Have you ever walked into the kitchen to get something but forgot what it was you needed? What about the times you couldn’t recall where you’d placed your keys? Or you’re at the gym but you’ve forgotten to bring your workout gear – again. More detrimentally, were there occasions when your mind drew a blank when your boss asked for some crucial numbers at a meeting?
If there are quite a few times when you find yourself saying “yes”, you might have entertained the thought that maybe, just maybe, you might be developing dementia.
But are you? It's a particularly salient question, considering September is World Alzheimer's Month. “The answer is no,” said Dr Ng Li-Ling, vice president of Alzheimer’s Disease Association (ADA) in Singapore. “Most people forget little things every day, like people’s names or where we’ve placed our keys. But this is a normal part of life.”
"To remember information, you first need to register it, process it, then recall it," said Dr Ng Li-Ling. "In some cases, if you have poor hearing or are inattentive, you may not even register the information." Multi-tasking doesn't help either as you may not pay sufficient attention to things that you need to remember, and that makes recalling the information harder, she said.
Dr Ng Kok Pin, consultant with the Department of Neurology at the National Neuroscience Institute (NNI), added that the forgetfulness may also be the result of other issues – such as the lack of sleep, certain medications, an underactive thyroid, stress and anxiety, alcohol or low mood – and not necessarily dementia.
WHAT IS DEMENTIA?
In Singapore, dementia can occur in individuals as young as 45 years old; or for some people, in their 30s, according to Dr Ng Li-Ling. In fact, as long as the dementia starts below the age of 65, it is medically classified as early or young onset dementia.
"In 2018, the NNI saw 228 new patients with young onset dementia," said Dr Ng Kok Pin. "This is a 25 per cent increase from 2017." He estimated that there are about 2,000 to 3,000 cases of young onset dementia in Singapore.
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So, what is dementia really? In normal ageing, the brain shrinks and memory is affected as a result, which explains why you sometimes can't remember what to get at the supermarket.
"In Alzheimer’s disease, which is the most common type of dementia, the brain shrinks at a faster rate than in normal ageing,” said Dr Yao Fengyuan, chief and consultant with the Department of Geriatric Psychiatry at the Institute of Mental Health (IMH).
Dr Ng Kok Pin explained that the prime suspects behind the brain shrinkage in Alzheimer's disease are "two abnormal structures called plaques and tangles". They damage and kill nerve cells in the brain, "which results in the brain cells dying at a faster rate than normal and brain function to fail".
Interestingly, the early signs seen in younger patients are different from the older ones, according to the Alzheimer's Society in the UK. Older patients tend to suffer from memory loss, but in younger sufferers, they may have problems with eyesight, planning and making decisions, and speech instead.
WHAT IS NORMAL FORGETFULNESS AND WHAT ISN’T?
While it is common to forget the name of someone you’ve just met, someone with early signs of dementia may do so repeatedly and even forget about ever meeting the person.
“There is evidence from research that people with slight but noticeable decline in cognitive ability – especially memory – are at a higher risk of developing dementia. However, it does not mean that all these people will eventually develop dementia,” said Dr Yao, who is also project director of the Aged Psychiatry Community Assessment and Treatment Service at the IMH.
The list below contrasts some of the possible signs between normal ageing and early dementia highlighted by the Alzheimer’s Society. However, note that not everyone with dementia will display these signs.
Short-term memory loss
- Normal ageing: You occasionally forget what your friends or colleagues tell you.
- Possible dementia: You keep asking your friends or colleagues for the same information over and over again.
- Normal ageing: Poorer eyesight due to physical changes in the eyes, such as cataracts.
- Possible dementia: Problems interpreting visual information, such as difficulty judging the distance on the stairs, or misinterpreting patterns or reflections.
- Normal ageing: You misplace your phone or wallet from time to time but you can retrace your steps and find it.
- Possible dementia: Your misplaced items are found in unusual places such as keys in the fridge.
Planning and decision making
- Normal ageing: You make a bad decision once in a while. You also find yourself less able to multi-task when you’re distracted.
- Possible dementia: You frequently make bad decisions, especially when it comes to money and risk taking. You also find it very difficult to concentrate.
- Normal ageing: You sometimes can’t think of the right word to say. You may also have to concentrate harder to follow a conversation. But you may lose the thread when a few people talk at once.
- Possible dementia: You frequently say “that thing” because you can’t recall the word for the object. At gatherings, you find it hard to join and keep up with the conversation.
- Normal ageing: You sometimes ask, “what is today’s date?”, but you figure it out later.
- Possible dementia: You lose track of the time, week, month and the passage of time.
- Normal ageing: You sometimes feel tired of socialising, be it with friends, family or at work. You may also get irritated when your routine gets disrupted.
- Possible dementia: You lose interest in socialising, work and even your hobbies. You are easily irritated at work, and even with familiar people and places such as friends and home.
If you think you may have dementia, you can get yourself assessed by your family doctor or at Khoo Teck Puat Hospital, Institute of Mental Health, Changi General Hospital, Tan Tock Seng Hospital, National University Hospital or Singapore General Hospital, advised the ADA.
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ARE YOU AT RISK OF DEMENTIA?
The more common form of young onset dementia is vascular dementia, which occurs when there are problems with the blood supply to the brain. It is closely linked to diabetes, stroke and heart disease, noted the Alzheimer's Society.
"Some types of dementia may be hereditary but there are other factors such as increasing age, lifestyle issues, poor hearing and education, and chronic health issues such as a high blood pressure, which may increase your risk of developing dementia," said Dr Ng Li-Ling. "In certain types of dementia, small strokes can lead to cognitive decline and dementia."
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For younger individuals, Dr Yao said that the risk factors for them are mainly head injuries, strokes and sometimes, a family history. “The early onset of Alzheimer’s disease before the age of 60 is hereditary in nature but is rare. However, it does not mean that a person will definitely develop dementia if they have a family history of dementia,” he said.
Age is a risk factor for developing dementia and unfortunately, "absolute prevention doesn't exist", said Dr Ng Li-Ling. But there are some ways to reduce your risk, she said, citing the World Health Organization's recommendations below:
- Look after your cardiovascular health
- Be more physically active
- Follow a healthy diet
- Engage in social activities
- Challenge your brain
- Quit smoking
And you’ll be happy to know that going on a holiday can help you reduce your risk of dementia – that’s something to tell the boss when you’re applying for leave. Chronic stress can be “deleterious to one’s brain”, said Dr Yao. Taking a break from your hectic work routine and adding travel to the mix can help you to de-stress and stimulate your brain with new experiences at the same time.
Don’t turn down invitations to dinner or catch-up coffee with friends. Maintaining strong social connections and relationships are other ways to minimise your risk, said Dr Yao. Even connecting with old friends on social media can improve your sense of connectedness, he said.