values individualism correlates with its average extraversion, whereas people living in cultures which are accepting of large inequalities in their power structures tend to score somewhat higher on conscientiousness. Personality differences around the world might even have contributed to the emergence of different political systems. A recent study has found that countries' average personality trait levels are correlated with their political systems: countries with higher average trait Openness tended to have more democratic institutions, an association that held even after factoring out other relevant influences such as economic development. Attempts to replicate the Big Five in other countries with local dictionaries have succeeded in some countries but not in others. Apparently, for instance, Hungarians do not appear to have a single agreeableness factor. Other researchers have found evidence for agreeableness but not for other factors. It is important to recognize that individual differences in traits are relevant in a specific cultural context, and that the traits do not have their effects outside of that context. Health Personality change from disease Some diseases cause changes in personality. For example, although gradual memory impairment is the hallmark feature of Alzheimer's disease, a systematic review of personality changes in Alzheimer's disease by Robins Wahlin and Byrne, published in 2011, found systematic and consistent trait changes mapped to the Big Five. The largest change observed was a decrease in conscientiousness. The next most significant changes were an increase in Neuroticism and decrease in Extraversion, but Openness and Agreeableness were also decreased. These changes in personality could assist with early diagnosis. Personality disorders , there were over fifty published studies relating the FFM to personality disorders. Since that time, quite a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM personality disorders in terms of the FFM domains. In her review of the personality disorder literature published in 2007, Lee Anna Clark asserted that "the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits". However, other researchers disagree that this model is widely accepted (see the section Critique below) and suggest that it simply replicates early temperament research. Noticeably, FFM publications never compare their findings to temperament models even though temperament and mental disorders (especially personality disorders) are thought to be based on the same neurotransmitter imbalances, just to varying degrees. The five-factor model was