KUALA LUMPUR, Dec 14 – Ten million new dementia cases are diagnosed every year, according to the World Health Organization (WHO). More than 55 million people worldwide live with a form of dementia, and it is the seventh leading cause of death among all diseases.
In Malaysia, 204,000 to 264,000 adults have dementia in 2020, according to the Alzheimer’s Disease Foundation. This will increase to 637,500 to 825,000 by 2050.
At the launch of Clinical Practice Guidelines on Management of Dementia and Schizophrenia during the opening ceremony of Malaysian Conference of Psychological Medicine 2022, it was revealed that the fifth Prime Minister of Malaysia, Abdullah Ahmad Badawi, has dementia.
Fondly known as Pak Lah, he no longer remembers his family members. Care management is the most challenging aspect for a person with dementia, and in Pak Lah’s case, his wife Jeanne Abdullah provides thorough round-the-clock care.
Breaking Dementia Down
Dr Teh Hoon Lang, consultant geriatrician at Sunway Medical Centre, Sunway City, shares that dementia is a general term for conditions where the decline in cognitive function is significant enough until it affects daily living.
While dementia is a collective term, Alzheimer’s disease is a brain disease that causes dementia, and is the most common cause of dementia.
“There are many factors associated with an increased risk of dementia, and these factors can be divided into modifiable and non-modifiable risk factors. Non-modifiable risk factors include advancing age, being female, and genetic inheritance. Certain types of dementia are genetic related, but having that gene does not mean that person will have dementia,” explained Dr Teh.
“Meanwhile, modifiable risk factors include diabetes mellitus, hypertension, obesity, excessive alcohol consumption, smoking, depression, traumatic brain injury, sedentary lifestyle, social isolation, mid-life hearing impairment, lower education level, and air pollution. The more risk factors a person has, the higher their chances of getting dementia,” she added.
There are many signs and symptoms of dementia, and different types of symptoms may present themselves differently at the beginning of the disease. Alzheimer’s Disease International (ADI) listed ten warning signs of dementia, which are also the early signs and symptoms of dementia. They are:
- Memory loss.
- Difficulty performing familiar tasks.
- Problems with language.
- Disorientation with time and place.
- Poor or decreased judgement.
- Problems keeping track of things.
- Misplacing things.
- Changes in mood and behaviour.
- Challenges understanding visual and spatial information.
- Withdrawal from work or social activities.
Diagnosis And Treatment
There is no single test that can diagnose dementia. Rather, dementia is diagnosed based on clinical criteria where the doctor needs to take detailed history from the patient and caregiver, perform physical examinations, cognitive assessments, functional assessments, run some blood tests, and perform brain imaging.
“Although there is no cure for dementia at the moment, there are many measures or strategies to slow down the progress of the disease and provide patients and caregivers a better quality of life,” Dr Teh shared.
There are pharmacological and non-pharmacological management for dementia. On top of that, good control of comorbidities and regular vaccinations against communicable diseases are also important to protect people with dementia from rapid deterioration if they are infected.
“The most important part of dementia care is to get diagnosed early and get professional advice on the management plan. Every person with dementia is unique and the approach should be individualised. The basic principles of care include understanding the disease pattern and the struggles or difficulty they are facing, providing a supportive environment, maximising their strength and minimising their loss due to cognitive decline,” Dr Teh explained.
Managing And Reducing Risk Factors
In Malaysia, there is a lack of a post-diagnosis support system for people with dementia and their caregivers. More health care professionals and volunteers are needed to support them after diagnosis, and a dementia support network between non-governmental organisations (NGOs), government and private health care facilities should be established.
Dr Teh is one of the authors for the latest third edition of Clinical Practice Guidelines on Management of Dementia. She believes it can help young doctors to recognise and diagnose dementia readily. The guidelines also emphasise the importance of non-pharmacotherapy for people with dementia like cognitive stimulation therapy.
“This is the area which we are still lacking in trained professionals. Non-pharmacological management should be the mainstay of dementia care, hence we should continue to strengthen this approach,” she said.
One of the crucial steps in reducing the risk of dementia is having a good control of cardiovascular risk factors such as diabetes mellitus and hypertension. Maintaining a healthy lifestyle such as exercising regularly, reducing alcohol intake, and stopping smoking is also important to maintain our brain health.
“Start building your cognitive reserve since young and keep your brain active even after retirement like learning new skills or hobbies and engaging in social interactions,” Dr Teh advised.
