'Alarming rise' in younger dementia patients

Number diagnosed last year up 4 times from 2011, says NNI study
By Linette Lai, The Straits Times, 6 Feb 2016

Four times as many younger people were diagnosed with dementia last year than in 2011, the National Neuroscience Institute (NNI) revealed yesterday.

It had 27 patients under 65 in 2011 and 121 last year, though the reasons for the "alarming" rise are not yet fully understood, according to Associate Professor Nagaendran Kandiah of the NNI's neurology department.

"If this trend continues, we are in big trouble because we don't have enough services for these patients at the moment," he said.

Prof Nagaendran carried out a study of 250 dementia patients - around a third of whom were under 65 - to find out the financial impact of getting dementia early.

Forthose over 65, he found, the median annual cost was around $11,400. For younger patients, it was nearly double that, at $21,400.

Around 40 per cent of the younger patients in his study reported losing their jobs due to dementia, which was a main contributor to the higher cost.

"If you have dementia when you are 75, you have already retired," Prof Nagaendran said. "But if you are 50, you are most likely still working, or even the sole breadwinner."

While dementia typically hits the over-70s, young dementia patients start showing symptoms in their 40s or 50s.

Prof Nagaendran estimates that there are 40,000 people in Singapore with dementia, 10 per cent of whom are under 65.

While dementia in older people tends to show up as forgetfulness, younger dementia patients usually have problems with language.

Their behaviour may also be radically different and could be disruptive, which contributes to their losing their jobs.

Prof Nagaendran said his study shows that more needs to be done to help younger dementia patients and their families cope with the financial and social impact of the disease.

For example, programmes at daycare centres are targeted at older patients. "(Younger patients) go once, and they see that everyone there is over 70, and they don't want to go back," he said.

One of his patients is Ms Jennifer Low, 60, who was diagnosed with dementia six months ago.

However, her son, actor Joshua Lim, said her symptoms started around two years ago.

"She kept forgetting words and repeating the same questions, even when we had just told her the answers," said Mr Lim, 30.

The first doctor they saw dismissed their concerns, saying that Ms Low was too young to have dementia, but her family knew that something was wrong.

Now, she is on medication and attends a programme that provides exercise and mental stimulation.

"Since then, there's been a slowing down of the (mental) degeneration," Mr Lim said.

Symptoms in younger patients
By Linette Lai, The Straits Times, 6 Feb 2016

Dementia symptoms in younger patients are slightly different from those in older ones.

According to Associate Professor Nagaendran Kandiah of the National Neuroscience Institute's neurology department, they include:

• Difficulties with language and a shrinking vocabulary. For example, they may refer to a knife as a fork, mispronounce the word or simply refer to it as "that thing".

• Changes in behaviour, especially a lack of inhibition, which results in their acting inappropriately in social situations. At work, for example, they may be disruptive when they were previously reserved.

• Problems with finding their way around, such as constantly alighting at the wrong MRT station or getting lost in shopping malls.

Prof Nagaendran added that people should see a doctor if:

• Any of the symptoms last more than six months;

• People, such as your family or colleagues, start noticing the differences;

• The problems are starting to affect functions in daily life, such as work meetings.

Sing in a choir, keep dementia at bay?
Two-year NUS study to test if choral singing can help seniors' memory and concentration
By Kok Xing Hui, The Straits Times, 5 Feb 2016

Shoppers at Jurong Point were yesterday treated to a lunchtime performance of rousing Chinese New Year songs - by participants of a dementia study.

To determine if singing in a choir can prevent dementia, researchers from the National University of Singapore (NUS) have recruited 93 senior citizens living in Jurong and put half of them in a choir.

While half of them practise singing, the other half, the control group, have been going for a health education programme to manage diabetes, diet and exercise - all factors linked with dementia.

Saw this lunchtime performance at Jurong Point yesterday? They are participants in a study that will test if singing in a choir can keep dementia at bay. http://str.sg/Z9GX
Posted by The Straits Times on Friday, February 5, 2016

Both groups spend an hour on their programmes and are given lunch once a week, in the study that started in October last year.

Researchers aim to study, over two years, 300 people aged above 60 and at high risk of dementia, and are recruiting more people.

"We're trying to test the efficacy of choral singing more scientifically, to see if it can slow down the development of dementia in those with high risk, and promote the mental health of the elderly," said Dr Feng Lei, the study's principal investigator and a research assistant professor at the NUS Yong Loo Lin School of Medicine.

Singing in a choir may delay dementia as singers work their memory when they learn new songs. They also learn to be mindful, to blend their voices with those of others.

Dementia affects one in 10 Singaporeans aged over 60. There were about 40,000 dementia patients here as at last year and this is projected to reach 53,000 by 2020, and 187,000 by 2050.

For the study, participants are assessed at the start of the study, as well as at 12 months and 24 months.

They go through a blood test to see if their immune systems have improved, and a urine test that looks at oxidation - an indication of brain cell degeneration. They are also tested on things like their memory, concentration and spatial awareness.

Results from both groups will be compared to see which approach is more effective in slowing cognitive decline.

The idea came from Dr Maurine Tsakok, a member of the NUS Society Choir and a consultant obstetrician and gynaecologist in private practice. A decade ago, she had an episode of amnesia at age 66 - she could not recall an eight-hour block, during which she had played golf and even boarded a flight.

"I was like a zombie," she said.

She was diagnosed with global amnesia, a temporary but almost total disruption of short-term memory, and it frightened her, even though doctors said it was benign.

She found anecdotal studies about how choral singing helps with dementia. "But none talked about prevention, which is what I'm concerned about," she said.

She signed up with the NUS Society Choir in 2009 to improve her own mental function. When the choir was looking to sing for a cause, she directed them to the study.

Researchers have raised $400,000 for the MRI scans of the participants, and buses to take them from Jurong Point to NUS, where they rehearse with trainers from the Yong Siew Toh Conservatory of Music. Researchers are now applying for a $1.2 million grant from the Health Ministry.

The clinical trial is part of the 10-year longitudinal Jurong Ageing Study, which aims to reduce depression and dementia in elderly residents of Jurong.

Professor Kua Ee Heok of the NUS Yong Loo Lin School of Medicine, who helms the Jurong Ageing Study, said they observed a side benefit of this study: The elderly start interacting socially.

"Most of them live alone and there's a sense of loneliness. So coming together, singing together, builds up a sense of caring and compassion and builds up social connectedness," he said.

If choral singing proves useful against dementia, choirs for the elderly can be easily replicated across Singapore, he added.

Participant Lee Yum Lum, 79, formerly an office manager, said he enjoys the singing, the regular outings to NUS and the social factor.

"When we meet, we talk about current affairs and family matters. I enjoy singing the songs with people who are also senior citizens."