Early intervention can make a difference in Alzheimer's prevention

Alzheimer's is a progressive disease that impairs memory and thinking skills, and eventually, the ability to carry out the simple tasks. It is the most common cause of dementia among senior citizens.

Memory problems are typically one of the first signs of Alzheimer's, though initial symptoms may vary from person to person. Mild cognitive impairment (MCI) is a condition that can be an early sign of Alzheimer's, but not everyone with MCI will develop the disease.

According to the Malaysian Research Institute of Ageing (MyAGeing), Universiti Putra Malaysia, what is worrying is about 45.2 per cent of senior citizens in Peninsular Malaysia have MCI.

"This means that nearly five out of 10 senior citizens face problems related to mild cognitive impairment or slight impairment in mental functions," MyAgeing Deputy Director, Assoc Prof Dr Rahimah Ibrahim told Bernama.

"Older adults with MCI have a heightened risk of developing Alzheimer's, but not everyone with MCI will develop the disease," she added.

However, she said, MCI does not interfere with the daily life of the individual with the condition as it can be treated with early intervention.

According to Dr Rahimah, people with MCI may be aware they have a problem and the signs may also be obvious to family members or friends, hence immediate intervention can be carried out.

Immediate and continuous intervention such as management of the disease, change in lifestyle and lifelong learning could prevent, or at least delay the onset of cognitive and functional decline among elderly folks, she said.

According to Dr Rahimah, studies have revealed that an individual with a strong religious foundation is unlikely to develop neurodegenerative conditions.

She said that MyAgeing also found that gender, age, ethnic, education level, marital status and household income are often associated with cognitive functions of senior citizens.

According to the National Health and Morbidity Survey 2018, about one in 10 persons aged over 60 suffers from dementia, and based on 2020 figures, senior citizens made up 11 per cent or 3.4 million of the Malaysian population.

She said Malaysia can expect a steady rise in cases of Alzheimer's given the rapidly ageing population, which reinforces the need for the community to provide continuous support to families who provide care for their aged parents.

"Elder care is actually a full time job, and many family members are not ready to assume the role as caregivers, and some of them are also financially constrained.

"As such, the burden on middle aged individuals 'sandwiched' between ageing parents and adult children, or referred to as 'the sandwich generation', has been widely reported by researchers. The responsibility of taking care of these older folks usually falls on women who are often forced to give up their promotion or leave their job to care for their family," she added.

According to Dr Rahimah, the stress of taking the role for a prolonged period can become overwhelming for the caregivers, in terms of their health and wellbeing as well as financial concerns when they themselves become senior citizens.

In addition, she said care for aged Alzheimer patients need the understanding of the community."We should understand that managing a patient with Alzheimer's is not the same as caring for normal elders, given that there is no cure for the disease.

"Patients are often isolated because they are regarded as senile by those who fail to recognise their need for care and interaction," she added.

Meanwhile, a trainee at the Alzheimer's Disease Foundation Malaysia (ADFM) Dr Nor Azlina Abu Bakar said, public education on Alzheimer's should be intensified through talks, reading materials and sharing of activities between patients and caregivers.

" Early signs of the disease should be highlighted so that early diagnosis can be carried out and this will help the patient to plan his or her life's journey in terms of medical treatment, social, financing and family aspects. The awareness should be introduced in schools.

"Focus should be given to maintaining a healthy lifestyle, including a healthy diet, stopping smoking, regularly exercising and acquiring new knowledge to stimulate the mind. The way forward is to prevent high blood pressure, diabetes, high cholesterol and obesity as they can reduce the risks of Alzheimer's," she added.

Dr Nor Azlina, who is also a geriatrician at Hospital Raja Permaisuri Bainun said, focus has always been towards advocating activities related to Alzheimer's, especially in educating the people on the disease.

"The ADFM recently launched a 'World Alzheimer's Month 2021' programme themed 'A Journey Begins With Early Dementia Diagnosis' to raise public awareness and to identify signs of early-onset Alzheimer's. Early diagnosis is fundamental for early intervention and hence delays the onset of neurodegeneration," she added.

"ADFM held a series of talks virtually through Zoom platform throughout September. In addition, a yearly event 'Memory Walk' is also held on line targeting to reach 10 million steps to raise awareness on Alzheimer's, reduce stigma associated with the disease and encourage people from all walks of life to be involved in community-based activities that are supportive of these patients.

"Other activities organised with senior citizens include yoga, expressive art and dancing classes," she said.

At the same time, Dr Nor Azlina said stigma or discrimination towards patients with Alzheimer's is due to the lack of public awareness and understanding of the disease.

"The problem arises when patients realised that there have been less visits from relatives or friends, hence causing them to be socially isolated. Some patients felt that their own family are over protective to the extent that that they become independent.

"The pandemic's impact on the patient is greater due to social distancing measures, which curb social interaction and exacerbate isolation.

"This has brought about a decline in cognitive function, with the patient suffering from depression. Patients are also not able to receive the much needed treatment due to business closures affecting clinics which offer therapy sessions. Hence, physical therapy such as walking in the park is one approach that has been shown to improve symptoms of Alzheimer's.