Alzheimer's disease is the most common form of dementia. But is it a normal part of ageing?

Alzheimer’s Disease (AD) accounts for 60-80% of all dementia cases. However, it is NOT a normal part of ageing.  

Common signs for Alzheimer’s Disease include short term memory, changes in judgment, reasoning and inability to perform daily tasks. Very often, the onset of symptoms and the progression of the illness is gradual. It is a condition whereby there is deposition of amyloid plaque and tau protein, with deficiency of neurotransmitters in the brain.

Alzheimer’s Disease International has stated about 12 risk factors, which includes:

• Physical inactivity,

• Smoking,

• Excessive alcohol consumption,

• Infrequent social contact,

• Obesity and more

To reduce your risk of getting Alzheimer’s Disease, the key is to stay healthy and active.

These include to:

1) Stay active

A physically active lifestyle is linked to good brain health. Exercises also can enhance balance and prevent falls. In addition, exercising together with friends improves our social connection. For example, a simple walk in the garden with friends under the early morning sun, amongst greenery with colourful flowers, with birds chirping away in the background, fills up our senses and helps us start the day well, which in turn contributes positively to our overall wellbeing.

2) Quit smoking (if you haven't) and avoid excessive alcohol consumption

Quitting smoking not only reduces the risk for Alzheimer’s Disease, at the same time it also reduces the risk for many types of cancer, cardiovascular diseases and respiratory disorders. Smoking cessation services are readily available if needed, such as the ‘I Quit Programme’ under HealthHub.

Consume alcohol in moderation. Men should drink no more than two standard drinks a day, and no more than one for women. A standard alcoholic drink is defined as a can (330ml) of regular beer, half a glass (100ml) of wine or 1 nip (30ml) of spirit.

3) Participate in social activities and learn new things

Social participation and social support are strongly connected to good health and wellbeing throughout life. It can take on the form of any activity that keeps one consistently engaged. Learning new things, such as picking up social dancing, gardening, singing and more, can keep our minds constantly busy and active.

In the ‘Ask the Specialist’ Q&A forum, don’t miss this chance to ask Dr Chan questions like:

• What are early symptoms of Alzheimer’s Disease to look out for?

• When to seek medical attention?

• How is Alzheimer’s Disease usually managed?

• Where to get help and support in the community?

About Dr Catherine Chan

Dr Catherine Chan is concurrently a Consultant and Director of Dementia & Cognitive Care Service at SingHealth Community Hospitals.

She graduated with a Bachelor of Medicine and Bachelor of Surgery and completed her fellowship with College of Family Physicians Singapore. Currently, she is also a Clinical Assistant Professor with Duke-NUS Medical School.

Her clinical interests are in family medicine, geriatric care and dermatology.

Questions and answers on Alzheimer's Disease

1. Question by Josephine

Hi Dr Chan,

I am 56 years old. I had breast cancer (stage 1) in 2016 and underwent chemo & radiotherapy. Recently this year, I found myself forgetting names of objects and not being able to recall some conversations.

Though these instances are very far and few, do u recommend that I go for a check-up in case these are early signs of Alzheimer’s disease? Or did the chemo affect my memory?

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. 

However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

2. Question by Miranda

Hello Doctor,

My family has had its share of Alzheimer’s. Of my father’s siblings 3/5 had Alzheimer’s including himself.  My mother’s cognitive function was perfect until she died of cancer at 86.

My older sister (71) is now showing significant signs of memory loss, ability to perform normal household duties and reduction of social interaction.

I am also beginning to lose my words (my sister’s first sign).  For example, I am finding myself referring to items in a sentence as “that thing” rather than the actual noun coming to me. I am still able to capture/recall the word later in most situations.

I am 66 keeping very socially active. I travel extensively and when not travelling, I teach Mahjong to large numbers of people monthly and run a weekly group.  I am a very outgoing person and can still. Maintain healthy social relationships.

Is there some early intervention I can avail myself to, to help with word loss or any other issues, even if I don’t have a diagnosis yet. I am pretty sure I’d pass most cognitive tests.

What I am asking is do I have to wait till I have it to start doing something about it?

Thank you for your advice.

Answer by Dr Catherine Chan

Having parent or sibling with dementia increase one’s risk of developing it, there is a likelihood of a genetic link if it is early onset form of Alzheimer’s disease. However, Alzheimer’s disease is believed to be caused by a combination of genetic, lifestyle and environmental factors.

A healthy lifestyle will help to reduce the risk. It is very encouraging that you are engaged in physical activity, social interaction and even cognitive engaging activity like mahjong game. Other areas will be healthy diet, sufficient sleep, refrain from smoking. Conditions like hypertension, diabetes, depression, obesity and hearing impairment are also risk factors for dementia.

Do consult a doctor for a more detailed assessment when there is a concern. In recent years, there are increasing number of Young Onset Dementia (YOD) cases attended by specialist in National Neuroscience Institute (NNI). Typically it affects those between 45-65 years old.

3. Question by Angeline

Dear Dr Chan,

My dad was recently diagnosed does it mean I have higher chance of getting it? Can any supplements help? Thank you.

Answer by Dr Catherine Chan

There are different types of dementia with different causes. It is important to understand more about your father’s dementia diagnosis and age.

There is a likelihood of a genetic link if it is early onset form of Alzheimer’s disease. However, Alzheimer’s disease is believed to be caused by a combination of genetic, lifestyle and environmental factors. Having parent or sibling with dementia increase one’s risk of developing it but will not necessarily develop dementia.

There is no strong evidence for supplements for dementia itself due to combination of factors leading to dementia. However, there are known risk factors such as physical inactivity, social isolation, excessive alcohol consumption, smoking, hypertension, diabetes, depression, obesity, head injury and hearing impairment etc. A balance of healthy diet and taking certain supplementation that your diet unable to provide is part of a healthy lifestyle.

4. Question by Chongwah

Hi Dr Catherine Chan,

I am an elderly man. 80 years of age.

I am suffering from chronic eczema, tinnitus, osteoporosis and high cholesterol. I am under medications for my illnesses. I walk about 6000 steps every day except when I am unwell.

I am quite forgetful as age increases. Sometimes I forget to take my daily dose of medicine.

Sometimes I can't remember that I have taken my daily dose of medicine. I need to write down those things to buy before I leave home otherwise I may forget what to buy.

Am I suffering from beginning stage of Alzheimer's diseases? How to slow down this disease?

Thanks.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

There are known risk factors such as physical inactivity, social isolation, excessive alcohol consumption, smoking, hypertension (also known as high blood pressure), diabetes, depression, obesity, head injury and hearing impairment etc. 

Good control of chronic disease like hypertension and diabetes and addressing the above factors will reduce the risk especially vascular dementia and its progression. There is medication that can help to slow down the progression of disease, however the doctor/specialists will need to assess one's suitability for the medication.

5. Question by Jeffrey

Hi Dr, I am asking on behalf of my dad.

He used to wake up 8-9am and recently he woke up 9-10am reason because no reason to do so.

Early this year during CNY he asked a few time in a short span of 1 hour whether had he gave our Ang Bao to the grand children when he had already done so

On the same afternoon if you ask him what he took for breakfast he can’t recall well

He does go out of house to meet his friend for late coffee & lunch from 11 to 2pm on most days.

Sometimes he do play mahjong with his friends for up to 5-6 hours (no issue)

Sometimes he can’t recall if he had already bought an item and wanted to buy it again

Kindly please advise.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. 

However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your father’s daily life.

Sometimes, there is a change in one’s social life and activity due to circumstances around him as well. It is good that your father is still socially engaged with his friends. You can try exploring about how his interactions with his friends during meals times and the mahjong sessions were like with respect to the forgetfulness.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

6. Question by Esther

Dear Dr. Chan,

When do I know normal forgetfulness as one age is not Alzheimer’s?

Where can I go to get tested for it?

What must I do if I have Alzheimer especially as I live alone?

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. 

However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment. There are memory clinics in polyclinics and in hospitals.

Being diagnosed with dementia will be life-changing for yourself and people around you. The doctor and the healthcare team will provide post diagnostic support. Dementia Singapore provide with help and services. Kindly refer to this link for more information on resources, services and support available: https://www.dementiahub.sg/i-live-with-dementia-category/i-live-with-dementia/independent-living/

7. Question by Valli

Hi Dr Chan,

What are the early signs of Alzheimer's disease? How do I manage it?

Answer by Dr Catherine Chan

Below is the table showing difference between normal ageing and dementia. Those under dementia can be early changes shown.

There are 3 stages of dementia: Early, Middle and Late.

For Early stage with mild impairment: some forgets names, misplaces familiar objects, shows decreased work performance, shows signs and symptoms of depression, has slight difficulty in concentrating, takes longer to accomplish daily tasks with mistakes in between, has problems managing finances etc.

First of all, will be to have a formal assessment by a doctor if there is a concern.

Being diagnosed with dementia will be life-changing for yourself and people around you. The doctor and the healthcare team will provide post diagnostic support. Dementia Singapore provide with help and services. Kindly refer to this link for more information on resources, services and support available: https://www.dementiahub.sg/i-live-with-dementia-category/i-live-with-dementia/independent-living/

8. Question by Yuxin

Hi Dr Chan,

I have an elderly father who is having difficulty in remembering things. I have a couple of questions to ask with regards to how I can help him.

1. Is there a difference between Alzheimer’s and senile dementia?

2. What are the symptoms of Alzheimer’s?

3. At what stage or when should we seek medical attention?

4. Are there any medication to delay the onset of Alzheimer’s?

5. How do we handle when the patient is stubborn and not willing to listen to his family members to seek help?

Thanks.

Answer by Dr Catherine Chan

There are many types of dementia. Dementia is often incorrectly referred to as senile dementia due to a formerly widespread but incorrect idea that the cognitive decline is normal part of aging.

Below a table shows the difference between normal ageing and dementia. (Symptoms of the Alzheimer’s disease will be similar as stated under Dementia in the table)

The common causes of dementia are Alzheimer's disease (60-80%), vascular dementia (20%), mixed dementia (Alzheimer's disease and vascular dementia).

Others include dementia with lewy bodies, frontotemporal dementia etc.

Below is the difference between Alzheimer's disease and Vascular dementia:

Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your father's daily life.

It is important to seek medical attention as early as possible as getting a diagnosis is an important first step. There is medication that can help to slow down the progression of disease, however the doctor/specialists will need to assess one's suitability for the medication.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

Having a conversation with your father may be difficult as often he may feel defensive, worried or be in denial.

Dementia Singapore provide with help and services.

Kindly refer to this link for more information on an article "My Loved One Refuses to Get a Diagnosis-what Can I Do?" available: https://www.dementiahub.sg/what-is-dementia/my-loved-one-refuses-to-get-a-diagnosis-what-can-i-do/

9. Question by Jasmine

Hi Dr Catherine Chan, I am not sure if I had early Alzheimer’s/dementia symptoms.

I am in my late sixties and had been sedentary for the past 5 years due to a compression fracture in my L3 spinal cord. However, I have started exercising about 2-3 months back.

My other risk factors and symptoms are:

1. Obesity borderline.  BMI is 30.
2. Poor short memory.  There was a time where I could not remember things like the 4 or 6 digits code. That I need to key to my OTP and will need to write this down.   This has since improved through vitamin supplements like B12 and vitamin D. However, if I am shown a sequence of steps, I will still forget the sequences subsequently.  I wasn’t like that when I am younger.

3. No loss of judgement or inability to perform daily task but now I tend to have difficulty in reasoning and doing mathematics equation like finding the cost of x number of items given y number of items cost so much.

4. Sometimes, I forget the vocabulary of the words that I need to use.

I suspect that I may have some mild symptoms of dementia/Alzheimer’s. I wonder if supplement like Gingko Bilbao would help to slow down the problem and if so, what is the recommended dosage. I am currently consuming the following supplements:
1. Calcium Carb 400mg, Vit D 200 unit x 2 tablets daily
2. Meconalamin 2 x500mg – twice a week
3. Cholecalciferol 1x 1000 unit daily
4. Omega 3

Thank you for your review, advice and guidance on this.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

There is no strong evidence for supplements for dementia itself due to combination of factors leading to dementia. A balance of healthy diet and taking certain supplementation that your diet unable to provide is part of a healthy lifestyle. There are known risk factors such as physical inactivity, social isolation, excessive alcohol consumption, smoking, hypertension, diabetes, depression, obesity, head injury and hearing impairment etc. Good control of chronic disease like hypertension and diabetes and addressing the above factors will reduce the risk especially vascular dementia and its progression.

10. Question by Li Ann

Dear Dr,

I need advice on when’s time to see a doctor.  Very often forgetting names. Is this ageing or are there other signs to watch out for?

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

11. Question by Paul

Dear Dr Chan,

Question, please... you mentioned that it's "a condition where there's deposition of amyloid plaque and tau protein, with deficiency of neurotransmitters in the brain."

May I ask, other than exercising and avoiding alcohol and smoking, what can we do to minimise deposition of amyloid plaque and tau protein, and what can we do to build up neurotransmitters in the brain?

Answer by Dr Catherine Chan

There are few types of dementia and Alzheimer’s disease is one of them. And Alzheimer’s disease is a condition where there's deposition of amyloid plaque and tau protein, with deficiency of neurotransmitters in the brain. It is believed to be caused by a combination of genetic, lifestyle and environmental factors.

A healthy lifestyle will help to reduce the risk of dementia, which includes physical activity, social interaction, and even cognitive engaging activity like mahjong game. Other areas will be healthy diet, sufficient sleep, refrain from smoking. Conditions like hypertension, diabetes, depression, obesity and hearing impairment are also risk factors for dementia.

Recent years, there are trials on new antibody drugs which are found to be capable of interfering with the formation of amyloid plaques and some are approved for use in overseas.

There is medication that can help to slow down the progression of dementia by reducing the breakdown of the neurotransmitters. However, the doctor/specialists will need to assess one’s suitability for the medication after diagnosis of dementia.

12. Question by Chor Hoo

Hello Doctor, I have the following questions:

1. What are early symptoms of Alzheimer’s Disease to look out for?

2. When to seek medical attention?

3. How is Alzheimer’s Disease usually managed?

Answer by Dr Catherine Chan

For Early stage of dementia with mild impairment: some forgets names, misplaces familiar objects, shows decreased work performance, shows signs and symptoms of depression, has slight difficulty in concentrating, takes longer to accomplish daily tasks with mistakes in between, has problems managing finances etc.

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for.

However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern.

Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

Being diagnosed with dementia will be life-changing for yourself and people around you. The doctor and the healthcare team will provide post diagnostic support. Dementia Singapore provide with help and services. Kindly refer to this link for more information on resources, services and support available: https://www.dementiahub.sg/i-live-with-dementia-category/i-live-with-dementia/independent-living/

13. Question by Pauline

Hi Dr,

Does prolong taking of statins (15 years) makes one prone to Alzheimer’s Disease and Dementia?

Can a scan of the brain detect Alzheimer’s or degeneration of the brain cells?

Answer by Dr Catherine Chan

There are few types of dementia and vascular dementia is one of them.  Vascular dementia is caused by a disease or injury to blood vessels in the brain, mostly in the form of strokes. Controlling risk factors for strokes such as high cholesterol, high blood pressure, diabetes and smoking may reduce stroke incidence, therefore reducing risk of dementia.

Statin is the common medication use for treatment of high cholesterol.

Alzheimer’s disease is believed to be caused by a combination of genetic, lifestyle and environmental factors.

A healthy lifestyle will help to reduce the risk of dementia, which includes physical activity, social interaction, and even cognitive engaging activity like mahjong game. Other areas will be healthy diet, sufficient sleep, refrain from smoking and good control of conditions like hypertension, diabetes and treating depression, obesity, and hearing impairment.

There is no single test to determine if one has dementia. The diagnosis process includes history taking, physical examination, various assessment like cognitive tests, lab tests and brain scan.

Brain scans like Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan maybe ordered to look for treatable cause of dementia, volume loss, blood vessel changes or strokes. Positron emission tomography (PET) scan can confirm the presence of amyloid and tau pathology, but they are not widely available.

14. Question by Hazel

Hi Dr,

My mom had multiple falls before, and she now seems to slow down and do not talk as much as before. Brain scan didn’t show any clot but just normal degeneration of some brain cells.

Is it something related to dementia?

She is also currently seeing geriatric as she was diagnosed as depression and some dementia Just wondering, are there any test to determine whether the person is suffering from Alzheimer’s? Thanks.

Answer by Dr Catherine Chan

I suggest speaking to the geriatric doctor for further information on the diagnosis as dementia and depression do co-exist for some patients. You can also clarify on the type of dementia, for example if it is Alzheimer’s disease.

There are many different types of dementia and Alzheimer’s disease is one of the common types.

There is no single test to determine if one has dementia. The diagnosis process includes history taking, physical examination, various assessment like cognitive tests, lab tests and brain scan.

As dementia progress, there will be increasing needs for assistance in view of progressive loss of functions like communication skills, walking and other self-care capabilities.

15. Question by Dorothy

Dear Dr,

May I know, 

What is the difference between normal Aging forgetfulness / absent mindedness and forgetfulness due to onset symptom of Alzheimer’s?

What are early symptoms of Alzheimer’s Disease to look out for?

When to seek medical attention?

How is Alzheimer’s Disease usually managed?

Where to get help and support in the community?

Answer by Dr Catherine Chan

Below is a table showing the difference between normal ageing and dementia. (Symptoms of the Alzheimer’s disease will be similar as stated under Dementia in the table).

For Early stage with mild impairment: some forgets names, misplaces familiar objects, shows decreased work performance, shows signs and symptoms of depression, has slight difficulty in concentrating, takes longer to accomplish daily tasks with mistakes in between, has problems managing finances etc.

Memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

Being diagnosed with dementia will be life-changing for yourself and people around you. The doctor and the healthcare team will provide post diagnostic support. Dementia Singapore provide with help and services. Kindly refer to this link for more information on resources, services and support available: https://www.dementiahub.sg/i-live-with-dementia-category/i-live-with-dementia/independent-living/

16. Question by Vincent

Dear Dr Chan,

I have recalling issues. I cannot seem to remember things even if I have been doing it routinely.

Like the restaurant’s name even when I have been going there. I can associate an item with the place … but my friends and family have been playing charades all the time. Example: “That roasted chicken place, Halal” = Kenny rogers.

I have short term memory but I don’t have changes in judgement, reasoning or the inability to perform task. (for now) ha..

Am I suffering from Alzheimer’s?

I don’t smoke, drink and do stay active if I can find the time. My grandparents have dementia. Parents do not fortunately. So I am quite worried.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

17. Question by Angelina

Dear Dr Catherine,

My mum is 75 years old this year. She had a bad fall in March this year and after her recovery her mental health is just down slope. She had an open surgery to fix her spine.

Her memory has been affected badly, cannot remember things which happen few hours ago. Things she has done often before now cannot remember how to do it, cannot focus to compete one task, no mood to do daily stuff, hands tremble, gets agitated when things go wrong, panicky about being scammed. Are these signs or Alzheimer's Disease?

We have tried bringing her to see a psychiatrist, but nothing came out from that session. Not sure if it's a medical condition that we are not aware of. Need your professional advice.

Answer by Dr Catherine Chan

Usually, it will be recommended to have more information through more history taking and physical examination to explore if there are any other signs and symptoms.

Suggest can seek consultation with a geriatric doctor for a more comprehensive assessment if concern about other medical conditions other than dementia, such as depression and resolving delirium (acute confusion state related to acute illness/trauma etc) with a new cognitive baseline. Sometimes there maybe more than one medical condition and may evolve over time.

18. Question by Siew Mui

Dear Dr Catherine,

Can I know what does early onset of Alzheimer look like and how do I differentiate it from aging forgetfulness?

Are there any medication which could help control degeneration?

Thank you and look forward to your response.

Answer by Dr Catherine Chan

For Early stage with mild impairment: some forgets names, misplaces familiar objects, shows decreased work performance, shows signs and symptoms of depression, has slight difficulty in concentrating, takes longer to accomplish daily tasks with mistakes in between, has problems managing finances etc.

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment.

There is medication that can help to slow down the progression of dementia, however the doctor/specialists will need to assess one’s suitability for the medication.

19. Question by Juliana

Dear Dr. Catherine Chan,

Are there exercises that we could do to avoid the onset of dementia? Thank you.

Answer by Dr Catherine Chan

A healthy lifestyle will help to reduce the risk for dementia, which includes physical activity, social interaction, and even cognitive engaging activity like mahjong game. Other areas will be healthy diet, sufficient sleep, refrain from smoking. Conditions like hypertension, diabetes, depression, obesity and hearing impairment are also risk factors for dementia.

Kindly refer to this link for more information on cognitive simulation therapy (a form of exercise for the brain) available: https://www.dementiahub.sg/dementia-practice/cognitive-stimulation-therapy/

20. Question by Cindy

Dear Dr Chan,

I noticed my mum who is 76 years old started to be slightly incoherent in her speech and I am unsure if this is related to Alzheimer’s disease.

For example, she meant to say “nearer” while gesturing her hands nearer but said “further” instead. She meant left but said right instead.

I have observed this in the recent months on occasions. But the 2 examples above, happened yesterday and today. I am concerned that the frequency of her incoherent speech has increased. Her motor skills seem to have deteriorated as well. Example, using the TV remote control. I am unsure if this is part of ageing.

Appreciate your advice.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern.

Usually, it will be recommended to have more information through history taking and physical examination to explore if there are any other symptoms and impact on her daily life.

Sudden deterioration in speech and motor skills raised a concern to evaluate for any possible stroke or other neurodegenerative conditions as well, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment for her.

21. Question by Arun

Hello Dr. Catherine Chan,

I am 76 years old.  Lately i.e. within the last year or so, I have been experiencing memory lapses and frequent forgetting episodes.

For example, I remember something or want to go and get something but I'm distracted by someone or a phone call and instantly I will forget what I wanted to do.  Or I put something in a safe place so I think I will find it when I need to, but when I want to retrieve it my mind goes blank. It will take some time before I will recall where I need to go to find it. 

Names of persons and places seem to disappear when it was on the tip of my tongue a moment ago.

I am sure all these happenings are not new to you, but I need to express what I am going thru for you to know.

I will be happy to hear from you soon.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

You can try the Memory Checklist on the SingHealth Health Buddy app to assess if your forgetfulness is ‘normal’, or if you should see a doctor for further assessment. 

If you have the Health Buddy app:

1. Simply tap on this link (https://healthbuddy.page.link/apps?m=memoryCare) to open the "Memory Care" function in Health Buddy. 

2. Next, tap on "Memory Care" again to access the Memory Checklist

If you have further concerns, please see your general practitioner (GP) or polyclinic for further advice or more detailed assessment. There are memory clinics in polyclinics and in hospitals.

22. Question by Wendy

Hi, below is my question for Dr Chan:

I suspect my dad, age 76, may be at risk of dementia.

He shows signs of weakness in remembering new routes and the orientation of less familiar places.

He didn’t have such a problem in the past.

However, he is still able to go about his daily chores independently and has coherent thinking.

I understand that the polyclinic diagnostic test is for patients in advance stage (i.e. those with trouble in remembering time & places).

Are there other tests available in Singapore to test for early stage of the disease? Pls advise.

Answer by Dr Catherine Chan

There is difference in forgetfulness between normal ageing and dementia. For example, with normal ageing, one may have occasional forgetfulness such as missing appointment, but remembering them later for. However, memory loss that affects daily life, especially forgetting recently learned information (short term memory loss) with increasingly need to rely on others for things that one used to handle by self will be of concern. Usually, it will be recommended to have more information through history taking to explore if there are any other symptoms and impact on your daily life.

There are memory clinics who are run by geriatric doctor, neurologist, or psycho-geriatric doctor in the hospitals. They do have more comprehensive assessment to pick up the early stages of dementia.

23. Question by Cindy

Dear Dr Catherine Chan,

I am worried if my risks are most highest of contacting dementia because my maternal grandmother, mother has Alzheimer's disease & my father has vascular dementia. Both grandma, mother has high cholesterol & my father is diabetic.

What should I do to lower my risk? Is there any tests to see what are my risk? I am in early 50s. Thank you.

Answer by Dr Catherine Chan

Having parent or sibling with dementia increase one’s risk of developing it, there is a likelihood of a genetic link if it is early onset form of Alzheimer’s disease. However, Alzheimer’s disease is believed to be caused by a combination of genetic, lifestyle and environmental factors.

A healthy lifestyle will help to reduce the risk. You should also engage in regular physical activity, social interaction cognitive engaging activities. Other areas will be healthy diet, sufficient sleep, refrain from smoking. Conditions like hypertension, diabetes, depression, obesity, and hearing impairment are also risk factors for dementia.

Do consult a doctor for a more detailed assessment when there is a concern. They will be able to advise you further on your concern about the risk.

In recent years, there are increasing number of Young Onset Dementia (YOD) cases attended by specialist in National Neuroscience Institute (NNI). Typically, it affects those between 45-65 years old.

24. Question by Sharon

Good evening Dr. May I know if taking Gingko Biloba supplements will help in brain, memory and mental support?

Will it help to slow down mental aging?

I’m currently taking this supplement long term. Is this safe?

What is the correct dosage if there is one?

I look forward to hearing from you.

Answer by Dr Catherine Chan

There is no strong evidence for supplements for dementia itself due to combination of factors leading to dementia. A balance of healthy diet and taking certain supplementation that your diet unable to provide is part of a healthy lifestyle. 

There are known risk factors such as physical inactivity, social isolation, excessive alcohol consumption, smoking, hypertension, diabetes, depression, obesity, head injury and hearing impairment etc. Good control of chronic disease like hypertension and diabetes and addressing the above factors will reduce the risk especially vascular dementia and its progression.

25. Question by Eddie

Dear Doctor Chan,

I was diagnosed with Inulin Dependent Diabetic 43 years ago. Along the journey I was afflicted with HBP. Three years ago I suffered a stroke and leading to Parkinson Disease. I am now on Memory Patch with Levodopa tablets 4 times a day.

My handwriting is getting small and often the body functions and walking is unbalanced.

How can I reduce memory progression and support treatment.

Please enlighten me. Thank you so much.

Answer by Dr Catherine Chan

Parkinson's disease is also a neurodegenerative condition whereby there is progressive decline in certain functions.

Reducing the risk factors does slow down the progression of condition. Suggest achieving good control of high blood pressure and diabetes. At the same time, avoid the other known risk factors such as physical inactivity, social isolation, excessive alcohol consumption, smoking, depression, obesity, head injury and hearing impairment etc.

Constantly engaging in activities will help in maintenance of the physical body and cognitive health. There are centre based services such as day rehabilitation, care centres, active ageing centres and home-based services across Singapore. Do speak to your doctor for recommendation and referral for the services.

Dementia Singapore also provide with help and services. Kindly refer to this link for more information on resources, services and support available: https://www.dementiahub.sg/i-live-with-dementia-category/i-live-with-dementia/independent-living/

26. Question by Siew Lian

Hi Dr,

My 75-year-old brother who is diagnosed with mid to late state Alzheimer’s Disease is unable to sit up except during meal times. He is lying down every moment.

The moment he gets up in the morning, he wants to go to bed again.

Do AD patients undergo so much changes in their brain that they feel giddy or have a headache all the time?

We have brought him to a private & public neurologists & all of them said he does not have an imbalance when they tested his movements.

My family would appreciate your advice.

Answer by Dr Catherine Chan

With progression towards late stage of dementia (including Alzheimer’s disease), there will be loss of functions over time and increasing the need to rely on others. Some examples are lack of motivation with the usual activities, more bedbound or unable to perform basic activities of daily livings like eating, toileting etc and reduction in communication and eventually uncommunicative/unable to express their needs verbally or difficulty understanding spoken language.

Mood disorder like depression do co-exits in some patients, can explore with his doctor for further evaluation.

Family do understand him the best, try to recall the things he likes or dislikes. Planning activities according to his likes maybe able to engage him in activities. Do try different activities to explore what interest him to engage him through his different senses (sight, hearing, smell, taste, and touch).

Dementia Singapore also provide with help and services. Kindly refer to this link for more information on resources, services and support available for caregivers: https://www.dementiahub.sg/living-well-with-dementia/caregiving-through-the-stages-of-dementia/

Ref: I23