JOHOR BARU: Dementia is not a single disease, but rather a clinical syndrome characterised by a decline in cognitive domains, which is more than just loss of memory, and accompanied by functional emotional impairment.
Sufferers eventually lose their independence and will be unable to perform their usual routine activities.
Senior consultant geriatric psychiatrist Dr Suraya Yusoff said an important part of dementia is the accompanying neuropsychiatric and behavioural symptoms, such as psychosis, agitation, aggressiveness, or disturbances of emotions, which sees people with dementia being stigmatised.
The sessional consultant with Sultan Ismail Hospital said, according to the World Health Organisation, there are around 50 million dementia sufferers worldwide, with nearly 60 per cent living in low- and middle-income countries.
There are nearly 10 million new cases every year and much of this increase is attributable to the rising number of people with dementia living in low and middle-income countries.
Dr Suraya told the NST Online that dementia prevalence continues to increase with increasing age, even in the most advanced ages; the probability of having dementia increased by 10 per cent each year, and 90 per cent every five years.
She pointed out that in order to reduce the prevalence and incidence of dementia, there was a need to find ways to prevent dementia from occurring, making it clear that prevention has to start early, and not following retirement.
"Living a healthy lifestyle with a controlled cardiovascular risk factor contributes greatly to reducing the risk of cognitive impairment in at-risk elderly people," she said.
She explained that a study showed that even spending one day a week in caring for grandchildren can help in reducing the risks of dementia.
Dr Suraya said established treatments are in place to counterbalance the neurotransmitter imbalance of the disease.
"Progressive neuronal destruction leads to shortages and imbalance between various neurotransmitters (ie: acetylcholine, dopamine, serotonin) and to the cognitive deficiencies seen in Alzheimer disease," she said.
The well-known specialist who has been treating a number of dementia patients said a number of widely prescribed medications have only limited and transient symptomatic effects, adding that they have no definite impact on the long-term neurodegenerative process.
"There are other alternatives or complementary treatments that have been investigated in the treatment of dementia but all have not been shown to have sufficient evidence for disease modifications," she stressed.
Dr Suraya added that there is always a tendency, especially among clinicians, to just look at the traditional medical model of care.
"The management of dementia goes beyond just treating the symptoms or simply dishing out medications to bring the disease to its knee," she said.
Elaborating further, she said care should be built around the needs of the individual and contingent upon knowing the person through an interpersonal relationship.
"It means tailoring to a person's care to their interests, abilities, history and personality," she sighed.
In Malaysia, said Dr Suraya, the Alzheimer Foundation of Malaysia (ADFM), the Dementia Society of Perak and the Johor Baru Alzheimers Disease Association (JOBADA) are at the forefront in providing education and skill training of both formal and informal caregivers, as well as healthcare workers in dementia care.
They are also providing daycare rehabilitative services to people with dementia in their areas.
Dr Suraya, who is a permanent committee member of the Asian Society Against Dementia (ASAD), said Malaysia was expected to host the 18th ASAD International Conference in 2024, the second time it will be doing so.
Consultant geriatrician Dr Peter Selestine concurred with Dr Suraya that social interaction and cognitively stimulating activities have shown to be effective in preventing dementia.
"Caring for and interacting with grandchildren may help senior citizens in preventing dementia," he said.
Dr Selestine, who is attached to KPJ Johor Specialist Hospital, said current medications only help in slowing down the progression of the disease.
"In Malaysia currently there are four such medications and there are no medications that are proven to prevent dementia," he said.
He stressed that more needs to be undertaken to increase awareness of dementia in society.
"We also need to create more dedicated dementia daycare centres that will help ease the burden of caregiving," adding that incentives should be given to nursing homes to accept and manage patients with behavioural problems.
He added that in the long term it will be good to have dedicated dementia nursing homes with staff trained to handle patients with dementia and behavioural problems.