Speaker 1: Now health matters with Daniel Martin. Thanks for joining me
Speaker 1: on health matters everybody. I'm Daniel Martin. And well, dementia
Speaker 1: is in the news again, specifically young onset dementia, there's
Speaker 1: people as young as their thirties and forties developing dementia.
Speaker 1: In a report on CN A dot Asia, you saw
Speaker 1: how the numbers that N I reports when it comes
Speaker 1: to young onset dementia in 2023 there were about 330
Speaker 1: cases of which 91 were new. In 2013, there were
Speaker 1: 60 new cases at that time and the estimation is
Speaker 1: that there are possibly around 3700 people in Singapore who
Speaker 1: have young onset dementia. And in another report,
Speaker 1: it showed that according to a survey conducted by Milieu
Speaker 1: Insight and released together with dementia Singapore, that about half
Speaker 1: of the respondents probably not likely to get tested for
Speaker 1: young onset dementia even if they notice developing some of
Speaker 1: the symptoms. What is young onset dementia? We need to
Speaker 1: understand this better and that's why I've gotten the show.
Speaker 1: Associate Professor Adeline,
Speaker 1: a senior consultant from the Department of Neurology, the National
Speaker 1: Neuroscience Institute and Dementia Program. Lead professor, always an absolute pleasure.
Speaker 1: Thank you for coming back on the show.
Speaker 2: Good evening, Daniel. Always glad to be back.
Speaker 1: Let's
Speaker 1: break up some misconceptions about young onset dementia because some
Speaker 1: of the signs and symptoms when they're showing up at
Speaker 1: thirties and forties they think to themselves. No, this is
Speaker 1: just forgetfulness. This is just something else altogether. How do
Speaker 1: we know it's young onset dementia versus something else?
Speaker 2: Ok. So those who, um, present really early. So in
Speaker 2: their late thirties, early forties, most of the time those are, are,
Speaker 2: you know, Alzheimer's, that's truly inherited. So they would have
Speaker 2: had someone in their family who probably had dementia, right?
Speaker 2: But when we talk about young onset dementia, those are
Speaker 2: not the norm. Those are the rarer cases. Most of
Speaker 2: the time we're talking about patients who present the symptoms
Speaker 2: in their fifties or sixties. So that's the most common, um,
Speaker 2: period of time that they would present with, with symptoms
Speaker 2: for. Yeah, for the ones in their fifties and sixties,
Speaker 2: usually it's not something that's genetic or inherited. Although we
Speaker 2: know that there could be a gene called the apoe
Speaker 2: gene that may increase your risk of having Alzheimer's, but
Speaker 2: it's not the sort of Alzheimer's that you would definitely
Speaker 2: pass on to the next generation, right?
Speaker 1: So, yod, young onset dementia is technically more 50 sixties
Speaker 1: than thirties, forties.
Speaker 2: Yeah. So the ones in thirties, forties, you know, they
Speaker 2: are usually quite rare. They make up less than 5%
Speaker 2: of all Alzheimer's cases and those are the ones that
Speaker 2: do you know, in all likelihood, carry a mutation or
Speaker 2: a genetic cause of their condition?
Speaker 1: Ok. So, in those numbers from NNI 2023 around 330
Speaker 1: cases of yod, of which 91 were new were those
Speaker 1: predominantly people in the early fifties and beyond.
Speaker 2: Yeah. So by definition, why are these below 65? Right,
Speaker 2: when they start having symptoms? So classically, it would be
Speaker 2: over in their fifties and sixties. Yeah.
Speaker 1: Right. Ok. And in your experience, how is it often
Speaker 1: picked up? What brings somebody in to get tested for it?
Speaker 2: To be honest, most of the time it's their family
Speaker 2: who brings them in. Uh, because at that age, like
Speaker 2: you rightly said, they don't think I could be having
Speaker 2: dementia in my fifties. I'm still quite young. Right. And
Speaker 2: they're working and sometimes even at work when they're making mistakes,
Speaker 2: colleagues don't tend to, um, be, feel comfortable enough to
Speaker 2: tell them that. Look, you're making mistakes, you're forgetting this
Speaker 2: and that. So usually it's the families who bring them in.
Speaker 2: But the, what we're seeing a lot more of is
Speaker 2: that when the families do notice some problems, some of
Speaker 2: the patients themselves are not so keen to come in
Speaker 2: for testing, um, often times even earlier stages of disease,
Speaker 2: they may lose a bit of insight into some of
Speaker 2: their impairments. And so they don't feel that they are
Speaker 2: actually declining and so hence, they refuse to come in
Speaker 2: for evaluation.
Speaker 2: So we often do get the younger dementias coming in
Speaker 2: often at a slightly later stage. I wouldn't, I wouldn't
Speaker 2: call it denial entirely on the part of the, the
Speaker 2: patient of the family. Although that does play a role sometimes,
Speaker 2: but usually it's really just a bit of a loss
Speaker 2: of insight into the impairment, but
Speaker 1: perfectly understandable. I can understand why because
Speaker 1: like, you don't know what resources to lead on. You
Speaker 1: don't know something as ephemeral as memory. You really don't
Speaker 1: know how to gauge whether or not it's a real
Speaker 1: health issue or not. Is there any advice you can
Speaker 1: give in terms of, you know, what to look out
Speaker 1: for and what should bring you in to see an
Speaker 1: expert even at that young age of your fifties,
Speaker 2: I think it's ok to seek medical help. Um Even
Speaker 2: if you go to primary care to your polyclinic and GP,
Speaker 2: you know, there's a lot of um you know, there
Speaker 2: are a lot of GPS and PO clinic doctors are
Speaker 2: now very skilled in, in, in diagnosing cognitive problems and
Speaker 2: knowing when to refer and often times it might be
Speaker 2: something reversible, right? So it could be something hormonal, something metabolic,
Speaker 2: um some thyroid dysfunction or even due to medication.
Speaker 2: Um So there are many different conditions that can cause
Speaker 2: cognitive impairment or difficulties that can be treated. So, I
Speaker 2: think if you know, you're in your fifties or early
Speaker 2: sixties and you feel something is not quite right. It's
Speaker 2: ok to just go and seek help and seek evaluation
Speaker 2: by a doctor.
Speaker 1: And usually this will be a very noninvasive thing. This
Speaker 1: will be like a, like a clinical assessment and maybe
Speaker 1: like some forms to fill up a service to
Speaker 1: do.
Speaker 2: Yeah. So at the bare minimum, you might get blood tests,
Speaker 2: you might get a couple of memory tests done by
Speaker 2: the doctor or the nurse in the clinic. And then
Speaker 2: you might be asked to go for a brain scan, right?
Speaker 2: If the doctor feels that it warrants doing an MRI
Speaker 2: scan or CT scan, they might suggest you go for one,
Speaker 2: some of the more invasive tests like where we collect
Speaker 2: cerebrospinal fluid, those are more specialist and we, we do
Speaker 2: that in NN I for younger dementias when we suspect
Speaker 2: Alzheimer's and we really want to confirm it with um
Speaker 2: various tests for the amyloid protein that um that causes Alzheimer's.
Speaker 1: So, ok, before we start talking a little bit more
Speaker 1: in terms of treatment and management of this, I'm curious,
Speaker 1: I mean, just look at those numbers. Would you say
Speaker 1: rates have held steady since 2013? If you look at
Speaker 1: population growth versus an actual increase, that warrants more attention.
Speaker 2: II, I think we are still seeing an increase in
Speaker 2: the numbers, but I think the numbers are varying and not.
Speaker 2: So um easy to track long term because there's increased
Speaker 2: awareness now. So also amongst the medical fraternity, lots of
Speaker 2: patients are getting diagnosed and treated outside of certain specialist centers, right?
Speaker 2: So that, yeah, so you know, definitely the numbers are growing.
Speaker 2: We do get referrals uh more and more. But what
Speaker 2: we are also seeing is also a default rate
Speaker 2: like what was uh you know, brought up and highlighted
Speaker 2: by the survey. So we do see quite a bit
Speaker 2: of defaults from patients with young onset dementia who may
Speaker 2: not practice, I know, decide not to come to the
Speaker 2: appointment as well.
Speaker 1: So estimations are they could be as many as 3700
Speaker 1: cases per year in Singapore.
Speaker 2: I mean, that's the ongoing prevalence that we know about.
Speaker 2: There's probably more that we probably unable to track accurately
Speaker 2: at this point
Speaker 1: if
Speaker 1: you're developing it at an earlier age. And for these cases,
Speaker 1: the yod cases
Speaker 1: is that going to, you're going to have more years
Speaker 1: with it? And does that mean that the degradation is
Speaker 1: going to be more challenging to deal with versus finding
Speaker 1: it later?
Speaker 2: Well, if you hit the nail on the head, you know,
Speaker 2: we we always say very simply that if you have
Speaker 2: dementia in your in the older years, you are more
Speaker 2: likely to pass on from other medical problems, right, like
Speaker 2: heart disease, cancer and other things.
Speaker 2: But when you're younger, you're more likely to live, you know,
Speaker 2: with a healthy body, not much medical illness. Um but
Speaker 2: in a more cognitively impaired state. So there is what
Speaker 2: we do see is a lot of caregiver stress for
Speaker 2: the family because we all know, you know, as dementia progresses,
Speaker 2: sometimes we do get behavioral problems because of the lack
Speaker 2: of insight and other factors. And, you know, the behavioral
Speaker 2: problems really are difficult for the family to manage.
Speaker 2: So we find that even though the yod numbers don't
Speaker 2: seem to be as high as the older dimension numbers,
Speaker 2: the burden is often a lot higher. Yeah,
Speaker 1: exactly. So how is it managed? If it is Yod
Speaker 2: management is the same medically in terms of medical treatment
Speaker 2: in terms of, you know, drug therapy, um a few things,
Speaker 2: number one, the counseling and the hand holding of the
Speaker 2: partner and the family is very important. So if we
Speaker 2: try to handhold them from the time of diagnosis, we
Speaker 2: try to get the Children involved. I think oftentimes the
Speaker 2: couple in their fifties, they, their Children are still relatively
Speaker 2: young in their twenties, they don't want to involve the Children,
Speaker 2: but we often try to encourage them to involve
Speaker 2: the Children because, you know, the the the spouse will
Speaker 2: burn out very quickly in a short period of time.
Speaker 2: So apart from that, we also know that they have
Speaker 2: difficulty finding cognitive stimulating uh programs because they can't go
Speaker 2: to a normal daycare. And when they go to a daycare,
Speaker 2: everyone that is a lot older than them. They feel
Speaker 2: very uncomfortable. So, Dementia Singapore does run a very good
Speaker 2: program for Yod, got voices for hope and a lot
Speaker 2: of my patients attended and we found it very useful.
Speaker 2: Um So I highly recommend patients to check out the
Speaker 2: programs run by dementia SG. Um Also at N and I,
Speaker 2: we run a program once a week for, for patients
Speaker 2: with Yod that don't want to go to a daycare,
Speaker 2: but want to come and still be part of a
Speaker 2: small group setting, doing some therapy and doing activities in
Speaker 2: a small group so that they find some support as well.
Speaker 2: And that's where the caregivers can also find support from
Speaker 2: each other.
Speaker 2: So I think the main answer to your question is
Speaker 2: honestly support, support, support, uh coun counseling, even throughout the
Speaker 2: whole journey of the disease, sometimes the doctor and the
Speaker 2: clinical team has to re evaluate and we sort of
Speaker 2: refresh the whole prognosis with the family because you know,
Speaker 2: in the first instance, when you're told you have Y MD,
Speaker 2: it's not easy, it's not an easy thing to accept,
Speaker 2: you know, you think about it yourself, even the family
Speaker 2: goes through a whole period of denial, anger sometimes. So
Speaker 2: this is, I mean, the main thing of treatment is
Speaker 2: really just that supportive care with the family from, from
Speaker 2: from the point of diagnosis. Otherwise the medical treatment is
Speaker 2: the same.
Speaker 1: It is so important to talk about those resources that
Speaker 1: you can lean on that you just described the support groups,
Speaker 1: the care networks, educating the family as well in terms
Speaker 1: of what can be done. I think that's very powerful.
Speaker 1: Is there anything around the, the lifestyle that needs to
Speaker 1: change for that individual? It's really about the support and
Speaker 1: the care works more so than anything else. Right.
Speaker 2: Yeah. So, I mean, it's, it's not new knowledge that,
Speaker 2: you know, controlling your lifestyle. Risk factors. Exercise is all
Speaker 2: important for reducing the risk of dementia. We also know
Speaker 2: good sleep is important, you know, when you sleep to
Speaker 2: echo what you've learned that day and they found that
Speaker 2: you don't sleep well, you have problems clearing all these
Speaker 2: toxic proteins.
Speaker 2: Um But recently the Lancet Commission for dementia, just big,
Speaker 2: you know, group of experts in dementia just published one
Speaker 2: month ago, certain additional factors that they found were important
Speaker 2: respectors for developing dementia, including hearing loss and vision loss
Speaker 2: as well as high as high cholesterol. So it is
Speaker 2: something we we often struggle with in the clinic. So
Speaker 2: vision loss is, is easier to manage. The patients tend
Speaker 2: to want to go and see a doctor when they
Speaker 2: can't see, right. They want to get treated
Speaker 2: but hearing loss, it's very hard to get patients to
Speaker 2: wear the hearing aid and understandably because often it's not comfortable,
Speaker 2: they don't find it help
Speaker 1: but so powerful to hear that controlling those two can
Speaker 1: be a contributing and helpful factor as well. Professor, and
Speaker 1: we're gonna have to leave it as there. Don't forget
Speaker 1: everybody can look up that Lancet report as well, hearing
Speaker 1: health and eye health and its impact here as well.
Speaker 1: Associate Professor Adeline, senior consultant from the Department of Neurology
Speaker 1: at the National Neuroscience Institute and Dementia program lead.
Speaker 1: Before making any decisions based on the information in our program,
Speaker 1: please consult a medical professional.