Dementia

• Memory: Difficulty in remembering new information, recall recent events and learning new skills
• Judgement: Lost problem solving skill and decision making capacity
• Function: Lost of ability for self care
• Behaviour: May ma​​​nifest behavioural and psychological symptoms of dementia. Some of the behavioural and psychological symptoms in dementia include:
  • Depression/dysphoria - seems sad, crying, constant verbalisation of negative thoughts, suicidal ideation
  • Agitation/aggression - refusing care, difficult to handle, verbally and physically aggressive
  • Elation/euphoria - excessively happy out of proportion
  • Apathy/indifference - less interested in his/her usual activities and plans
  • Disinihibition - act impulsively out of his/her usual character
  • Hallucinations - seeing or hearing things that are not present
  • Delusions - believing things that are not true, thinking people are trying to harm them
  • Motor disturbances - engage in repetitive activities such as pacing around the house/doing other things repeatedly
  • Sleep disturbances - unable to sleep at night, sleep excessively in the day
  • Appetite/eating - change in taste, lost appetite

​​Signs that may point to dementia include:

• Getting lost in a familiar neighbourhood
• Forgetting the names of close family members or friends
• Words finding difficulty, ie. using unusual words to refer to a familiar object
• Forgetting old memories, as the dementia progresses​
  

The signs and symptoms of dementia can be manifested differently at different stages of dementia.
Dementia has 3 stages of severity. It can progress over time from mild, moderate to severe stage.

• Mild stage:
  • Still able to self care in the basic activities of daily living, ie: personal hygiene, dressing, bathing
  • Difficulty in handling more challenging task, ie: difficulty with problem solving, difficulty in handling money, forgetting to pay bills, mismanaging medications, getting lost outside.
• Moderate stage:
  • Require assistance with basic activities of daily living, ie: personal hygiene, dressing, bathing
  • Needs prompting and reminders to perform daily activities and can only do simple chores
• Severe (Advanced) stage: 
  • Unable to self care, totally dependent on others for basic care, such as toileting, bathing, feeding
  • Communication limited to a few words​​​
    
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There ​are many types of dementia. Different types of dementia may present differently and progress at a different rate. Hence, it is important to seek expert opinion so that timely and accurate diagnosis of dementia can be made for appropriate treatment.

The most common types of dementia are Alzheimer’s dementia and Vascular dementia.

• In Alzheimer’s dementia, there is degeneration of brain cells controlling the memory. The disease presents insidiously with loss of memory first and slowly progresses to involve other brain functions as the disease progresses. Alzheimer’s dementia may have a genetic predisposition.
• Vascular dementia is a type of dementia caused by reduced blood flow to the brain depriving the brain tissues of oxygen and nutrients. It is often associated with strokes, which can be silent and only evident on brain scan. In vascular dementia, controlling the risk factors to prevent a stroke is important.

There are many other less common types of dementia such as Parkinson’s disease dementia (which is associated with Parkinson’s disease), Lewy Body Dementia, Frontotemporal dementia and many others hence an expert opinion should be sought when one is suspected to have dementia.​

​Although there is no certain way to prevent any type of dementia, adopting a healthy lifestyle can reduce one’s risk of developing dementia.

• Physical inactivity
• High blood pressure
• High blood cholesterol
• Diabetes Mellitus
• Excessive alcohol consumption
• Smoking
• Mid-life obesity
• Lack of mental stimulation
• Hearing loss
• Social isolation
• Low education level

• Be active physically and exercise regularly
• Be socially engaged, ie: participate in community programmes, build friendship
• Go for regular health screening
• Keep your blood pressure at a healthy level
• Monitor blood glucose if you have diabetic
• Eat healthy; ie: Mediterranean diet
• Quit smoking
• Refrain from heavy alcohol intake​
  

Treatment of dementia involves multi-pronged strategy that encompasses an accurate diagnosis of dementia, consideration of stage-specific challenges, non-pharmacological and pharmacological measures, and education, care and support for caregivers.

Presently, there is no cure for dementia.

There are, however, medications that may help to improve the symptoms of dementia such as mental and physical function, mood and behaviour and this in turn help reduce dependency and caregiver stress.

Hence, seeking expert opinion is important when one is suspected to have dementia so that timely and accurate diagnosis of dementia can be made for appropriate treatment that may help to delay progression and relieve symptoms of dementia.

There are also certain medical conditions, such as depression and delirium that may mimic dementia and these are potentially treatable hence early assessment by a dementia specialist is crucial.

Medications for dementia

Depending on one’s suitability based on the types and stages of dementia, medications that are available include:

• Cholinesterase inhibitors
  • Examples: Donepezil (Aricept), Rivastigmine (Exelon)
  • Mostly use for mild to moderate stages of dementia, and selective cases of advanced dementia
• Memantine
  • Alternative for those who cannot tolerate cholinesterase inhibitor

​Other medications that are used to help with mood and behavioural issues related to dementia depending on the needs are anti-depressants, mood stabilizers, anti-psychotics and benzodiazepines.

All these dementia medications should only be considered after a thorough assessment by a dementia specialist.

Other strategies to manage person with dementia

Apart from medications, there are various ways that family members and caregivers can learn and adopt to provide support to person with dementia. Some of these include:

• Use of memory aid such as calendars, list and whiteboards can be helpful in keeping the person functional.
  
• Pictures are easier to remember.
  
• Set a routine, so that it is easier if the person can continue the routines he/she has been used to for much of his/her life. Try to think of the things that your loved ones used to enjoy doing and try to keep them involved in some way. For instance, a homemaker may still enjoy folding laundry even if they are no longer able to operate the washing machine without help.
• Music is helpful at all stages of dementia.
  
• Social activities have shown to improve cognition, function and reduce behaviour and psychological symptoms in dementia. Encourage them to join family gatherings, group activities, and may consider dementia daycare.
  
• Cognitively stimulating activities like aerobic exercises can improve memory, in addition to its beneficial effects on cardiovascular health and mood.

• Reassure - let the person know that they will be cared for and their wishes will be respected
• Reconsider - consider how things look from the person’s point of view
• Redirect - do not confront the person when they are wrong, frustrated or confused but distract them by moving to a different activity or topic of conversation

Caregiver support

Looking after a person with dementia is a long journey. Always remember that part of your duty to your loved ones is to take good care of yourself.

There are many caregiver support group. To speak to someone who shares the same experience with you in the caregiver support group will allow you to get help from others and help others too.

• Dementia Singapore (Tel: 63770700)
• Project Angels (Tel: 6274 6904)
• TOUCH Caregivers Support (Tel: 6258 6797)
• Caregivers Alliance Limited (Tel: 6753 6578)
• Filos Community Services (Tel: 6242 5978)
• Caregiving Welfare Association (Tel: 6466 7957)

​Driving
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Driving is a complex task that requires much concentration, split-second decision making and good judgment. It also represents one’s autonomy and independence.

A diagnosis of dementia, however, does not necessarily imply the person is incapable of driving. Your doctor can arrange for a driving assessment with a healthcare professional who specialises in testing drivers with cognitive impairment.

Eventually, a person with dementia will need to stop driving if it is no longer safe.

Advance Care Planning and Lasting Power of Attorney

As dementia progresses, the person with dementia will gradually lose his/her ability to make decisions on personal health and wealth. It is important to involve the person with dementia in the discussion and planning while he/she may still have the decision making capacity.

Advanced Care Planning (ACP) is a process to plan for one’s future health and personal care. You can visit this website to learn more about ACP.
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Lasting Power of Attorney (LPA) is a legal document to allow an individual who still has the mental capacity to appoint one or more donees to make decisions on his/her behalf in the future when they lose the decision making capacity one day. You can visit this website to learn more about LPA.

Court-Appointed Deputy (CAD) can be made when an individual has not made a Lasting Power of Attorney (LPA) and lacks mental capacity to do so. Hence, a deputy is appointed by the court to make certain decisions on behalf of a person who lacks mental capacity. A deputy can be an individual or a licensed trust company under the Trust Companies Act (Cap.336), as prescribed by the Mental Capacity Regulations. 

Please approach your doctor and nurse to enquire more about ACP, LPA or CAD.

Dementia Singapore (DSG)
Dementia Singapore is a non-profit organisation aiming to reduce stigma and increase awareness and understanding of dementia; involve and enable persons with dementia to be integrated back into the community; support family and caregivers caring for persons with dementia.

DSG provides a wide range of resources about dementia and caregiving, provides dementia caregiver training and has caregiver support groups

You can find out more about DSG at www.dementia.org.sg or call in to their hotline 63770700 (Monday-Friday 9am-6pm, Saturday 9am-1pm. Closed on Sundays and public holidays)

Agency of integrated Care (AIC)
AIC has all the useful information about community resources that may be useful for your loved ones with dementia, such as dementia daycare.

You can find out more in the AIC website or call in to their hotline 1800-650-6060 (Monday-Friday 8.30am-8.30pm or Saturday 8.30am-4.00pm)

Go To Points (GTPs)
Go-To Points also serve as “safe return” points for people with dementia who are lost. Public can bring the person who seems lost and unable to identify him/herself to the GTPs.

Family and caregivers can download GTPs applications and post notification when the person with dementia is missing.

You can find out the locations of the GTPs​. You can also download the mobile application named "Dementia Friends".