23.OCT.2017 10 MIN READ | 10 MIN READ

While dementia typically occurs among the elderly, more and more people are starting to develop dementia in their 40s and 50s.

Last updated on 9 February 2021

According to a nationwide study in 2015, 1 in 10 Singaporeans aged 60 and above had dementia. There were 28,000 Singaporeans diagnosed with the condition that year and that number is expected to rise to 80,000 by 2030. But it’s not just the older population that suffers from dementia. In 2015, there were 121 Singaporeans below aged 65 diagnosed with the condition, up from just 27 cases in 2011.

To accommodate the rising numbers, the number of dementia care places are expected to increase from 1,000 to 3,000 by 2020. But while preparations are ongoing to build a dementia-friendly Singapore, the trend continues to rise, putting you and your loved ones at risk.

The good news is that our everyday lifestyle choices may help reduce the risk of dementia.

What is dementia?

Dementia

According to the National Institute on Ageing (NIA), dementia is a brain disorder that affects communication and performance of daily activities. Dementia is an umbrella term for a set of symptoms including impaired thinking and memory. The condition is often associated with the cognitive decline of ageing.

Alzheimer’s disease is a form of dementia that specifically affects parts of the brain that control thought, memory and language. Other diseases like Huntington’s Disease, Parkinson’s Disease and Creutzfeldt-Jakob disease can progress to dementia.

What causes dementia?

Dementia is caused by damage to brain cells, which then interferes with the ability of brain cells to communicate with each other.

Different types of dementia are associated with different types of brain cell damage in particular regions of the brain. They manifest differently, for example, as memory loss, judgment impairment, movement difficulty and others.

Sometimes, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:

  • Depression
  • Medication side effects
  • Excessive alcohol intake
  • Thyroid problems
  • Vitamin deficiencies

Risk factors for dementia

Some risk factors for dementia cannot be changed. These are age and genetics.

There are other risk factors that researchers continue to explore that may be addressed by adopting healthy lifestyle choices, such as:

  • Consuming a healthy diet
  • Quitting smoking
  • Regular exercise
  • Cognitive stimulation

Early signs and symptoms of dementia

Early signs of dementia vary. Common ones include:

  • Memory problems, particularly in remembering recent events
  • Increasing confusion
  • Decreasing concentration
  • Personality or behaviour changes
  • Apathy and withdrawal or depression
  • Loss of ability to do everyday tasks

Dementia symptoms specific to Alzheimer’s disease

Alzheimer’s disease progresses in several stages. Signs are symptoms worsen as the disease progresses. They include:

  • Memory problems
  • Difficulty with language, reading, writing and working with numbers
  • Poor judgement leading to bad decisions
  • Taking longer to complete normal daily tasks
  • Repeating questions
  • Trouble handling money and paying bills
  • Wandering and getting lost
  • Losing things or misplacing them in odd places
  • Mood and personality changes, including anxiety, aggression, hallucinations, delusions

Symptoms specific to frontotemporal dementia

Symptoms of frontotemporal dementia varies from person to person as different parts of the frontal and temporal lobes of the brain are affected. They can be generally categorised as behavioural symptoms and language and emotional symptoms.

Symptoms include:

  • Problems with executive functioning. This refers to tasks that involve planning, sequencing, prioritising, multitasking, and self-monitoring and correcting behaviour
  • A tendency to repeat the same activity or word
  • Social disinhibition and acting impulsively
  • Compulsive eating
  • Difficulty resisting impulses to use or touch objects that one can see and reach
  • Impaired ability to use or understand words
  • Impaired ability to speak properly, e.g. slurring
  • Apathy, exaggerated or inappropriate emotions.
  • Difficulty reading social signals, such as facial expressions.

Symptoms in the later stages of dementia

Symptoms of later stage dementia include the following:

  • Severe memory loss, thinking they are living in an earlier time period and difficulties recognising themselves and others.
  • Problems with concentration, planning and orientation.
  • Problems with verbal communication, such as not understanding what is said to them, losing speech and using sounds, gestures and body language instead and repeating the same words and phrases.
  • Mobility and physical problems, such as inability to move around, stand, or get themselves out of a chair.
  • Behavioural changes, such as becoming distressed, agitated, repetitive or aggressive. This behaviour can be very upsetting for the person themselves.
  • Physical deterioration, including frailty, weight loss and difficulty swallowing and chewing.

How to prevent and reduce your risk of dementia

The following are some things you can do to reduce your risk of dementia:

  • Be physically active. This should include both aerobic and resistance activities for about 150 minutes a week at moderate intensity.
  • Eat healthily by consuming at least 5 portions of fruits and vegetables a day and protein at least twice a week. Limit sugar, salt and saturated fat intake. Eat starchy foods moderately and drink 6 – 8 glasses of water a day.
  • Don’t smoke. If you are currently smoking, talk to your healthcare provider about the different methods to stop smoking and choose one that best works for you.
  • Drink less alcohol. Limit your drinks to no more than 6 pints of beer or 10 small glasses of wine per week.
  • Exercise your mind by doing activities that challenge yourself mentally, such as studying, learning a new language, doing crosswords, playing board games, reading books or writing and being socially active.

With Alzheimer’s being the most common cause of dementia, the following 5 tips will equip you with relevant information to help you prevent or combat Alzheimer’s.

Clock in regular exercise

Did you know regular physical exercise can reduce your risk of developing dementia by up to 50%? Exercise can also slow further deterioration in those who have already started to develop cognitive problems.

Exercise for at least 30 minutes, 5 times a week. You could walk, jog, cycle, swim or join a dance group. Add strength or weight training sessions to your weekly routine – these  exercises don’t just build muscle, they help you maintain brain health. Weight training exercises don’t just mean lifting weights – hiking, dancing, jogging and walking count as well!

As you age, you may be more at risk of head injuries from falls, which in turn increase your risk of injuring your brain. Balance and coordination exercises can help you stay agile and avoid falls. Balance and coordination exercises include taichi, yoga, pilates or exercises using balance balls.

Opt for a healthy diet

Research suggests that making the right food choices could protect your brain function and lower your odds of getting dementia. Additionally, for a person with dementia, proper nutrition can keep the body strong and ease behavioural symptoms.

Less sugar and saturated fat. Sugary foods, refined carbs and fatty foods can lead to weight gain, putting you at the risk of further health problems such as diabetes. Diabetes has been closely linked to Alzheimer’s. Read food labels, watching out for the amount of sugar and saturated fat a product contains, and seek out healthier options.

Follow a Mediterranean diet. A Mediterranean diet is high in whole grains, vegetables, nuts, legumes, spices, oily fish, olive oil and other foods high in omega fats, while being low in red meat, refined foods and sugar. Mounting research shows that the DHA found within these healthy fats may help prevent Alzheimer’s disease and dementia. Food sources include cold-water fish such as salmon, tuna, trout, mackerel, seaweed, and sardines. You can also supplement with fish oil. 

Enjoy your tea. According to a study in the December 2016 Journal of Nutrition, Health & Ageing, frequent and regular consumption of tea – whether black, green or oolong – is linked to a lower risk of dementia. It is suggested that the benefits of tea on the brain come from the bioactive compounds in tea, catechins and theaflavins, which contain anti-inflammatory and antioxidant potential and other brain-protecting properties.

Supplement your diet. Vitamin B3 and B6 are needed by the body to form neurotransmitters, making them important for the healthy functioning of the nervous system and brain. Vitamin D is a strong anti-inflammatory and immune boosting nutrient, which may help to slow the onset and development of dementia. Vitamin E has also been found to be helpful in preventing dementia diseases such as Alzheimer’s.

Stimulate your mind

If you don’t keep your body active it will start to lose its muscle and fitness. Your brain is no different.

Mental challenges help to build up the brain, making it less vulnerable to developing the lesions that can cause Alzheimer's disease. Mental stimulation can also help to slow brain deterioration in people who already have the disease.

Learn something new. Practise a musical instrument, pick up a foreign language, read a good book, take up a new hobby. The greater the novelty and challenge, the greater the benefit.

Play strategy games and puzzles. Brain teasers and riddles can give you a mental workout and train your brain to form and maintain cognitive associations. Crossword puzzles, board games, cards, Scrabble and Sudoku are all great options.

Break convention. Eat with your non-dominant hand, take a new route home, break an old habit. doing something out of your comfort zone generates new brain pathways.

Reduce stress

Persistent stress takes a toll on the brain, increasing the risk of dementia. In fact, many studies have linked anxiety with the development of Alzheimer’s, especially in people who are already at risk for the disease.

Relax and have fun daily. Make it a point to keep stress under control by intentionally spending time to relax. Find leisure activities that will relax you and do them – whether it is knitting, taking a walk in the park, yoga or playtime with your dog. 

Meditate. Meditation can increase protective tissue in the brain and reduce the hormone cortisol, which has been known to increase the risk of developing dementia.

Laugh more. The act of laughing can help your body fight stress. Socialising, laughing, playing and being active helps to engage the brain and aid in preventing dementia.

Sleep well

It is not uncommon for people with Alzheimer’s disease to suffer from insomnia and other sleep problems. Research suggests that poor sleep isn’t just a symptom of Alzheimer’s, but a possible risk factor.

Researchers found that poor, disrupted sleep promotes buildup of a certain protein in the brain that can lead to impaired memory and Alzheimer’s. Getting more deep sleep, then, might be able to clear the protein burden in the brain.

Make sleep a priority by establishing a regular sleep schedule. If you've received complaints about your snoring, you may want to get tested for sleep apnoea, a potentially dangerous condition where breathing is disrupted during sleep. Being treated for sleep apnoea can make a huge difference to your sleep quality.

If insomnia is a problem, try exercising, creating a relaxing bedtime ritual, or consulting a doctor.

 

Article reviewed by Dr Lee Kim En, neurologist at Mount Elizabeth Hospital

References

One in 10 people over 60 have dementia, new Singapore study claims. (2016, January 19). Retrieved from http://www.straitstimes.com/singapore/health/one-in-10-people-over-60-have-dementia-new-singapore-study-claims

Challenges of building a dementia-friendly Singapore. (2017, March 13) Retrieved from http://www.channelnewsasia.com/news/singapore/challenges-of-building-a-dementia-friendly-singapore-7957346

'Alarming rise' in younger dementia patients. (2016, February 05). Retrieved from http://www.straitstimes.com/singapore/health/alarming-rise-in-younger-dementia-patients

Exercising Later in Life Might Lower Risk for Alzheimer's. (2014, April 30). Retrieved from http://www.alzheimers.net/2014-04-30/senior-exercising-may-lower-alzheimers-risk/

Is Alzheimer's the Newest Form of Diabetes? (2015, December 15). Retrieved from http://www.alzheimers.net/2013-10-28/alzheimers-newest-form-of-diabetes/

Best Fruits to Possibly Prevent Alzheimer's and Protect Memory. (2014, April 01). Retrieved from http://www.alzheimers.net/2014-04-01/best-fruits-to-prevent-alzheimers/

How Vitamin K is Good for the Brain and Alzheimer's Prevention. (2016, August 16). Retrieved from http://www.alzheimers.net/2014-07-09/vitamin-k-alzheimers-prevention/

Stress Management. (n.d.). Retrieved from https://www.helpguide.org/articles/stress/stress-management.htm

How Meditation Can Slow Alzheimer's. (2016, June 16). Retrieved from http://www.alzheimers.net/2013-11-25/how-meditation-can-slow-alzheimers/

The Serious Benefits of Laughter for Alzheimer's. (2014, August 13). Retrieved from http://www.alzheimers.net/8-13-14-laughter-and-alzheimers/

Sleep Apnea. (n.d.). Retrieved from https://www.helpguide.org/articles/sleep/sleep-apnea.htm

Preventing Alzheimer's Disease. (n.d.). Retrieved from https://www.helpguide.org/articles/alzheimers-dementia-aging/preventing-alzheimers-disease.htm

Alzheimer's Prevention through Diet and Supplements, Stress Management, Exercise, and Spiritual Fitness. (2017, June 24). Retrieved from http://alzheimersprevention.org/4-pillars-of-prevention/

What Is Dementia? (n.d.) Retrieved December 16, 2020, from https://www.alz.org/alzheimers-dementia/what-is-dementia

Dementia – Early Signs. (2014, May) Retrieved December 16, 2020, from https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/dementia-early-signs

What Are the Signs of Alzheimer’s Disease? (2017, May 16) Retrieved December 16, 2020, from https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease

What are the Symptoms of Frontotemporal Disorders? (2019, March 29) Retrieved December 16, 2020, from https://www.nia.nih.gov/health/what-are-symptoms-frontotemporal-disorders

Caring for Someone with Dementia Towards the End of Life. (2020, August 26) Retrieved December 04, 2020, from https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/condition-specific-short-guides/dementia

How to Reduce Your Risk of Dementia (n.d.) Retrieved December 16, from https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/how-reduce-your-risk-dementia

23.OCT.2017
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Lee Kim En
Neurologist
Mount Elizabeth Hospital

Dr Lee Kim En is a neurologist practising at Mount Elizabeth Hospital, Singapore. His clinical interests include intensive care medicine and stroke treatment.