Don's study sheds light on dementia in Singapore

SINGAPORE - Dementia patients in Singapore can expect to live 10 to 12 years after being diagnosed, longer than the eight years for those in the West.

But Professor Kua Ee Heok also warned that as many as 80 per cent of sufferers here do not benefit from early treatment, as only a fifth of all cases here are detected.

Prof Kua, a senior consultant psychiatrist at the National University Hospital (NUH), will present his findings on dementia life expectancy at next month's World Congress of Asian Psychiatry in Bangkok.

Using previous studies and data collected from patients at NUH's memory clinic over the last 20 years, the veteran geriatrician has mapped out the course of dementia in Asians for the first time.

By breaking down the debilitating condition into mild, moderate and severe stages, he has also managed to figure out the health cost of dementia, and how much stress caregivers face.

"This helps families know what to expect and do at each stage, and also helps policymakers to develop support services," the 64-year-old said.

Around 28,000 Singaporeans aged 60 and above have dementia, and the number is projected to hit 80,000 by 2030.

The condition robs a person of his memory and ability to think, which affects his daily life. It also increases the risk of death as it lowers the person's immunity to other diseases.

Given the smaller family units in the West, patients there are often sent to nursing homes, where their condition deteriorates faster if there is inadequate care.

Those diagnosed with dementia here live longer because the condition is detected and treated earlier. And that is key.

This is why Prof Kua has spent the last 20 years mapping out how the disease progresses, so that family members and doctors can recognise the symptoms.

He found that someone with mild dementia is usually forgetful - for instance, failing to remember where he left his car keys. During this stage, the patient usually spends a monthly average of $280 on medical bills.

Those with moderate dementia go on to see and feel things that are not real. These may include feelings of paranoia, such as a belief that people are planning to steal from the patient.

At this point, the cost of health care can soar by more than four times to $1,250, as patients have to see the doctor more frequently, and may even need to hire a maid to provide home care.

It is also at this stage that caregivers face the highest levels of stress, as patients are more likely to display distressing behaviour - such as rushing to the door when footsteps are heard - because of the hallucinations and delusions they experience.

When the condition becomes severe, the patient may no longer recognise his family or even his own reflection. Medical costs drop to around $850 a month, given that the patient would likely have to be kept in bed most of the time.

Prof Kua said that early treatment - including proper nutrition, stimulatory activities such as exercise or listening to music, and medication - has been shown to effectively delay the progression of dementia.

With proper treatment, a patient with a mild form of the condition, for instance, can delay the onset of the next stage to six or eight years later, instead of the usual four.

"With what we know now, family members and doctors can better help patients seize the day so that they can have more than a few good years," said Prof Kua.

"Dementia is not a death sentence."

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