Monday, August 1, 2016
Malaysia - When forgetfulness is a concern
Mild cognitive impairment could be the start of dementia, writes Nadia Badarudin.
HOUSEWIFE Irdina, 40, worries about her mother, Saadiah, 63 (not their real names). Irdina says after her father passed away 10 years ago, her mother was generally well, and living independently.
Lately however, this has changed; her mother has become more forgetful. She notices that her mother asks the same question over and over again during conversations and keeps losing things.
“My mother is very organised. So when she told me that she often misplaces her reading glasses and later finds them in strange places like in an empty pot in her garden, I merely thought age was catching up,” she says.
Her mother recently lost her way driving home after her religious class. This has occurred several times.
“I find it quite strange because my mother uses the same route every day. When it has happened more than once, I just don’t know how to react,” she says.
“Although she manages her daily responsibilities like she normally does, I think something is not right.”
Going into a room and forgetting why you went there, or misplacing things, can happen to anyone, not only older people like Saadiah.
Forgetfulness is part and parcel of the normal ageing process. According to the National Institute of Ageing, changes occur in all parts of the body, including the brain, as people get older.
It says memory loss can be linked to health issues such as side effects of medication, chronic alcoholism, tumours or infections in the brain, and to some thyroid, kidney or liver disorders.
It can also be related to stress, depression, anxiety and other emotional issues such as coping with the death of a close family member.
However, consistent forgetfulness or memory loss can be a sign of something more serious in the elderly.
As Malaysia becomes an ageing nation by 2035 with 15 per cent of the population classified as senior citizens (aged 60 and above), this should be a concern because it will result in higher costs of acute and long-term medical and healthcare services.
MILD COGNITIVE IMPAIRMENT
When people are more forgetful than normal for their age but can still function and carry out their daily tasks, as in Saadiah’s case, the condition is called Mild Cognitive Impairment (MCI).
Experts believe that MCI “may be an early warning sign of memory disorders later in life”, according to Health After 50, an American online health portal for the elderly.
Psychology Today describes the syndrome as being in-between normal ageing and dementia, hence being “stuck in the middle”.
Beacon Hospital consultant physician and geriatrician Datuk Dr Rajbans Singh says MCI often presents as slight decline in cognitive abilities, including thinking and memory skills that are serious enough to be noticed by the individual or by others.
“The changes due to MCI are different from normal ageing but less severe than someone with dementia — a broad term for memory loss of which 60 per cent is due to Alzheimer’s disease. “Unlike Alzheimer’s, the changes do not interfere with daily life or independent function and patients can manage their daily responsibilities such as shopping or driving,” says Dr Rajbans, who is founder and past president of Malaysian Healthy Ageing Society, member of the Elderly Committee of the Malaysian Medical Association and member of the American Academy of Anti-Ageing Medicine and British Geriatrics Society.
In normal ageing, the memory loss is not consistent and the person can remember again what he has forgotten.
In Alzheimer’s the memory loss is persistent and progressive, especially short-term memory, he says. “Patients with MCI are usually able to manage themselves and are not a burden to their families.
However, 20 per cent of MCI cases progress into Alzheimer’s and these are the ones who will need extra care and support,” he adds.
The National Institute of Ageing says signs of MCI, which mainly affect men, include losing things often and struggling to come up with desired words. A person’s health and lifestyle can influence the chances of developing MCI as he grows older.
Dr Rajbans says the risk groups for MCI include people of advanced years, or with a family history and those with cardiovascular risk factors including diabetes, hypertension and high cholesterol.
“Those at risk tend to be overweight and lack exercise. Smokers and those who are under stress are also prone to the symptoms,” he says.
The symptoms can be caused by several factors, some treatable and some not. Studies show that although MCI increases a person’s risk of developing dementia, it does not always get worse and progress into dementia.
Thus, diagnosing the condition is crucial and this helps prevent onset of dementia. Dr Rajbans says a thorough diagnosis is done to ascertain the causes of memory loss.
“Some blood tests and even a CT scan of the brain would be done to exclude an organic cause of memory loss or to rule out underlying illness. Regular follow-ups are important so that early diagnosis of Alzheimer’s can be made and addressed.”
According to Alzheimer’s Society, UK, there are currently no drugs which have been approved to treat MCI. It says there is growing evidence that exercising the body and mind, socialising and doing leisure activities such as reading, playing card games or puzzles can help prevent or delay the onset of MCI and dementia.
“There is no treatment for MCI. The drugs that work for Alzheimer’s do not seem to have any effect on it,” says Dr Rajbans. Apart from medical treatment for vascular risk factors, patients are normally advised to adopt a healthy lifestyle and be active (physically and socially) to lower their risk of developing dementia.
“Exercising and keeping the mind active may prevent the progression to Alzheimer’s. In Japan, the elderly are encouraged to play Sudoku, which seems to help. Studies show that people who have purpose in their lives and who are socially connected with their families and friends have a lower incidence of MCI and Alzheimer’s,” he adds.
Being ignorant or dismissing forgetfulness as just a normal sign of ageing are not an option. Family members like Irdina have a huge responsibility. Dr Rajbans says: “Caregivers must monitor for signs of progression into dementia.
“Caregivers need to be well-informed and help the patient adopt and maintain a healthy lifestyle to reduce the risk of progression.”