In Focus: Tackling and demystifying dementia

By Kimberley Wang, Manager, Media and Publications, Communications and Outreach

Dementia is a syndrome caused by a variety of brain illnesses that affect memory, thinking, behaviour and the ability to perform everyday activities. In Singapore, one in 10 people aged 60 and above has dementia and it affects half of those above 85.1 With one of the most rapidly ageing populations in the world, the number of people with dementia here is projected to increase from 82,000 to 152,000 people by 2030.² 

Early diagnosis is critical for effective management and treatment of dementia. However, many people may not recognise the early signs and symptoms and tend to be reluctant to seek help due to the stigma associated with the disease. Raising awareness and educating the public about the condition can help promote early detection and diagnosis, which can lead to better outcomes for those living with the condition.

Understanding “Asian dementia”

To effectively tackle dementia in Singapore, LKCMedicine launched a new research centre last April to better understand how the condition develops in Asians and to advance new strategies that will one day help to predict and delay the progression of the disease. 

The Dementia Research Centre (Singapore) (DRCS) aims to shed light on “Asian dementia” and capture changes in the brain before dementia sets in. The Centre is part of the School’s ongoing research efforts in neurodegenerative disorders under the Neuroscience and Mental Health research programme, in line with its vision to transform healthcare.

Since its launch, DRCS has embarked on a five-year longitudinal Biomarker and Cognitive Impairment Study (BIOCIS) to look at what is happening to the brain at the very earliest stages of dementia and even before brain changes set in. Partnering local hospitals, the Centre is on track to recruiting 1,500 Singapore participants between 30 and 95 years old for the study. 

Participants go through a comprehensive cognitive assessment, which includes brain MRI scans, a neuropsychological assessment, and blood sample collection to measure markers in blood that are associated with cognition. A combination of these tests and the blood biomarkers, digital biomarkers and neuroimaging markers can help researchers detect early brain changes and determine whether the person is at risk of developing dementia.

Link between silent strokes and dementia 

Preliminary findings from BIOCIS based on data from 631 participants uncovered that vascular pre-dementia resulting from silent strokes is the most prevalent cognitive disorder in the BIOCIS cohort which is likely to be reflective of the entire Singapore population. This is of great concern as individuals with vascular pre-dementia have a 20 to 27 per cent annual risk of developing dementia.

Unlike studies on Western populations, the prevalence of pre-dementia patients with the amyloid beta protein and APOE4 gene – a significant risk factor for developing Alzheimer's disease – is low in Singapore. The study found that among Asians, there was a low prevalence of amyloid and a high burden of silent strokes. This finding underscores the urgent need to develop interventions that target the more prevalent vascular pre-dementia. 

Among study participants with vascular pre-dementia, 93 per cent have suffered some form of silent strokes and 41 per cent have severe burden of silent strokes. Those living with vascular pre-dementia have significant impairment in executive function, processing speed and visuospatial function. They are likely to have more problems with planning and organising their job duties, deficits in judgement, take a longer time to complete their duties and are more likely to have difficulties finding their way.

Director of DRCS Associate Professor Nagaendran Kandiah said, “These findings highlight the biological differences in the Asian brain and the need to develop interventions targeting silent strokes.”

Silent strokes are associated with hypertension, diabetes mellitus, high lipids. physical inactivity, and smoking. Having one or more of these chronic conditions negatively impacts the brain and can result in vascular pre-dementia and eventually dementia.

To prevent this, there is a need to reduce development and worsening of silent strokes, for example, lowering the burden of silent strokes using medications. The team at DRCS is also developing lifestyle intervention programmes targeted at reducing the risk of developing dementia through cognitive exercises, physical activity, dietary advice and control of hypertension, diabetes mellites and high lipids.

First ever Cognition Awareness Day

To this end, DRCS organised the inaugural Cognition Awareness Day 2023 on 23 February for the public to increase awareness about how cognitive disorders such as mild cognitive impairment and dementia can be affected by the health of their blood vessels. The event supports the national effort to strengthen prevention and early detection, one of the three-pronged approach that the Ministry of Health is adopting to address dementia.³

Held at the LKCMedicine Novena campus, participants picked up vital facts about the biological aspects of cognitive disorders, lifestyle-related risk factors for dementia and practical strategies to maintain a healthy brain through a series of expert talks, poster displays and exhibition booths.

LKCMedicine Dean Professor Joseph Sung warmly welcomed the attendees and said, “Early research findings show that if we can protect the blood vessels well by controlling blood pressure, sugar and so on, we may be able to prevent or at least slow down the progress of dementia. That is the reason why you here today – Professor Nagaendran and his colleagues are going to tell you more about their research findings through talks, posters and educational activities.”

 In his speech, Guest-of-Honour NTU Acting President, Deputy President and Provost Professor Ling San said, “DRCS believes that we can improve cognitive function and reduce the incidence of dementia in our population by targeting cerebral small vessel disease. This is a goal worth pursuing, not only for the health and well-being of the population, but also for the economic and social benefits for both Singapore and the greater Asian region.”

Among the highlights was a presentation by A/Prof Kandiah on preliminary findings of BIOCIS, including the most prevalent cognitive disorders in Singapore, the role of silent strokes in cognitive disorders and the impact of high blood pressure, diabetes and high cholesterol on the brain. He also touched on the measures that need to be taken to prevent or delay the progression of pre-dementia to dementia.  

One of the speakers, Consultant Geriatrician at Khoo Teck Puat Hospital, Dr Cheong Chin Yee, gave insights into the latest research on reversible risk factors of dementia. During her informative talk, she covered some of these risk factors, such as high blood pressure, smoking, depression, social isolation and lack of physical activity, that can contribute to the risk of developing dementia and how addressing these risk factors may help reduce that risk. She also discussed practical steps that the participants can take to make positive changes to their lifestyle and potentially lower the chances of developing dementia.

DRCS Psychologist, Ms Soo See Ann, spoke about preventing dementia through cognitive stimulation. She shared simple ways in which the participants can stimulate their minds to slow down the progression of the disease through applying cognitive stimulation therapy into their daily lives.

In tandem with Healthier SG’s focus on preventive care, DRCS will continue to promote awareness of cognitive disorders and develop lifestyle intervention programmes to reduce the risk of developing dementia. The Centre also aims to share further research findings on dementia with the public as the study progresses. 

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Footnotes:

[1] Alzheimer’s Disease Association releases research report on “Impact of the Arts & Dementia Programme”, Alzheimer’s Disease Association, 3 December 2019

[2] Let’s talk about Vascular Dementia, HealthHub, 2023

[3] Speech by Ms Rahayu Mahzam, Senior Parliamentary Secretary, Ministry of Health, on Adjournment Motion on Dementia, Ministry of Health, 20 October 2022