Dementia Screening in Singapore
Dementia is a syndrome that develops over time. It is the loss of cognitive functioning such as remembering, reasoning and thinking. This will lead to problems with language, visual-spatial skills, or executive functioning. This impairment is enough to interfere with social or vocational functioning in a conscious person.
Patients and their relatives suffer greatly as a result of dementia. It promotes patient reliance and exacerbates other medical issues. It can cause worry and depression in families, as well as increase the amount of time spent caring for loved ones.
Dementia screening is an important step in detecting the early signs of dementia, so that appropriate treatment can be started as soon as possible
Dementia Screening Test Accuracy and Reliability
It is recommended that elderly should receive timely assessments of cognition, mood, and behavior in order to support effective therapy. This is especially essential in primary care settings for older people with cognitive impairments that could suggest dementia. However, many older patients are still underdiagnosed with psychological and neurological disorders.
Stress, medical ailments and drug side effects, and associated psychiatric conditions such as depression or anxiety can all cause cognitive impairment in the elderly, which is vital to be aware of if dementia is suspected.
Screening for cognitive functioning is frequently useful for clinicians working with older clients and is especially important if dementia is suspected or diagnosed, as it can detect previously undocumented cognitive declines or changes and can serve as a basis for a referral for neuropsychological testing.
Brief cognitive screens, such as the Montreal Cognitive Assessment (MoCA), Modified Mini-Mental State Exam, and the Rowland Universal Dementia Assessment Scale (RUDAS), are all in relatively wide use for persons suspected of dementia or mild cognitive impairment.
Many of the current brief screening measures, such as the Mini-mental state examination (MMSE), have modest sensitivity but only fair specificity in detecting dementia. The MMSE’s accuracy is determined by a person’s age and educational level; using an arbitrary cut-point which could result in false positives in those with lower education levels and false negatives in people with higher education levels.
While cognitive and affective functioning tests are valuable when used as intended, they are ineffective when used as diagnostic tools or as a replacement for a thorough clinical interview, especially when used as the only basis for diagnosis.
An evaluation of impairment in daily activities is required to establish whether a patient satisfies the criteria for dementia. The Functional Activities Questionnaire is a short, standardized test that helps therapists to get objective information from family members or spouses about their capacity to complete everyday tasks.
It was discovered that using a cut-off point of 6 points or above had an accuracy rate of 85 percent or higher in identifying those with MCI from dementia. The Total Functional Capacity assessment, which was created for Huntington’s disease, could be useful for dementia in general.
A complete routine blood workup is necessary to rule out underlying diseases including infection ( including HIV/ Syphilis) , uremia, or liver disease. Thyroid function, B12, folate, and fasting glucose levels are also important to rule out metabolic and nutritional issues. Toxicity to drugs (such as antiepileptics or digoxin) must be considered.
To rule out any potentially reversible causes of dementia, such as stroke, intra-axial, and extra-axial tumors, subdural hematomas, and hydrocephalus, structural imaging, ideally MRI, is required.
The physician must assess whether the patient has no cognitive impairment, cognitive impairment without dementia, or dementia using the following guidelines. Those who do not have impairment assurance should be followed up in around 6 months or sooner if there is a significant change in function.
Serial cognitive tests are now the most useful indicators for changes in cognition because they provide a baseline and trajectory of cognitive function across time to the physician. A recent study of cognitive impairment screening found that, despite being beneficial for diagnosing dementia, quick cognitive evaluations have a low sensitivity for detecting MCI in primary care.
There are currently no guaranteed ways to avoid all types of dementia. Making good lifestyle choices, on the other hand, can lower your risk of dementia. This involves frequent exercise and a nutritious diet. Other medical disorders that might cause dementia, such as stroke, can be reduced by taking these simple precautions.
The importance of an accurate diagnosis cannot be overstated, as early intervention is critical in managing dementia. If you or a loved one are showing signs of dementia, it is essential to seek professional help as soon as possible.
There are presently no treatments available for dementia. Specific drugs, such as cholinesterase inhibitors, can, nevertheless, be used to treat the symptoms of certain kinds of dementia. Recently FDA approved drug “ Aduhelm “ for Alzheimer’s disease, is currently being studied at various centers in the world for risk vs benefit ratio.
What factors contribute to the development of dementia?
Age: Increased age is the strongest known risk factor for dementia, with most occurrences affecting persons 65 and older.
Family background: Those who have dementia-affected parents or siblings are more prone to develop the disease themselves.
Poor cardiovascular health: If not addressed properly, high blood pressure, high cholesterol, and smoking all raise the risk of dementia.
Traumatic brain injury: Head traumas, especially if they are serious or occur frequently, can raise the risk of dementia.
Types of Dementia
1. Alzheimer’s disease
Trouble remembering recent events, such as a conversation that took place minutes or hours ago, is the typical symptom, while trouble remembering more distant memories develops later in the disease. Other issues, such as walking or talking difficulties or personality changes, arise later. The most significant risk factor is family history. Having a first-degree family who has Alzheimer’s disease raises your chances of getting it by 10% to 30%.
2. Vascular dementia
About 10% of dementia cases are connected to strokes or other problems with brain blood flow. High blood pressure, diabetes, and high cholesterol are all risk factors. The symptoms differ based on the affected location and size of the brain. The disease proceeds in stages, so as the person has additional strokes or mini-strokes, their symptoms will abruptly worsen.
3. Fronto-temporal dementia
Because of the area of the brain, it affects, this type of dementia frequently causes personality and behavior abnormalities. People with this issue may cause embarrassment or inappropriate behavior. A formerly cautious person, for example, may make insulting remarks and disregard obligations at home or at work. There could also be issues with language skills such as speaking and comprehension.
4. Mixed dementia
Multiple types of dementia can exist in the brain at the same time, especially in those over the age of 80. A person may have Alzheimer’s disease with vascular dementia, for example. Because signs of one kind of dementia may be more pronounced or overlap with those of another type, it is not always obvious that a person has mixed dementia. One type of dementia may progress more quickly than another.
What are dementia’s signs and symptoms?
Dementia is a broad term with many different symptoms that vary from person to person. Dementia patients have issues with:
- Problem-solving, reasoning, and judgment
- Beyond the standard age-related changes in eyesight, visual perception
The following are symptoms that could indicate dementia:
- Being lost in a familiar area
- referring to common objects with strange terminology
- Forgetting a close family member’s or friend’s name
- Forgetting old memories
- unable to do activities on their own
How to Get Dementia Screening in Singapore
Dementia is a serious condition that can have a significant impact on your life. If you are showing signs of dementia, it’s important to seek professional help as soon as possible. The Neurology Practice has highly trained professionals who can provide dementia screening and treatment to help you manage this condition.
We understand that this may be a difficult time for you and your loved ones, and we are here to support you every step of the way. Have you or someone you know been affected by dementia? Contact us if you have any questions about this condition or our services.