Deconstructing Alzheimer's Stigma: Gender identities correspond with patterns of internalization and judgment

<h2>ABSTRACT</h2><h3>Objective</h3> This study examined how features of the observer and observed contribute to stigma in Alzheimer's disease (AD). To do this, we conducted a vignette experiment examining how participant and patient gender identities modify AD stigma. <h3>Participants</h3> A sample of 1,817 U.S. adult men and women invited at random. <h3>Methods</h3> Participants read a vignette about a hypothetical patient that was either a man or woman. The patient's clinical characteristics varied by symptom stage (from Clinical Dementia Rating stage 0, no impairment, to 2, moderate dementia), biomarker result (positive vs. negative), and disease-modifying treatment (available vs. unavailable). Multiple regression analyses assessed whether participant gender, patient gender, or their interaction influenced ratings on the Modified <i>Family Stigma in Alzheimer's Disease Scale</i>. <h3>Findings</h3> In comparisons of mild stage symptoms and no clinical symptoms, women made stronger attributions of symptom severity than men (aOR = 1.60, 95%CI 1.06–2.40) and expressed stronger support (aOR = 1.62, 95%CI 1.09–2.40) than men. In comparisons of a positive vs. negative biomarker test result, women had a larger increase than men in worries about structural discrimination (aOR = 1.39, 95%CI 1.01–1.92) and pity (aOR = 1.52, 95%CI 1.10–2.10). The female patient in the vignette evoked fewer negative aesthetic attributions compared to the male patient (aOR=0.79, 95%CI 0.66–0.95). <h3>Conclusions</h3> In most instances, participant gender effects modified AD stigma while patient effects did not. Men may be judged more harshly as patients, while women may experience a worse internalized stigma. The findings advance understanding of AD stigma mechanisms.