Understanding Dementia - Doctor Q&A

Dementia is not part of normal ageing.

Dementia is an umbrella term for brain conditions that cause progressive cognitive decline, making everyday activities increasingly difficult.

Beyond memory loss, dementia affects problem-solving skills, thinking abilities, and language.

In Singapore, 1 in 11 seniors over 60 lives with dementia, with an estimated 100,000 people currently affected.

These numbers are expected to rise significantly as our population ages.

Types of dementia

Common types of dementia include:

• Alzheimer’s disease: The most common form, accounting for 60-80% of cases, characterised by memory loss and cognitive decline due to brain cell damage.
  
  
• Vascular dementia: Caused by reduced blood flow to the brain, often following strokes or other conditions affecting blood circulation.
  
  
• Lewy body dementia: Features fluctuating cognition, visual hallucinations, and movement problems similar to Parkinson’s disease.

Comprehensive dementia care requires a multidisciplinary approach involving geriatricians, neurologists, psychiatrists, occupational therapists, physiotherapists, medical social workers, nurses, and trained caregivers.

Early detection and intervention are crucial for managing symptoms, planning care, and maintaining quality of life for both persons with dementia and their families.

In this Q&A, post your questions about dementia and learn more about prevention, early detection, and the support services available for managing this complex condition.

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Understanding Dementia

CGH Dementia Ward - Person-centred care that truly matters

Adjunct Assocociate Professor Lim Si Ching is a Senior Consultant with the Department of Geriatric Medicine at Changi General Hospital (CGH). She is also Education Director for the Centre of Memory and Cognitive Disorders with SingHealth Duke-NUS.

Prior to training in geriatric medicine, Dr Lim was a renal physician overseeing the largest dialysis centre in Brunei. After completing her specialist training in geriatric medicine at CGH, she went on to set up the inpatient service for geriatric medicine at Singapore General Hospital (SGH), including training for nurses, medical students, junior doctors and trainees.

As a Senior Consultant in CGH, Dr Lim established Ward 58 for patients with dementia, and is actively involved in multiple quality improvement projects at CGH. 

Dr Lim is a keen teacher and is affiliated with NUS, Duke-NUS, LKC and SUSS. She is also an appointed as Visiting Professor for Beijing University First hospital, Gellar Institute of Ageing and Memory of University of West London.

1. Question by Han H

Dear professor,

I have been having bad memory problems recently.

For e.g. When I am in the dining room and I want to go to the kitchen to take utensils, however, I forget what I want to take only after a few seconds, and I can recall only when I see the utensils! Is this an early sign of dementia?

Male, 75 years old

Medical history: chronic anxiety and depression. Taking medicines over 45 years

Thank you.

Answer by Adj Assoc Prof Lim

Dear Han,

As long as you can remember what you wanted to do, even after a few seconds, this is not dementia. This kind of forgetfulness is common with ageing.

2. Question by Kris

Hi Doctor,

How can a caregiver support a loved one who is forgetful and claims her things are stolen, and is not motivated to join activities.

Currently not on medication but how to prolong the forgetfulness and avoid progressing to Alzheimer’s?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Kris,

Being forgetful and not motivated to do activities may or may not be due to dementia. There may be other treatable causes, such as medication side effects, depression, sleep problems etc.

We would advise your loved one to start with gentle exercises like going outdoors for short walks.

If still in doubt, we suggest for you to bring your loved one for a full medical check-up including a dementia assessment.

3. Question by Tan

Hi Dr,

Is there any way to keep dementia at bay? Or delay the process if any? Dietary including vitamin D? Mental or brain exercises?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Tan,

There are many ways to reduce your risk of dementia, and if we do them all well, we can reduce the risk by about 40%.

These include managing your cardiovascular risk factors like diabetes, high blood pressure, high cholesterol, and addressing issues such as hearing impairment, depression, head injuries, sleep disorders, and a sedentary lifestyle.

Keeping to a Mediterranean diet (that prioritises plant-based foods and healthy fats) is also protective, and keeping socially and mentally active are all also helpful.

4. Question by Stella

Dear Dr,

I would like to check if there are tests to gauge the onset of dementia...I am in my sixties and am beginning to forget things...are these indications of early onset dementia?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Stella,

Forgetfulness as part of the dementia condition is mainly a “short term” problem, meaning you may not remember recent events such as what you had for breakfast or who came over to see you a few days ago.

However, you would still be able to remember your long term memories, such as those from your youth.

Deriving at a diagnosis of dementia is a clinical process which must be carried out a doctor.

The doctor would need to ask you or your caregiver a series of questions, followed by a physical examination, brain scan, and blood tests as the minimum requirement for a memory assessment.

Nurses may also ask you a long series of questions to assess your memory and mood.

5. Question by Irene

Hi Dr,

a) Will one inherit dementia?

b) Is there any way to test if one will get dementia in future and prevent it?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Irene,

This is a common question as to whether dementia is hereditary.

Young onset dementia (dementia which affects those 60 years old and below) may be hereditary, if there is a strong family history of family members getting dementia at a young age.

Older people with dementia have a weaker genetic association, because there are usually multiple age-related changes in the brain, like the accumulation of the proteins amyloid and tau which are related to Alzheimer’s disease, or changes to the blood vessels, etc.

Genetic tests are not routinely advised for dementia screening. At Changi General Hospital, we offer genetic testing only if the patient is aged 60 and below, where the patient also has a strong family history of dementia and is showing signs of memory problems which affects their day-to-day function.

6. Question by Mr Chua

Hi Associate Professor Lim Si Ching,

What would you advise a family on what they can do so as to minimise patients from talking profusely to themselves and “seeing things or persons”?

How to encourage the patient to consume meals? The patient’s appetite changes drastically day to day or meal to meal.

For a Mixed Dementia patient, it seems that their muscles are affected and at times, they will feel they are extremely in pain or weak to even stands up or sit up. Is this correct?

Thank you for your advice.

Answer by Adj Assoc Prof Lim

Dear Mr Chua,

Thank you for your questions about caring for your loved one with mixed dementia.

For a patient who is talking to themselves and "seeing things", the most important thing would be to check with your doctor what is causing this. It could be a medication problem, or related to the dementia.

Regarding appetite changes, again, it’s best to consult your doctor, or ask for a referral to see a dietitian or a speech therapist. There may be problems causing eating difficulties, such as swallowing problems.

Lastly, dementia should not cause muscle pain, but the condition may cause stiffening or weakening of muscles. It is advised to inform your regular doctor to get this checked out.

Thank you for your questions.

7. Question by Eileen

Hi Doctor Lim,

I am a 52-year-old female. In the recent 1 to 2 years, my memory has deteriorated noticeably and I often forget for instance people's names, names of places, shows I watched recently or even some words.

People also told me some past events which I have no recollection.

Should I be concerned and should I go for a screening on dementia? Where can I go for such screening or consultation?

My mom is diagnosed with dementia at 80 plus and my dad has MCI. Does this increase my risk of dementia?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Eileen,

Thank you for sharing your concerns.

You may have a higher risk for dementia due to your family history of dementia and mild cognitive impairment (MCI), but it does not mean you will definitely develop dementia.

I would recommend that you see your GP or polyclinic doctor first about your memory concerns. They can conduct an initial assessment and determine if further evaluation or referral to a specialist is needed.

8. Question by Caleb

Good morning Prof Lim,

I am 78 years. Male. Lately I begin to be unable to remember or recall events, words and things that I did in the week or even yesterday. Do these indicate that I may be suffering early onset of dementia and if yes what can I do to slow or prevent dementia 

Kindly advise. Thank you.

Answer by Adj Assoc Prof Lim

Dear Caleb,

The inability to remember events, words and things from the past week or yesterday can be worrying. However, there are also other causes for memory lapses like normal ageing, poor sleep, medications, or mood disorders.

It is best to seek advice from your regular GP or polyclinic doctors and tell them about your concerns. They might be able to advise or refer you to see a specialist.

9. Question by Be

Morning Prof Lim.,

I am a caregiver to my mum, suffering from vascular dementia. 

I would like to know how to manage her constant fear of the supernatural:  wanting to move house, fearing to sleep in room deemed to have a 'presence'.

Thank you and best regards.

Answer by Adj Assoc Prof Lim

Dear Be,

Your mother seems to be displaying behavioural symptoms related to her vascular dementia.

You may try to manage these symptoms by speaking gently to her to try to calm her down, giving her a pillow to hug, playing gentle soothing music, and keeping night lights on at nights. Sometimes, those with dementia may have poor vision at night, so they may see shadows around their environment, which can worsen their fears.

Please inform her doctor of these symptoms when she sees her doctor again, as there may be additional strategies or treatments that can help.

10. Question by Daphne

Dear Dr,

My mother is turning 80 in March. Am monitoring her and am not sure whether I am missing any signs of dementia from her. What should I look out for? Thank you.

Answer by Adj Assoc Prof Lim

Dear Daphne,

Thank you for your question about caring for your mother.

The signs of dementia to look out for include forgetfulness, being repetitive, and asking the same questions. You should also watch for getting lost in familiar places, inability to recognise places or people, and inability to do the usual tasks that she is normally familiar with, like housework or cooking.

Sometimes, persons with dementia also have problems with language, such as difficulties in understanding what was being said or replying incorrectly to conversations.

If you notice any of these signs developing or worsening over time, it would be advisable to bring your mother to see a doctor for proper evaluation.

11. Question by Annie

Dear Doctor,

Thank you for arranging this topic for discussion. 

In your experience, do you think the dementia patients are aware that they may have dementia or that something is wrong, before getting treatment?

At what point is the memory loss part of normal aging vs dementia, and how do we convince the elderly to seek help?

Thank you so much for taking the time to provide your advice.

Answer by Adj Assoc Prof Lim

Dear Annie,

Regarding whether people with dementia are aware of their condition – some do have some insight, but not all patients do. This varies from person to person and can change as the condition progresses.

To distinguish normal ageing from dementia, normal ageing does not cause progressive memory loss.

Ageing-associated memory problems are usually mild and do not get worse, such as occasionally forgetting to turn off lights or forgetting people's names, however they would be able to remember these things again after a short time.

Ageing-related memory problems also do not interfere with day-to-day function, and people can remain independent with all their activities of daily living and can still go to work.

12. Question by CL

Dear Dr,

My sister has some dementia issue. Recently, she was not eating/drinking and/or taking medication and spit out the content most/all the time.

Currently she is in the hospital for dehydration and low BP. Is this a normal progression of the illness and is there anything we can do to help her?

Answer by Adj Assoc Prof Lim

Dear CL,

Thank you for your question about your sister's condition.

Yes, refusing to eat and drink usually suggests her dementia is at the advanced stage.

Given that she is currently hospitalised, I would advise you to speak to her doctor about further care plans and management options during this stage of her illness.

13. Question by Laraine

Dear Assoc Prof Lim Chi Sing,

The women in my family (my mother's sisters) all were confirmed with having dementia and all lived to 90 or more.

I personally believe that I will be going on this route as I notice the difference in myself. I am now 79.

I heard though (BBC) that strides have been made in preventative medications. Do we have these in Singapore?

Another question: Are you familiar with the mental sickness where illusions become a person's reality? Lying but not aware of it.

Thank you for your advice.

Answer by Adj Assoc Prof Lim

Dear Dear Laraine,

Regarding preventative medications, there is no magic pill to prevent dementia. However, there are medications available to delay the progression of early dementia. There are also other means to reduce your dementia risks through lifestyle modifications.

Given your family history and personal concerns, I would recommend seeing your GP or polyclinic doctor for advice and proper evaluation.

14. Question by Mdm Kwok

Dear Dr,

Our 94-year-old mother is diagnosed with Alzheimer’s disease moderate-advanced dementia (diagnosed more than 3yrs ago).

About 8 months ago left thalamic/occipital stroke impaired her vision. Her four upper and lower limbs are not affected by the stroke.

Kindly assist the followings so we can provide a more organised holistic care for her:

a) How to 'tailor' daily programmes for her? She is basically wheelchair bound.

b) What kind of games set are suitable for her to improve her brain functions? Where can we purchase such games-set?

c) Where can we (include helper) get trained to be ' qualified' caregivers for our mother?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Mdm Kwok,

Thank you for your questions.

You may wish to get some information from AIC’s website or other social service agencies and community care programmes which specialise in dementia care at home.

Alternatively, you can also discuss with your mother’s doctor to draw up an individualised care plan for her.

15. Question by Jimmy

Dear Professor Lim,

Since there is no cure for dementia, is there a method or test to check whether a person is suffering from dementia?

If there is such a test and someone has symptoms of dementia, is there any medication to slow it down?

Thank you.

Answer by Adj Assoc Prof Lim

Dear Jimmy,

Currently, there is no single test to firmly diagnose dementia. A diagnosis of dementia is obtained clinically, which means a doctor will need to ask you a series of questions and do a physical examination. This will then be followed by a brain scan and blood tests to rule out other causes.

There is also no cure for dementia currently, but there are medications and treatment options to delay the progression of the condition. Early intervention can also help maintain quality of life for longer periods.

Please see your GP or polyclinic doctor for more advice.

16. Question by Andy

Hi Prof Lim Si Ching,

My mom has mild dementia.

Her hearing has also deteriorated and on the 2nd try, I managed to get a set of hearing aid for her.

I tried to explain to her the benefits and importance of using the hearing aid but she has been persistent with saying the hearing aids are uncomfortable and refuse to wear them.

Her condition is such that logical explanation of many things such as with the hearing aids.

I've tried all manner of ways to convince her so would you have any advice how best to persuade someone with dementia in doing things which are intended to help them?

Thanks and best regards.

Answer by Adj Assoc Prof Lim

Dear Andy,

I understand your frustration with trying to get your mother to wear her hearing aids. This is not an easy task, especially if she cannot hear properly.

What you need to practice now is patience, and lots of it. Her poor memory also means she cannot retain the information you just gave her, so you too have to keep repeating what you said to her when convincing her to wear the hearing aids.

I wish you all the best.

17. Question by Koh

Hi Prof Lim,

It sounds like Alzheimer’s can be diagnosed in an MRI scan, i.e. ‘Hippocampus atrophy’ is noted and this is substantiated with a psychologist’s examination.

Is this accurate or there are other factors/tests to confirm a diagnosis of Alzheimer’s? Thank you.

Answer by Adj Assoc Prof Lim

Dear Koh,

Thank you for your questions.

A Magnetic Resonance Imaging (MRI) scan cannot diagnose dementia. Hippocampal atrophy is the shrinkage or loss of volume in the hippocampus, which means the memory area of the brain has shrunken. This is also a common sign of ageing and is not specific to dementia.

Currently, there is no single test to firmly diagnose dementia. A diagnosis of dementia is made clinically, which means the doctor needs to ask you a series of questions and do a physical examination. This will then be followed with a brain scan and blood tests.

There is also no cure for dementia currently, but there are ways to delay progression. Please see your GP or polyclinic doctor for advice if you have concerns.

18. Question by Seetoh

Dear Doctor,

I do forget and misplace items, forgetting names and appointments from time to time etc.

I took up drum lessons recently as a hobby at the age of 75 years.

Does playing the drum potentially help to lower the risk of getting Dementia?

I notice all my limbs are working, brain works to read notes when to hit and kick the drum sets, making me more alert and increases memory as compared to playing mahjong, solving puzzles etc.

Thank you for your advice.

Answer by Adj Assoc Prof Lim

Dear Seetoh,

It is encouraging that you're staying active and learning new skills at 75 years old. Learning a new hobby, like drumming, is always a good way to reduce dementia risk.

However, I would not say it prevents dementia entirely. Keep up with your drumming and other mentally stimulating activities as they can be beneficial for your overall cognitive health.

19. Question by the Ang Family

Dear Dr Lim,

Thank you for taking the time to accept questions regarding dementia.

My father will be 79 years old this year. Over the past 10 years, our family has observed gradual changes in his behaviour, particularly in his temperament, logical reasoning, and memory.

In terms of forgetfulness, he often forgets to bring home one or two bags of groceries after shopping, or leaves home without essential items such as his mobile phone, wallet, or transport card.

He also frequently forgets to close the door after leaving the house or after entering, which has become a growing concern for us.

At times, we were alarmed to notice that he could not recall what he had eaten for lunch within about 15 minutes. He has also forgotten details of family vacations that took place not too long ago.

On the positive side, he is still able to find his way home independently and recognises all family members and relatives.

Given the above, may I ask if there is cause for concern at this stage, and whether these could be early signs of dementia or age-related cognitive decline?

Additionally, could you kindly advise if there are any hospitals, memory clinics, or specialist centres in Singapore where my father can undergo a thorough diagnostic assessment, preferably at a subsidised rate for Singaporean seniors?

Thank you very much for your time and guidance. I look forward to your advice.

Answer by Adj Assoc Prof Lim

Dear Ang family,

It would be best for you to consult your GP or visit a polyclinic first. If the doctors feel your father requires seeing a memory specialist, they will be able to provide the relevant referrals.

Ref: F26