The only child in his family, 24-year old Melvin (not his real name) has been fighting an uphill battle ever since his father was first diagnosed with Alzheimer's disease four years ago.
According to the report of a study commissioned by the 15 Asia Pacific organization members of Alzheimer's disease International, the number of people with dementia in Singapore is estimated to be 22,000 and is projected to increase 8.5 times to 187,000 by 2050.
Alzheimer's disease is one of the most common types of dementia in Singapore, which also includes vascular dementia and front temporal dementia. Dementia is not a single disease, but rather a non-specific illness syndrome in which affected areas of cognition may be memory, attention, language and problem solving.
"The first warning sign that my father had Alzheimer's disease was when he was a cab driver and he started forgetting directions, especially to newer developments like Sengkang," said Melvin. "At first, my mother and I dismissed it as just a symptom of old age. Soon after, he became involved in three traffic accidents and slowly lost the ability to drive," he said.
One of the most commonly used staging scales to identify the severity of Alzheimer's disease is the Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS), which divides the disease process into seven stages based on the amount of cognitive decline.
By the time Melvin's father was diagnosed, he was already in Stage 4 which indicated moderate cognitive decline. It is an early stage of Alzheimer's disease and is marked by difficulty concentrating, decreased memory of recent events, and difficulties managing finances or travelling alone to new places.
"As you start to develop dementia, you will lose deficit cognition and skills, forget knowledge or rather the information to do things. As time passes, this will intensify and ultimately result in you having difficulty performing any voluntary cognitive functions whatsoever," said Dr Solomon Wong, medical doctor and psychiatrist at the Institute of Mental Health (IMH).
Impact on family
When a loved one is diagnosed with Alzheimer's disease, the effects on the family can be devastating.
"The reality that a direct family member has such an overwhelming illness can trigger a range of emotions, including fear, sadness, confusion and anger. Conflicts are common as family members struggle to deal with the situation," said Fitriana Ali, a nurse at Singapore Home Nursing.
However, in Melvin's case, he decided to accept his father's illness to the best of his abilities, describing it simply as a reversal of roles in the family.
"It was very distressing at first as I couldn't accept the fact that my father had fallen victim to such an illness. I constantly had arguments with my mother over how we should handle the situation.
"After some time, I had no choice but to accept it and adjust to him not being able to do certain things. I have to treat him as a kid who is unable to take care of himself," said Melvin.
Not many people are aware of the effort taken by caregivers of people afflicted with dementia. With 9 per cent of the population over the age of 65, the social and economic ramifications of dementia are serious.
In Singapore, there are several avenues of help for families affected by dementia which includes dementia day care centres, home nursing and various respite services.
Despite having these options available, Melvin refused to admit his father into any nursing home or allow a home nurse to take care of him. As a result, he has to juggle taking care of his father and his job as a property agent.
"He is still able to do daily activities and he does not need any special care. What he does need is someone to accompany him and be there for him, just like how a child needs his parents to be there for him.
"It's hard to cope, but at the end of the day he is family," Melvin said.
Under the dementia umbrella, Huntington's disease is the only one that can be clearly inherited. However, the possibility of inheriting Alzheimer's disease, while slim, is present nevertheless.
"There is indeed a connective component. Dementia is a multi-factorial disease which includes genetics, environmental and developmental factors amongst others. Similar to many other conditions, having Alzheimer's in the family does increase the chance of people in later generations developing the disease," said Dr Wong.
Melvin isn't too bothered by the possibility of inheriting Alzheimer's disease and is instead taking a proactive stance.
"I believe that prevention is better than a cure. There are ways to prevent early onset dementia and keeping healthy is one of them," he said.
"Even if I do inherit Alzheimer's from my father, I will still go ahead with life and try to make the best out of it.
"I'm more concerned of what I can provide for my family during my healthy years and I believe if I have done enough for them, my future children will take care of me when I am no longer able to take care of myself," he laughed.
Despite having such a positive approach towards his family's situation, Melvin admits that dealing with his father's illness is a daily battle that can sometimes be overwhelming.
"He is no longer able to recognise me. I'm just a guy living in his house and he feels shy when I buy food for him," Melvin lamented.
Afiq Fitri B Alias is a student reporter from Republic Polytechnic.