Dr Wan Izwin Najla Wan Hassan, a Consultant Geriatric Psychiatrist at Parkcity Medical Centre explains the importance of catching dementia early and its implications on the caregivers of dementia patients.
Do you occasionally find yourself forgetting where you left your keys or where you were driving to? You may eventually find your keys or find your way, but if this happens alarmingly too often, it’s time to get yourself checked at a memory clinic. You could have mild cognitive impairment, which could possibly be an early indicator of neurologic disorders and dementia.
Mild cognitive impairment
“An example of the differences between severe dementia and a mild case is with dementia you may forget your keys everywhere to the point of being locked out of the house, or you may go the shops and lose your way back home, but patients with mild cognitive impairment might lose their keys every now and then, can’t remember where they’ve put it but eventually will find their keys,” highlights Dr Izwin, who is one of the few geriatric psychiatrists in the entire country.
“If they find themselves being lost driving somewhere familiar, they can just redirect themselves back, whereas someone with dementia might struggle and they’ll get lost. Nevertheless, it’s important to stress that not all people who have memory problems will have dementia, but it can be an early indicator.”
Studies show that patients with mild cognitive impairment have 20-30% per cent higher risk of developing dementia, and the key to treating it is with early detection. Unfortunately, in Malaysia, patients with cognitive difficulties tend to come in for a checkup when their dementia has advanced to a later stage.
“Dementia may not be a curable disease, but it is a treatable one. The medication that we prescribe for the condition works better at an earlier stage so it’s important for people who have cognitive issues to seek help early. In 20-30 per cent of the cases, we find the patients to suffer from other issues such as depression, bereavement, side effects to medication, anaemia, and hypothyroidism. In these cases, simply correcting these reversible causes is enough to help the patients with their memory problems,” Dr Izwin clarifies.
There are two types of medication that are currently the most common for dementia treatment; one being cholinesterase inhibitors—a drug that increases acetylcholine levels in the brain, helping with enhancing cognitive functions, and the other is NMDA blockers, that help to stabilise toxic brain chemicals in the brain. These medications may not necessarily help the patients to remember better but studies show that they help in reducing the rate of decline in cognitive abilities. Some patients also feel brighter, with better focus and less agitation.
“A lot of research is now going into preventing Mild Cognitive Impairment into dementia, including immunotherapy, new forms of medication, better early detection, lifestyle changes, alteration of dietary habits, exercise, and cognitive stimulation. Hopefully we will become better at preventing people from developing dementia soon,” hopes Dr Izwin.
If you face any short-term memory difficulties or noticed that you’re unable to plan things like you’re used to and would like to get your cognition checked, you can walk into any memory clinic near you, such as the one in Parkcity Medical Centre.
There you can find a multi-disciplinary team that usually will consist of a geriatric psychiatrist and occupational therapist who can help with day-to-day activities and memory aids, physiotherapist, dietician, and speech and language therapist. It is a holistic approach that will assist patients with their memory disorders.
“At the memory clinic, a doctor or nurse would ask careful questions to both patients and carer. The reason why we speak to both of them is because sometimes the patient would be unaware of what is wrong with them. The carer will then report what they have noticed and that gives us both sides of the story. The subsequent cognitive tests vary from long ones to short ones depending on the level of memory problems. We would also conduct various tests such as blood test, scans, and physical examinations to rule out any other reversible cause, diseases that share the same symptoms, or simply medication side effects,” says Dr Izwin.
Most of the time, visits to the memory clinics are not only beneficial to the patient but their caregiver as well.
“Often times when we speak to caregivers who accompany the patients, we find that they are under a lot of stress because of the big responsibility of taking care of a patient with dementia. It is very important for caregivers to upskill themselves with psychoeducation for example to understand the patient’s condition to help them deal with it better. If you’re a caregiver and you need assistance, you can find great trainings provided by the Alzheimer’s Disease Foundation Malaysia and many others,” enlightens Dr Izwin.