cause of dementia, 60% to 80 % of all cases is Alzheimer’s disease [3].

Globally, undetected dementia is high among various countries. Approximately 60% of people with dementia are not detected in the community [4]. Education of various symptoms of dementia is needed for early detection and future health. Health care professionals should take lead roles for the improvement of dementia care settings. Improved quality of care in general hospitals should be considered as a priority in the Department of Health and aging services. Health care students’ knowledge was assessed to help determine the quality of services provided for dementia patients in the clinical field. Non-health care related students’ knowledge was determined to emphasize the efficacy of care that was provided for dementia patients [5,6]. A review of research specifically focusing on college and university students among various countries was conducted to address the gaps of knowledge about dementia among the students. Most studies in the review related to the knowledge of students in America and Europe with a few additional studies covering parts of Asia [7].

According to the global impact of dementia, about 22.9 million people in Asia live with dementia [2]. Based on a systematic review of 33 studies in Eastern Mediterranean countries, the prevalence of dementia was found to be high [8]. However, only a limited number of studies investigated the level of knowledge about dementia among university students in Asian countries. A study in Malaysia analyzed the level of knowledge and attitude toward older adults among health care students. The results showed that the majority of students had moderate knowledge of the topic and held a positive attitude toward aging. A significant correlation between knowledge of aging and attitudes toward older adults was identified [9].

Another study in Korea determined the level of knowledge about dementia of both health and non-health-related students. The results of this study demonstrated that health-related students had greater knowledge and more positive attitudes toward dementia compared to non-health-related students. The dementia knowledge scores of health-related students were significantly higher than those of non-health-related students [5]. Only one study in the Middle East, which focused on the attitude of medical students toward old people in Ajman, United Arab Emirates was found. The results showed that the first-year students had limited knowledge of and care for the elderly, compared to final-year and internship students who both had some theoretical and clinical experience in geriatrics [10]. This limited study does not provide an appropriate picture about dementia among particular population. Since Middle East countries include diversity of cultures and economics, other studies are critical to understand the knowledge of dementia. Therefore, the aim of this study was to analyze the level of knowledge about dementia among Kuwait University students in all faculties.

Participants

The participants of this study were undergraduate students from various academic years at Kuwait University. They were enrolled at Kuwait University during the academic year of 2017- 2018. The students were from different campuses including Jabriya, a health-related campus, Shuwaikh, a non-health related campus, Kaifan a non-health related campus, Adailiya a health and nonhealth related campus and Khalidiya a non-health related campus. Jabriya campus included the colleges of Medicine, Dentistry, Pharmacy and Allied Health Sciences. Shuwaikh campus included the colleges of Business Administration, Sociology, and Law. Kaifan campus included the colleges of Arts, Education, and Sharia and Islamic studies. Adailya campus included college of Computing Sciences and Engineering and college of Life Sciences. Khalidya campus included college of Petroleum and Engineering and college of Sciences.

In each campus, students were randomly selected from the cafeterias, campus halls, and waiting areas. Two research assistants participated in collecting data across all campuses. The students selected for this study were given a brief overview of the study. They were also informed about the purpose and the significance of the study. The students were assured that participation was anonymous and voluntary. Each participant was required to sign an informed consent prior to participating in the study. The study was reviewed and approved by the Institutional Review Board (IRB) for Research involving human participants.

Outcome measures

The students’ demographic information and knowledge about dementia were collected using two questionnaires. They filledout the demographic questionnaire as well as the Arabic version of the Dementia Knowledge Assessment Scale (DKAS). The first questionnaire, which pertained to the student’s demographic information included gender, age, faculty and academic year. The following questions were included in the questionnaire: if there was someone in the family diagnosed with dementia, if they attended any presentations, workshops, or conferences about dementia, if they would like to attend and listen to a presentation, seminar or conference about dementia or Alzheimer’s disease, and if they would like to receive special training about the management of people with dementia or Alzheimer’s disease. The second assessment used was the Dementia Knowledge Assessment scale (DKAS). The DKAS is a knowledge questionnaire that was created in the Wicking Dementia Research and Education Centre, Australia, the University of Tasmania in 2017. This questionnaire was established to determine the level of knowledge of dementia among community members including students, and health care professionals and to promote effective educational intervention as well as provide care and support. This questionnaire contains 25 items and 4 subscales.

The first subscale is causes and characteristics, which focuses on the biological and pathological aspect of dementia. The second subscale is communication and behavior, which contains the psychological features of the disease and how a person with dementia interacts in the world. The third subscale is care considerations, which focuses on the symptoms that are applicable to the arrangement and formation of care. The last subscale is risks and health promotion, which focuses on risk factors and conditions that are associated with or mistaken for dementia [11]. The DKAS questionnaire was a modified likert scale, and included five response options, false, probably false, probably true, true and I don’t know. It was modified in to three options true, false or I don’t know in order to simplify the questionnaire for the students. The English language version of the DKAS was valid and reliable. It has a high internal consistency with scale (0.7-0.90) without evidence of potential redundancy that can occur with very high coefficients. This shows that it is a reliable instrument to measure the level of dementia knowledge with suitable inter item correlation. In addition to that, it has good construct validity since it measures significant increase of dementia knowledge as well as having good discriminative capabilities, enabling comparison of the results of different groups [12].

In this study a cross cultural adaptation and translation of the Arabic-language version of the DKAS was developed. A crosscultural adaptation is defined as a “process which looks at both language (translation) and cultural adaptation issues in the process of preparing a questionnaire for use in another setting [13]. Research assistance in this study utilized the Arabic version of the DKAS since the majority of Kuwait University students use Arabic as their first language. A pilot study was performed to check the applicability and accuracy of the Arabic version of the DKAS [13].

Data analysis

All analyses were established using SPSS software version 24. Descriptive statistics including percentage, mean and standard deviation were applied. We used one-way ANOVA to determine the results between the four subscales, causes and characteristics, communication and behavior, care consideration, and risk and health promotion as well as determining the dementia knowledge total score. In addition to that, Post Hoc tests were also used to determine the level of knowledge among students in all colleges and in all campuses at Kuwait University.

Data characteristics and demographic information

to complete the social demographic questionnaire and the DKAS questionnaire. 22.9% of the students were male and 77.1% female. 61% of the of the students’ ages were between 18-21 years old and they were from different years of studying at Kuwait University. Students participated from various campuses and colleges. The college of Allied Health Science, which is located on the Jabriya campus, had the highest number of participants with the college of Computing Sciences and Engineering in Adailiya campus having the lowest (Table 1). A range of results were gathered based on the following questions, do you have someone in the family diagnosed with dementia, have you attended any presentations, workshops or conferences about dementia and weather you want to receive special training about dementia. Results showed that 80% of the students did not know anyone diagnosed with dementia and 20% knew someone diagnosed with dementia. 91% of the participants did not attend a presentation, a conference, or a workshop about dementia. 60% of the students expressed their interests to receive special training about dementia (Table 1).

According to the social signal transduction theory of depression, perception of social threat by exposure social, symbolic, or imagined threats and adversity up-regulate the HPAAxis. Modern media recasts social, cultural and political events and highlights our current vulnerabilities to terrorism and dystopia 24 hours a day [19]. The persistence of these messages within this climate of heightened awareness and vigilance about domestic and international terrorism, causes chronic HPA-Axis activation which leads to the release of proinflammatory cytokines that can trigger depressed mood, anhedonia, fatigue, psychomotor retardation, and behavioral withdrawal [6].

These messages are of increased concern regarding youth who, depending on their developmental level, may not be able to discern something that is being recast from something that is still occurring, setting the stage for generalized anxiety to develop [19]. The excitoxic effects from frequent or persistent activation of the HPA-Axis in children is also of great concern, because, youth and adolescence is a time of rapid brain development making the brain more susceptible to injury. It is important to note that all people, not just adolescents, have a tendency to pay greater attention to and engage in more detailed cognitive processing of negative than positive information [20]. Therefore, exposure to the predominantly negative stories in the news results in increased negative emotional responses increasing HPA-Axis activation and anxiety-related behaviors [21].

Social media is another example of a modern lifestyle factor that exposes people to social and symbolic threats and adversity. Social media has been defined as computer-mediated technology that allows one to create and share information and other forms of expression though virtual communities. In 2016, 98% of young adults used approximately 7.6 different social media regularly [22]. Individuals who spent more than 120 minutes on social media per day or who visited social media sites more than 9 times per day had significantly increased odds of depression [23,24]. Increased time online is associated with decline in communication with family members, a reduction of the internet user’s social circle, a reduction in sleep and increased feelings of depression and loneliness [25]. All of these behaviors and symptoms are triggers for and can be symptoms of HPA-Axis dysregulation [26].

Another social stressor that is all too prevalent on social media is people who need to experience approval and reassurance through their social media connections “liking” their posts. When this does not happen, people who are more invested in social media often experience HPA-Axis activation as evidenced by poorer sleep quality, lower self-esteem and increased anxiety and depression. Stronger associations between technology-based SCFS and depressive symptoms for unpopular individuals [27,28].

Even people who are not seeking approval and validation can experience negative effects of social media. It is estimated that more than 50% of people have witnessed online hate in their “feeds” or in comments left on their posts. Approximately 10% have perpetrated online hate and 23% of people have been victimized by online hate [29].

Another way social media increases stress among young adults and adolescents is Fear Of Missing Out (FOMO). FOMO drives people to regularly check their social media feed to ensure they are not missing anything. This constant preoccupation with checking social media is associated with reduced work productivity, reduced involvement in real-life activities and relationships and higher anxiety when not online [30].

Even though social relationships are one of the greatest buffers against stress, social media relationships often do not provide the same benefits as real-life relationships [31]. Instead of enhancing social relationships, social media communication may lead to the mistaken impressions about physical appearance, success and happiness of other people, thus increasing feelings of jealousy (social threat) and depression [30,32,24]. Additionally, there is a strong positive correlation between amount of social media usage and perceptions of isolation [33]. Without a feeling of belonging from social relationships to help buffer against stress, people experience more distress and resultant HPA-Axis activation [34,35].

Sleep, in particular lack of quality sleep, is another aspect of modern lifestyles which contributes to HPA-Axis activation and development of chronic illnesses. Deep sleep has an inhibiting influence on the HPA axis, and activation of the HPA axis can lead to insomnia and 24 hour increases of ACTH and cortisol secretion [36] Likewise, sleep disruption or deprivation can lead to significant increases of plasma cortisol levels, reduction in serotonin and melatonin and increases in norepinephrine which further impair the quality of sleep and lead to hyperactivation of the HPA-Axis [36- 38].

According to the CDC, 1 in 3 adults does not get enough sleep [39]. There are many causes of sleep deprivation in American culture. Poor sleep hygiene including noisy sleep environments and blue light exposure; use of nicotine, alcohol of caffeine too close to bedtime and dependence upon sleep aids are among the most common.

More than daytime noise, nighttime noise exposure causes more frequent awakening, less deep sleep and increased subjective disturbance and is correlated with an increased risk of HPA-Axis activation, cardiovascular disease, depression, anxiety. In fact, long-term nocturnal noise exposure >42decibles is associated with a 14% increase in prescriptions for sleep medication and a 17% increase in risk for being on antidepressant or anti-anxiety medications [40,41].

A recent study of the 2007-2008 National Health and Nutrition Examination Survey (NHANES) found inadequate intake of vitamin A, calcium, selenium, carbohydrates, vitamin D, and lycopene to be associated with “poor sleep” and low levels of zinc and magnesium are implicated in the development of depression through overactivity of the HPA-Axis [42,43]. A significant negative correlation was found between sleep quality and low quality carbohydrate intake from processed foods [44].

Additionally, skipping breakfast and eating irregularly were strongly associated with hypoglycemia which can cause chronic HPA-Axis activation and poor sleep quality [44,45].

Another factor impacting sleep is working in buildings with lack of access to natural light, shift work and overnight work which prohibits the body from receiving cues from the environment which would regulate a 24-hour circadian rhythm. Nearly 20% of Americans are at risk for “graveyard shift work disorder” which is characterized by insomnia and daytime drowsiness. Insomnia at night causes people to experience frustration and increases stress because the person was drowsy all day and desperately wants to sleep but cannot. Daytime drowsiness also causes people to use stimulants to wake up or get energy throughout the day contributing to even more HPA-Axis activation [46].

The ubiquitous presence of blue light from digital devices and televisions is yet another modifiable lifestyle factor. Blue light disrupts the signals to the brain that trigger the production of melatonin. While this may not lead to as much frustration as insomnia, the reduction in duration of quality sleep will also trigger the stress response [36].

According to the American Academy of sleep medicine, 26% of adults have sleep apnea which is associated with HPA axis activation [47]. While there are not a lot of ways to prevent sleep apnea, use of a CPAP device has been shown to reduce HPA-Axis activation via reduced cortisol levels [48].

According to the Centers for Disease Control (CDC), heavy drinking is defined as drinking more than 15 drinks per week for men and more than 8 drinks a week for women (CDC, 2018). Twenty percent (20%) of Americans are heavy drinkers and 50% of heavy drinkers drink more than 10 alcoholic beverages each day [49]. Alcohol stimulates the hypothalamic-pituitary-adrenal (HPA) axis, via the hypothalamus, and repeated alcohol exposure leads to a blunted HPA-Axis response which is associated with depressive symptoms such as anhedonia, fatigue and behavioral withdrawal as well as widespread inflammation and increases the risk for development of other chronic health problems [50].

Many people use alcohol specifically to help them “wind down” so they can get to sleep. While it is true that alcohol decreases the time it takes for people to fall asleep (sleep latency), and increases the quality and quantity of NREM sleep during the first half of the night, during the second half of the night sleep, as the depressant effects of the alcohol wears off, sleep becomes disrupted [51]. Within the USA, it is estimated that societal costs of alcohol-related sleep disorders exceeds $18 billion [51,52].

Nicotine use is pervasive in the United States. Recently with the introduction of e-cigarettes, more and younger people have begun using nicotine products [53]. The blunting of the HPA-Axis response in the face of persistent exposure to a stimulant (nicotine) is evident in the findings that recent nicotine use and lower dependence is associated with increased activation of the HPA-Axis, but as dependence goes up, response of the HPA-Axis decreases [54]. Research has also found a significant reciprocal, relationships between smoking and sleep disturbances. The stimulant effects of nicotine may intensify sleep problems and be used during waking hours to counteract the effects of sleep problems on cognitive function [55,56].

Caffeine is found not only in coffee, but also soda, chocolate, over the counter migraine medications, decongestants and some diet and workout supplements. Like other stimulants, caffeine has been found to cause a significant increase in cortisol levels. Interestingly, when caffeine was paired with a mental or physical stressor, cortisol and adrenaline levels exceeded levels seen when caffeine or stressors were encountered independently [57,58].

We already discussed the impact of nutritional deficiencies, eating low quality carbohydrates, skipping breakfast and erratic eating patterns on sleep quality and resultant HPA-Axis activation. However, nutritional deficits are implicated in a host of other problems that can dysregulate the HPA-Axis. Up to 95% of some neurotransmitters are made in the gut [59]. Recently scientists have discovered the gut-brain axis which is a bi-directional system between the brain and gastrointestinal tract, that links emotional and cognitive centers of the brain with the digestive tract via the vagus nerve [60]. The influence of gut bacteria on behavior is becoming increasingly understood, introducing the possibility that alterations in gut bacteria may be important in the development of disorders of the nervous system including HPA-Axis dysregulation. A healthy gut microbiome has over 1000 species of bacteria and can decrease depression and anxiety, regulate sleep, appetite and improve cognition [61]. An unhealthy gut microbiome contributes to an exaggerated HPA-Axis response [61,62]. Additionally, a healthy diet that supports the creation of hormones and neurotransmitters will help the body regulate the balance between excitatory (e.g., norepinephrine, dopamine, and glutamate) and inhibitory (e.g., serotonin and GABA) neurotransmitters and positively affect neurological, emotional and behavioral responses [63]. Many of the hormones and neurotransmitters in the body are constructed from proteins (amino acids) with the help of carbohydrates, vitamins and minerals. Without adequate intake of these nutrients, the body cannot create norepinephrine, corticotropin releasing factor (CRH), serotonin, glutamate, dopamine and many more.

Serotonin is an inhibitory neurotransmitter which helps stabilize mood, downregulate the HPA-Axis and is broken down to create melatonin to promote sleep. It is constructed from the amino acid tryptophan with the help of iron, magnesium, vitamin B6, folic acid, vitamin C and zinc. Insufficient levels of any of these nutrients can lead to serotonin depletion and hamper the body’s ability to down-regulate the HPA-Axis. Additionally, frequent intake of caffeine or other stimulants can cause serotonin levels to become depleted [64]. Another neurochemical, GABA is also an inhibitory neurotransmitter which is constructed from the amino acid glutamine with the help of vitamin B6. When either of these two nutrients is insufficient, the HPA-Axis will stay activated until sustained activation triggers the conservation response of hypocortisolism.

Americans are becoming increasingly sedentary [65]. As stress levels increase, it is important to find ways to reduce related inflammation and oxidative stress from HPA-Axis activation to prevent chronic conditions. Exercise has been shown to moderate both inflammatory cytokines and oxidative stress [66]. Low intensity exercise (at 40% VO2max) has even been shown to reduce cortisol levels and increase serotonin contributing to the relaxation response [67,68].

Additionally, research has demonstrated that unfit individuals have increased HPA, inflammatory, and cardiovascular reactivity indicating that individuals who maintain sedentary lifestyle may have slower recovery from acute stress [69-72]. These studies support the idea that exercise can reduce the consequences of HPA Axis activation [73-75].

While some stress is necessary for energy and motivation, and some stress in life is inevitable, frequent or persistent stress is toxic to our bodies producing a host of physiological changes that can cause chronic health problems including mood disorders, metabolic syndrome, diabetes, chronic pain, auto-immune disorders and hypothyroidism. These changes have a bidirectional influence on the HPA-Axis. Under conditions of stress, pain or inflammation, the HPA-Axis is activated. When the HPA-Axis is activated too much, it can produce inflammation, anxiety and depressive symptoms. Several factors that are common to the American lifestyle including being inundated with information about threats to our social welfare from the news media, excessive engagement with and exposure to disinhibition on social media, insufficient quality sleep, poor nutrition, use of alcohol, nicotine and caffeine and sedentariness significantly contribute to the persistent activation of the HPA-Axis. Each of these factors is completely modifiable and can reduce the demands on the HPA-Axis as well as ensure it has all of the building blocks it needs to function effectively.

Table 1:Students in all campuses and colleges.

Comparison between groups

ANOVA was used to compare dementia knowledge among students studying in various campuses. The results showed that there was a significant difference in the dementia total score (p = .000) and all subscales of the DKAS (Table 2). A Post hoc analysis was performed to understand the differences between all campuses. The results showed that students in Jabriya and Adailiya Campus had higher level of knowledge compared to the other campuses (Table 3). Table 4 showed that students in health and non-health related courses had low scores in the causes and characteristics subscale, the communication and behavior subscale and the risk and health promotion subscale. In contrast, in the care consideration subscale, all health and non-health related students had fair scores. The results showed that there was a significant difference between the knowledge of Jabriya campus and other campuses except Adailiya campus (Table 2-4).

A t-test analysis was employed to differentiate between the various groups. Initially, the knowledge of students who know someone in the family diagnosed with dementia was compared with that of students who did not. Then, the knowledge of students who attended any presentations, conferences, or workshops about dementia was compared with those who had not. Finally, the knowledge of students who wanted to receive special training about management of people with dementia was compared with students who do not want to receive special training on this topic.

Table 2:Students in all campuses and colleges.

Table 3:Students in all campuses and colleges.

Table 4:Students in all campuses and colleges.

The results showed that the students who knew someone in the family diagnosed with dementia had higher knowledge than students who did not know someone in the family diagnosed with dementia. In addition, there was a significant difference among the care consideration subscale, which emphasized that the students who knew someone in the family diagnosed with dementia were more exposed to the symptoms of dementia than students who did not know someone in the family diagnosed with dementia (Table 5). As for students who attended presentation, conferences, or workshops about dementia, their knowledge was similar to those students who had not attend any presentations, conferences, or workshops. The results also showed that there was a significant difference between all subscales between the students who wanted to receive a special training about the management of people with dementia and those students who did not (Table 5 & 6).

Table 5:Students in all campuses and colleges.

Table 6:Students in all campuses and colleges.

Dementia is an incurable disease that increases among the elderly year after year. The use of DKAS helped the research team to have a base line about the level of knowledge about dementia among Kuwait University students. The results of this study showed a low level of knowledge among students in all campuses. This is in agreement with the literature which found that two hundred and forty-two final year undergraduates from health and social care professionals in Hong Kong had poor knowledge of dementia [14].

Due to this low level of knowledge about dementia, early diagnoses may not be applied as it should be and dementia management might be delayed. Also new strategies and techniques for treating people with dementia may not be implemented. Students are the future target. Some of them may either work with people with dementia or may know someone with dementia, in particular those students who are in the health-related fields. In the future, they will also provide care and support to a caregiver or a family member who has dementia.

This study shows that student from health care departments (Jabriya and Adailiya) had a moderate knowledge of 63.48% and 64.08%, respectively. In the literature, health care students in various countries had a moderate knowledge about dementia with a percentage of (68.9%), which emphasizes that our results are similar to the literature. Although dementia knowledge is part of their education, better results were expected from the health care field students. In the future, they are expected to provide possible assessments of and treatments for people with dementia [11].

Based on the results of the four subscales in the DKAS, students who are related to the health care fields in the Jabriya and Adailiya campuses had higher knowledge in the first subscale (causes and characteristic) and the fourth subscale (risk and health promotion). Health related students were more educated about the pathological aspects of the brain and the risk factors of dementia. However, the results were expected to be higher than this. For the second subscale (communication and behavior), students in the Adailiya and Jabriya campuses had higher results than the other campuses. Students in these two campuses had a higher knowledge of how to interact, communicate and behave with a person with dementia.

On the other hand, students from Khaldiya campus had low results in the (communication and behavior) subscale. On this campus, the education background of students from the College of Petroleum and Engineering and the College of Science their education is related to mathematics and equations, which mean that there may be less emphasis on communication between people [15]. For the third subscale (care consideration), all the students, whether from health or non -health related fields showed high results in this subscale. Such results show that caring for the elderly is necessary according to the Islamic religion and Middle Eastern culture.

The elderly in Kuwait and the Middle East as whole mostly live with their families rather than nursing homes. According to the Islamic religion and the Middle Eastern culture, it is important for the elderly to live with their families. They can spend time with their children and spouses, which in turn improves their quality of life and wellbeing as composed to living in nursing homes [16]. The majority of the students who knew someone in the family diagnosed with dementia had a higher sore in the (care consideration subscale) than the other subscales and scored the least in the (communication and behavior subscale). This indicates that communication and behavior should be taken as an important consideration since communication is an essential component in establishing a relationship with people with dementia and helps to fulfill their social needs [17]. The majority of the studies in the literature focused on students’ attitude and knowledge toward people with dementia but did not specifically consider their knowledge about the communication and behavior of people with dementia [18]. The knowledge of the students who attended presentations, conferences or workshops about dementia is similar to the knowledge of students who did not. For students who wanted to receive special training, it appears that they were interested in dementia and thought that was important to receive specialized training since dementia is a life -threatening disease.

One of the limitations of this study was that the Nursing College was not included in this study. In Kuwait, the Nursing College is under the remit of the Public Authority for Applied Education and Training and not under Kuwait University. Therefore, researchers were not able to analyze the nursing students’ level of knowledge about dementia and compare it with the other health field related students. It is important to examine nursing students’ level of knowledge about dementia since they also provide care at the hospitals and at patients’ homes [19]. Further recommendations such as dementia awareness in public places should increase the level knowledge of students in Kuwait University, and conferences or workshops should be offered on various campuses to increase awareness and provide health promotion.

The baseline knowledge of the students was moderate. Although there were differences in the results, we should increase awareness among all campuses at Kuwait University especially on Adailiya campus, which includes Faculty of Life Sciences and Jabriya campus, which includes Faculty of Medicine, Faculty of Dentistry, Faculty of Pharmacy and Faculty of Allied Health Sciences. Students at the faculties on these campuses require training since they will be working in the medical field. This will help in promoting more appropriate care and effective intervention for dementia patients. There is a pressing need in Kuwait to improve undergraduate education on dementia in order to help future doctors obtain the ability to provide competent care for patients. It is suggested to refine existing curricula covering dementia and to build an evidence-base for successful dementia-specific teaching interventions in Kuwait.

Ethical approval and consent to participate

Ethical approval for the collection of volunteer participants’ dementia knowledge and demographic information was granted by Kuwait University, International Review Board for research involving human participants. (Ref no.1046). The consent that we obtained from the participants was written and they were informed in the consent that all information will remain confidential. Neither name or nor address will be recorded in the assessment. There is no obligation or compulsion for the participants to participate in the study and they have the freedom to agree or disagree to participate. The participants may withdraw from the research any time. This research will not have any effect on the academic standing of the participants.

Consent for publication

Not applicable

Availability of data and materials

The datasets of the study are publicly available at the Health Science Center, Faculty of Allied Health Sciences, Occupational Therapy Department, Kuwait University and can be obtained after submitting a data use agreement to the research team, however the confidential participant’s data will not be shared.

The authors declare that they have no competing interests.

This research was not supported by Kuwait University

FM contributed to the drafting and critical review of the manuscript as well as providing helpful comments on theoretical conceptualization. GH and SA collected all data and prepared the manuscript. MR critically revised the manuscript and conducted data analysis.

The authors wish to thank the Deans and Assistant Deans of all colleges at all campuses for giving us the approval to distribute the questionnaire among the students at Kuwait University.

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