Ministry of Health Singapore. All Rights Reserved.
Is there a common cause of dementia? What is the difference between people with vascular dementia and those with Alzheimer’s disease? Are there available drug treatments for those who develop dementia? Learn more about the types of dementia and how we can provide proper care for persons with dementia.
Dementia is a disorder of the brain that is characterised by progressive worsening of memory and intellect (cognitive abilities), orientation and personality. Dementia affects a person’s ability to think, reason, remember, learn new information and skills, solve problems and make judgements. It results in a progressive worsening of the affected person’s work, daily activities and ability to interact socially.
The risk of dementia increases with age. In Singapore, about 1 in 10 (amongst the elderly aged 60 years and above) suffers from dementia. This corresponds to approximately 82,000 people with dementia in 2018 and is projected to increase to 152,000 by 2030.
There are many causes of dementia. They can be divided into irreversible and potentially reversible:
Dementia which is potentially reversible may be curable. Dementia due to irreversible causes cannot be cured. However, it may be possible to slow down the progression by treating any risk factors. It may also be possible to treat the cognitive symptoms.
Vascular dementia is a type of dementia that is caused by a series of small strokes. You can reduce your risk of stroke and therefore prevent vascular dementia by:
The signs and symptoms of dementia include the following:
In addition, the following behavioural and psychological symptoms may also occur:
The family doctor should first be consulted if any symptoms of dementia are noticed. If dementia is suspected, the doctor will screen further by using special questionnaires. For some, referral to a clinical psychologist or psychiatrist may be required for further assessment.
Various tests may be conducted to identify possible cause(s) of dementia as well as check if there is any other condition that could be causing the symptoms. The tests will be conducted after discussion with the affected person, family members or caregivers and these include:
After the diagnosis of dementia, the attending doctor will do further assessments which include:
The management of dementia usually involves one or more of the following
This may involve:
At present, there are no recommended medications. Vitamin E may give rise to a slight improvement, but its safety in the high doses required is as yet uncertain.
These medications help to improve the cognitive symptoms in those with Alzheimer’s Disease:
Generally, these medications are well tolerated. Possible side effects include:
Please also remember that:
symptoms, these ultimately do not prevent the disease from getting worse
Behaviour problems are usually a cause for major stress among family members or caregivers. Managing BPSD involves non-medication measures (involving a multi-disciplinary team) as well as the use of medications.
Non-medication measures include:
Medications used in the management of BPSD include:
The attending doctor will discuss with the family members or caregivers regarding any decision to start the affected person on medications to manage BPSD.
Non-medication measures should generally be considered as the first step in managing those with BPSD. Using medications to treat BPSD carries the risk of side-effects and may mask or suppress behaviour that actually allows the person with dementia to communicate his or her needs.
Support for the person with dementia as well as the family members and caregivers is important as it allows appropriate care to be provided. These support services include:
The attending doctor or healthcare professional may also refer family members or caregivers to community resources to meet various care needs. Examples of such community resources include:
Driving represents independence, freedom and mobility for a person. However, if driving compromises the affected person’s safety and public safety, the attending doctor may enlist the help of the family members and caregivers to persuade him or her to stop driving.
Restraints (environmental, physical, etc.) are sometimes used in order to restrict or control the affected person’s movement when he or she is assessed to be dangerous to himself or herself or others. Such restraints should only be used as a last resort and only as a temporary measure. Restraints should be removed as soon as possible and excessive use must be avoided.
The use of restraints can be harmful. They can cause:
Many people diagnosed with dementia continue to insist on living alone. This can affect their safety and well-being and also exposed them to mistreatment, fraud and exploitation by others.
The attending doctor will assess whether someone with dementia is capable of living alone.
For more information and a list of community resources, download
“Your Guide to Understanding Dementia” (PDF), available in four languages.
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This article was last reviewed on
Monday, December 9, 2019
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