Forgetfulness or other cognitive slips are usually dismissed as a normal part of ageing. But memory problems can also be an early symptom of dementia. While diagnosing dementia can be a difficult, lengthy and an intensive process, early diagnosis allows healthcare professionals to stabilise symptoms and help patients achieve a better quality of life.

To detect symptoms of cognitive or emotional difficulties of seniors living alone, Clinical Associate Professor Iris Rawtaer, Head, Department of Psychiatry, Sengkang General Hospital and Consultant, SingHealth Duke-NUS Centre for Memory and Cognitive Disorders, piloted the Sensors In-home for Elder Wellbeing (SINEW) project. She shares more about the project and its potential impact on Singapore’s ageing population.

Q: Can you tell us more about dementia and how it affects Singaporeans?

Dementia is a neurodegenerative condition that affects the brain. Persons with dementia lose the ability to think, reason and remember things, and eventually have difficulty coping with everyday activities. It is a disease of the brain and not a part of normal ageing.

Common symptoms include repeating questions, misplacing personal items, having difficulties with expressing oneself, confusing places and times, difficulties performing familiar tasks and being unable to recognise friends and family.

The Well-Being of the Singapore Elderly (WiSE) study found that one in 10 seniors aged 60 and above has dementia . In 2017, there were 80,000 Singaporeans with dementia, and this is expected to more than double to 150,000 by 20301.

While there is currently no cure for the condition, there are many programmes to support patients in the community, with Dementia Singapore, a social service agency specialising in dementia care, being one of the key providers.

Q: Why is early detection important in dementia and how does the SINEW project help with this?

Prevention and early detection of mild cognitive impairment, or early dementia, is important. Studies have found that by addressing risk factors such as obesity, high blood pressure, diabetes, social isolation, and lack of physical activity, we can potentially delay or prevent 40% of dementia worldwide. This will have a significant impact on healthcare costs and the quality of life of affected persons.

The SINEW (Sensors IN-home for Elder Wellbeing) project aims to evaluate a home-based sensor remote monitoring system which detects behavioural patterns associated with early dementia among older adults (above the age of 65) living on their own.

Despite interruptions caused by the COVID-19 pandemic, we have made progress and have over 70 participants active in the study. We have also partnered with artificial intelligence experts to explore novel approaches to analyse the data.

At the end of the pilot study, participants shared that the sensors were unobtrusive to their daily activities and many of them felt that it provided them a sense of security as they could easily call for help if they needed to.

Currently there are multiple ground-up efforts to use smart technologies to remotely monitor the health states of older adults but the majority are designed to detect falls or distress in order to facilitate timely assistance.

If home-based sensors can also detect mild cognitive disorders and early dementia, this set-up can be scaled and integrated into population health initiatives which will empower healthy ageing and better prepare seniors to self-manage at the earliest signs of change.

Q: How has philanthropic funding supported your work on this project?

Philanthropic funding has been pivotal in extending this earlier pilot study into a longitudinal three-year cohort study. Findings from our study is expected to shed light on specific behavioural patterns that are associated with the different cognitive states and identify digital signatures that can flag up potential cognitive decline so seniors can seek help early. This would be a good complement to existing smart elderly alert systems put in place by various agencies for the purpose of detecting falls and death. It would also be aligned with Singapore’s Smart Nation vision.

We are hoping to seek further funding to extend the duration and reach of this study. At present, the study is limited to seniors who live alone. However, through our outreach efforts, there has been substantial interest from seniors who live with their families, and we hope to include them in subsequent phases of the study. In addition, we plan to work with frailty experts to incorporate other health metrics and outcomes into this remote monitoring system.

Q: Are you working on other research projects pertaining to the early detection of dementia?

In collaboration with the Nanyang Technological University and Geriatric Education Research Institute, I am working on a robotics study for cognitive and motor training in older adults. In this study, we focus on automating errorless learning as an early intervention to reduce reliance on trained manpower, a scarce resource in our rapidly ageing population.

Through the use of a robot, we are conducting a pilot study to evaluate if it is feasible to combine motor and cognitive skills training with a relatable visuo-haptic game platform. The importance of early detection and early intervention cannot be overstated.

Clinical Associate Professor Iris Rawtaer’s work on early detection of dementia will improve the lives of many living with dementia. If you would like to support her endeavour, please contact the Development Office at Sengkang General Hospital at giving@skh.com.sg. 

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