I Keep Forgetting My Keys!

“What is that unpleasant smell?”

That is Mr Lee’s first thought upon entering his home after a long day at work. It only takes him a few seconds to realise it is coming from the kitchen.

“Is anyone home? There is something burning!” He shouts frantically.

He rushes over to find smoke billowing from a burning stove. Without thinking, he immediately switches off the gas, grabs a large cup from the sink and douses the fire.

An indistinguishable charred mess lies in the pan.

Amidst the commotion, Mr Lee’s mother walks in from the living room.

“Aiyo!” She smacks her forehead. “I forgot that I was cooking eggs for dinner! I wandered out to watch my favourite TV show and forgot!”

This is not the first time his 80-year-old mother has forgotten things. From keys to her phone password to certain phrases and words. However, this is the most dangerous situation yet.

As Mr Lee takes in the aftermath, it dawns upon him that his mother has not been her usual self lately. She has been taking a long time to get dressed and carry out her daily activities. She has also become more withdrawn and struggles to formulate sentences.

Could the root of his mother’s forgetfulness be chalked up to old age, or perhaps something more sinister?

An Ageing Nation

Malaysia is expected to be an ageing nation by the year 2030. According to the Alzheimer’s Disease Foundation of Malaysia (ADFM), the number of Malaysians living with dementia is expected to increase by a staggering 312 per cent by 2050.

Despite that, dementia is still very much a stigma-laden topic in Malaysian households. It is time we break that stigma and shed light on this.

The Malaysian Health Coalition (MHC) and Malaysian Society of Geriatric Medicine (MSGM) is currently calling for dementia to be raised as a Public Health Priority.

Dementia- What Is It?

It is a degenerative disease of the brain which causes cognitive impairment.

Dementia is an umbrella term which involves the deterioration of one’s brain function, memory, attention, abstract thinking and thought to process.

It is commonly known as a disease that robs one’s self, dignity, memories and identity – essentially, what makes you, YOU.

There are at least 100 types – Alzheimer’s disease is the most common. Others include vascular dementia, frontotemporal dementia and Parkinson’s disease.

It is also the 7th cause of death globally.

Who Is At Risk?

It is caused by multiple factors, which can be further broken down into one’s genetics, environment and age.

If you have

A history of dementia in your family
Comorbidities like diabetes mellitus, high blood pressure, multiple sclerosis, heart disease or Down syndrome
Depression
A previous brain injury
History of stroke
History of brain infection – meningitis or syphilis

Or are

Heavy smokers
Heavy alcoholic drinkers
Sedentary – do not exercise regularly
Above 65 years old. People under this age group can develop dementia too (“younger onset dementia’), though uncommon.
Female. This isn’t to say that males will not get dementia, but studies have shown that it affects women more than men.

These factors increase the risk of developing dementia.

COVID-19 infections are also found to increase the risk of developing dementia – studies are currently being carried out to identify and further cement the correlation between this virus and cognitive impairment.

Environmental elements (nitrogen oxide, ozone and tobacco smoke) can also increase the risk of developing dementia!

Signs and Symptoms

Dementia does not happen overnight. It is a gradual progression. Symptoms creep up insidiously, without warning.

Similar to Mr Lee’s mother, it can start from something as innocent as forgetting where you put your keys to something as serious as forgetting loved ones’ faces and names.

However, it would be rash to immediately conclude that your loved one has dementia simply because they forgot what they ate for dinner last night.

Diagnosing dementia requires a team of healthcare professionals. Your doctor will run multiple tests which we will explore further below.

However, some key features to look out for, especially if you or your loved one have at least one of the risk factors above:

Impaired concentration

It is a struggle to focus on the task at hand.

Changes in mood and personality.

“He/ She does not seem like her usual self” is one of the more common phrases family members and friends start to realise. Some may even experience depression – loss of motivation or interest in activities, low mood and increased thoughts of death or suicide.

Memory loss

This can range from recent memories (e.g. forgetting to turn the kitchen stove off) to past memories. Some might even struggle to recognise the faces of loved ones and their names.

Disorientation to time and place

One might think they are in a different time, country or place. It is also common for people with dementia to wander outside their homes and get lost.

Deterioration in language and speech

Articulating oneself might be a challenge. They often have difficulty expressing themselves. Some might even forget certain words or phrases.

Problems with abstract thinking

One might struggle with higher thought processes like contextualising or generalising.

Difficulty performing simple tasks

These tasks may include buttoning clothes, showering and carrying out daily activities.

Difficulties with balance, fine motor movements

These include an abnormal gait, unusual stiffness, tremors or balance problems.

Diagnosing Dementia

It is important to go for a checkup with your doctor if you notice these symptoms.

Your doctor will carry out a thorough assessment to assess your health and cognitive functions.

A physical examination
Cognitive and mental state examinations
Mini-Mental State Examination, Montreal Cognitive Assessments, and Cornell Scale for Depression in Dementia (CSDD) are tools your doctor might use to assess the severity of your symptoms.

Factors like education level, illness and language will be taken into account as they can impact results.

Your doctor may also run

blood and urine tests
conduct brain scans (MRI, CT scans) to distinguish the subtype of dementia
An electroencephalogram

This is to rule out other possible medical causes like hyperthyroidism, anaemia, kidney or even liver disease.

What Now?

An increasing amount of research and clinical trials are being conducted to find a cure for dementia.

Currently, there is no cure.

Thus, the goal of dementia treatment is to maintain the individual’s independence and quality of life as much as possible. Early diagnosis of dementia is essential to ensure the best quality of treatment possible.

Medications

To slow the progression of dementia, your doctor may prescribe acetylcholinesterase inhibitors (donepezil, rivastigmine) and NMDA receptor antagonists (memantine).

Cognitive Interventions

Dementia does not affect two people in the same way. Hence, psychosocial and environmental interventions are tailored and personalised to each individual.

Cognitive stimulation, training and rehabilitation can help individuals improve thought processing and functions. These include music-based therapy and group therapy sessions.

Physical activities like exercise are beneficial in maintaining the quality of life and slowing down the progression of dementia.

Long-Term Support

Long-term support (emotionally, financially, socially and physically) as well as education for families and carers of people with dementia can tremendously improve the quality of life.

Knowledge is power.

Understanding the manifestation of symptoms like behavioural changes can help prepare and equip them to take care of those with dementia.

In 2019, the World Health Organisation found that informal carers (family members and friends) spent about 5 hours a day caring for people living with dementia. It can be devastating to see a loved one suffer from dementia.

Can I Prevent Dementia?

There is no guarantee that you can prevent dementia for good.

However, a healthy lifestyle can significantly reduce the risk of developing comorbidities and improve your general well-being.

These include

Exercising regularly and having an active lifestyle – Exercising can improve one’s cardiovascular health, maintain muscle mass and release hormones that can reduce stress levels.
Increasing daily fibre intake – A daily fibre intake of 20-30 grams is recommended. Happy munching!

Maintaining a healthy diet.

The Ministry of Health has created a ‘My Healthy Plate’ for fellow Malaysians to adhere to. It is simple, easy and practical! It is also known as the ‘Suku Suku Separuh’ (Quarter Quarter Half) method.

½ = vegetables and fibre-rich foods

¼ = lean protein (tofu, poultry, fish, egg)

¼ = complex carbohydrates (whole grains, brown rice, wholemeal bread)

Reducing the amount of processed and sugary foods
Controlling your weight
Quit smoking
Limiting alcohol intake
Managing stress levels

Conclusion

The management of dementia requires a multidisciplinary approach in which the government, family members, doctors and healthcare professionals work together to provide the best care possible for the person and their carers.

If you suspect your loved one or you have dementia, do seek a doctor for a screening test today!

You may even consider visiting a geriatrician (a doctor specialising in the elderly) or a psychiatrist for assessment and diagnosis.

If you are a carer of a person with dementia, do not hesitate to reach out for support, be it emotionally, financially, physically or legally.

What Is Dementia (Dementia 101)