Alzheimer's Disease in Singapore: Signs, Symptoms and Treatment

Alzheimer’s disease is the most common type of dementia. It is the progressive loss of brain cells related to the formation of insoluble proteins in and around the brain cells. The disease accounts for 60-65% of all dementia cases.

The condition will lead to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.

As the condition often occurs in the elderly, most people are unable to recognise the symptoms. They often brush them off as just part of the normal ageing process.

However, if the symptoms are not addressed early, they can lead to potential problems years down the road. These include severe changes to behaviour and brain function.

To coincide with World Alzheimer’s Day on 21 September, World Alzheimer’s Month was also launched in 2012 by the Alzheimer’s Disease International (ADI), every September. Their goal is to raise awareness and challenge the stigma that surrounds dementia.

“Early diagnosis and intervention allow patients with Alzheimer’s to prolong the joy of spending quality time with their loved ones,” says Dr Seng Kok Han.

Alzheimer’s Disease in Singapore

Very often, the condition begins long before family and friends notice if there is anything different about the patient’s behaviour.

Alzheimer’s disease usually occurs in older people, with symptoms typically appearing after the age of 60. However, it is possible for people between the ages of 30 to 60 to develop Alzheimer’s dementia early.

Signs and Symptoms at Each of the 3 Stages of Alzheimer’s

The following is a general guide of how abilities can change as the disease progresses.

1. Early Stage: Mild Alzheimer’s Disease

At the early stage of Alzheimer’s, one can still function independently and carry on with day-to-day activities. However, more complex activities such as handling finances and engaging in employment tend to be impaired.

• Poor memory of recent events
• Missing appointments
• Word-finding difficulties
• Misplacing everyday items from time to time
• Spending more time than usual to complete daily tasks
• Personality changes: declining motivation, social withdrawal, irritability

2. Middle Stage: Moderate Alzheimer’s Disease

This may last from one to five years. A greater level of care and attention has to be given to patients at this stage.

• Memory lapses are more obvious.
• They may lose track of time and events.
• Wandering and getting lost is common.
• They are dependent on others in managing finances, shopping or transportation.
• Family members need to remind them to bathe and dress appropriately.
• They may exhibit inappropriate and disturbing behaviour: becoming irritable and agitated, experiencing hallucinations and delusions.

3. Late Stage: Severe Alzheimer’s Disease

At the final stage of the disease, patients are dependent on others for basic activities such as dressing, bathing, going to the toilet and eating.

• Unable to recognise family members.
• Language is restricted or there is a loss of speech.
• The patient loses mobility.
• Constant supervision is required.

Commonly Overlooked Signs of Alzheimer’s Disease

There is a common misconception that Alzheimer’s is just about memory loss and being forgetful. As the condition often occurs in the elderly, most people are unable to recognise the symptoms. They often brush them off as just part of the normal ageing process.

Here are some signs that we may not recognise as symptoms:

• Difficulty completing normal, more complex tasks such as managing finances
• Mood changes and personality changes. The unpredictable mood may be due to impairment of judgment and inability to assess their own actions. Along with mood changes, there may be a change in personalities such as declining motivation, social withdrawal, irritability, and disinhibition.
• Difficulty finding the right words during conversation
• Difficulty in writing, signing or spelling out words
• Inability to read or understand; individuals may find themselves unable to finish reading a sentence or paragraph or have difficulty understand the meaning of it

Possible Treatments for Alzheimer’s Disease in Singapore

Assessment for dementia involves detailed medical history-taking, physical examination, cognitive testing, blood investigations and brain imaging.

Although there is no cure for Alzheimer’s, early diagnosis enables patients and caregivers to have a better understanding of their condition. This also helps them to receive anticipatory guidance for emerging symptoms.

Interventions can slow down the progression of cognitive decline. This can help prolong patients’ functions in the community and delay institutional care.

Medication

Prescribed medications such as Donepezil, Rivastigmine, Galantamine or Memantine can slow down the progression of the illness.

Antidepressants can be used to treat depression while antipsychotics can help treat hallucinations and paranoia, which can be seen in dementia.

Psychological Support

Psychological approaches include helping to orient patients (reality orientation) and focus on meaningful activities of the past (reminiscence therapy).

Cognitive training can equip them with skills to decrease everyday problems and improve the quality of their lives. Behavioural modifications can help patients change specific challenging behaviour.

Social Interventions

It is important to work with families as they play a role in influencing treatment outcomes and management.

Referring patients to appropriate agencies such as daycare, befriend-er services and family service centres can help in the aftercare.

Problems Alzheimer’s Patients Face Along Their Journey

• Patients may experience disorientation and confusion. They may experience disorientation with time, place and circumstances, or confusion about what day or year it is. They may even lose track of what they are doing. What’s more, they may find themselves confused in familiar surroundings, unable to recognise landmarks and to remember regularly used routes
• Experience anxiety and fear. They are prone to depression
• Inability to manage finances as patients may find it hard to remember their PIN number or keep track of money being spent and received
• Lack of understanding and empathy from family and society can result in patients having lower self-confidence, feel left out and alone
• They may be vulnerable to neglect and abuse.

How Doctors, Family Members, Neighbours, and Caregivers Can Provide Help to Alzheimer’s Patients

1. Be patient and empathetic towards Alzheimer’s disease patients.

If an approach fails, don’t let yourself be discouraged. Don’t raise your voice or throw a temper tantrum. Instead, think of another approach and keep trying out different ideas.

Alzheimer’s disease patients often need help to handle routine daily activities, such as bathing, dressing, eating and using the bathroom.

Caregivers can try to balance his or her loss of privacy and independence by being gentle and tactful.

2. Communicate in a calm, quiet environment, with good eye contact.

Use simple language, and be specific. Keep sentences short and clear. Refrain from speaking too fast to help reduce confusion and misunderstanding.

Repeat if needed. Offer simple choices. Beware of your body language. Break down activities into simple steps. Offer reassurance and praise. Finally, avoid arguments.

3. Maintain a regular routine to help bring structure and decrease anxiety.

Include exercise and social activities.

4. Simplify activities. 

Break them into simple step by step tasks, allow him/her to do as much for himself/herself as possible to give dignity, independence and maintain functioning as long as possible.

5. Write down reminders and place them around the house where it is visible.

This will help the patient keep track of important appointments such as a visit to the doctor and when to take medication.

6. Create a safe environment.

Install handrails, lock dangerous items such as knives, cleaning products, remove unnecessary furniture/clutter, secure electrical cords to prevent tripping.

Use non-slip rugs, keep frequently used items at the same place, the temperature gauge on hot water heater turned low to prevent scalding.

Lock window grills, keep recent photos handy to assist police in case person wanders off, have the person wear an identification bracelet or have a “safe return card”.

Do not leave the person home alone if he or she cannot respond to an emergency situation.

7. When the person becomes agitated, distract with another activity.

Be flexible, but allow the behaviour to continue if it’s not hurting anyone or the patient. Also, remove triggers to difficult behaviour.

8. New difficult behaviour

A new difficult behaviour may be due to a medical condition such as infection or medication side effects and needs evaluation and treatment by a doctor.

9. Neighbours

Neighbours can also help to keep a lookout for each other, especially if anyone starts to act out of the norm or appears to not recognise the surroundings.

10. Support groups

Join a support group and learn from each other by sharing experiences and discover solutions when caring for patients with dementia.

Dr Seng Kok Han is a Consultant Psychiatrist from Nobel Psychological Wellness Clinic, a member of Healthway Medical Group. Dr Seng subspecialises in Geriatric Psychiatry. He has experience in treating mood disorders such as depression and bipolar disorder, and psychotic disorders such as schizophrenia. He also treats insomnia, anxiety and stress-related disorders.