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Alzheimer’s Disease: Memory Loss That Is Not A Normal Part Of Ageing

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Alzheimer's Disease: Memory Loss That Is Not A Normal Part Of Ageing
Arthur Foo’s 91-year-old father was diagnosed with Alzheimer’s disease last year.
We have in-laws with this condition so when he started getting forgetful and repeating recent questions, we knew,
shares the 64-year-old.
His parents live by themselves with a helper, but when it comes to medical appointments, Arthur steps in as his dad can’t manage it on his own. While his dad is mobile and can feed, bathe, and clothe himself, he doesn’t walk steadily, often needing to lean on someone for support.
Previously, when his in-laws were diagnosed with Alzheimer’s disease, Arthur admits “we totally had no clue” what was going on.
Therefore, he thinks it’s important to publicise more about the condition so that people are more aware of the early signs of Alzheimer’s, and so they can better prepare themselves for how to care for their loved one.
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Alzheimer's Disease: Memory Loss That Is Not A Normal Part Of Ageing - Arthur with his father during mealtime
Arthur with his father during mealtime.
Credit: Arthur Foo
Meanwhile, Lim Kay Kwong’s wife, Betty Pay Pheck Choo, had to stop working in 2016 when she was 59. In her job as a cashier at a town council office, she had difficulty handling money accurately, and the couple often had to reimburse the council for losses caused by her mistakes.
At that time, I suspected she may have been in the early stages of dementia. However, I did not seek medical attention as she was still able to go out and return home independently,
recalls 73-year-old Kay Kwong.
He was working as a bus captain then, but resigned to care for his wife full-time.
By 2019, Betty’s condition had deteriorated to the point that she needed help with basic daily tasks such as eating, showering, dressing, and using the toilet.
She eventually underwent a medical evaluation in 2021 and was diagnosed with Alzheimer’s disease.
The couple’s son eventually helped to enrol his mother into a day care service as he saw how difficult it was for his father to be a caregiver 24/7.
Alzheimer's Disease: Memory Loss That Is Not A Normal Part Of Ageing - Kay Kwong with his wife Betty
Kay Kwong with his wife Betty.
Credit: Methodist Welfare Services
Betty now requires around-the-clock care and full assistance with every aspect of daily living.
This demands patience, physical assistance, and emotional support to meet her needs holistically while preserving her dignity, says Valerie Koh, centre manager at MWS Senior Care Centre – Eunos, operated by Methodist Welfare Services.
Being a caregiver is very stressful. Without the day care service, I wouldn’t have managed on my own,
says Kay Kwong.

"Now, with the staff at MWS Senior Care Centre – Eunos caring for my wife, I’m able to catch up on sleep or meet friends for a meal or coffee."

Alzheimer's is the most common form of dementia
World Alzheimer’s Day, taking place 21 September annually, helps spread awareness about the eponymous disease every year.
Alzheimer’s disease is the most common form of dementia. Memory loss in Alzheimer’s disease is persistent and progressive – and it gets worse over time, says Dr Yao Fengyuan, senior consultant, chief, at the Department of Geriatric Psychiatry, Institute of Mental Health (IMH).
Persons living with Alzheimer’s disease can have other cognitive problems such as deterioration in their language, hand-eye coordination, recognition of objects, judgement, and planning,
he adds.
It is also important to understand the differences between Alzheimer’s disease and natural age-related forgetfulness so that our loves ones can receive important care and treatment as soon as possible. One way to distinguish this is if you notice memory loss affecting their daily life.
Alzheimer's Disease: Memory Loss That Is Not A Normal Part Of Ageing - Dr Yao Fengyuan, Senior consultant, chief, at the Department of Geriatric Psychiatry, Institute of Mental Health (IMH)
Dr Yao Fengyuan.
Credit: Institute of Mental Health
The cognitive problems in Alzheimer's disease disrupt the daily life of the individual as they encounter new problems with everyday activities around the house, in the community, or at work,
says Dr Yao.

"For example, the person may start to face problems making bill payments, using the phone, managing medications, driving safely, and meeting up with friends."

Dr Jinesh Mukesh Shah, associate consultant, Department of Neurology at the National Neuroscience Institute, notes that everyone has trouble with memory at times, but the memory loss related to Alzheimer’s disease is lasting.
While age-related changes involve sometimes forgetting names or appointments but remembering them later, memory loss with Alzheimer’s disease consistently disrupts daily life.
And while we might make occasional errors when managing finances or household bills as we get older, people with Alzheimer’s disease face challenges in planning or solving problems.
Also, although we tend to develop very specific ways of doing things and become irritable when a routine is disrupted as we get older, Alzheimer’s disease involves changes in mood and personality, says Dr Shah.
Stages and treatment of Alzheimer's disease
Alzheimer’s disease is classified as mild, moderate, or severe. In the mild stage – which Dr Yao says lasts round two years – patients need assistance in their instrumental daily activities such as shopping, housekeeping, managing personal and family finances, food preparation, and taking public transport.
However, they are still independent in their basic activities of daily living.
In the moderate stage, patients need assistance in their basic activities of daily living such as toileting, dressing, grooming, feeding, and bathing. Dr Yao reveals that this stage lasts the longest – around four years.
In the severe stage, patients are unable to perform any of their basic activities of daily living. This stage last around 2 years.
In general, the life expectancy after a diagnosis of Alzheimer’s disease is about eight to 10 years,
says Dr Yao.

"Certain conditions can predispose the patients to faster progression of dementia, for example, developing delirium or stroke."

Dr Shah says that, on average, people with Alzheimer’s disease live between three and 11 years after diagnosis, but some live 20 years or more.

Alzheimer's Disease: Memory Loss That Is Not A Normal Part Of Ageing - Dr Jinesh Mukesh Shah, Associate consultant, Department of Neurology at the National Neuroscience Institute
Dr Jinesh Mukesh Shah.
Credit: National Neuroscience Institute

In terms of risk factors of developing Alzheimer’s disease, Dr Shah mentions age, family history, and female gender.

Modifiable risk factors such as sleep, smoking habits, hypertension, or diabetes can further increase the risk,
he says.
The treatment of Alzheimer’s disease is two-fold – to delay the progress of the disease and to treat responsive or behavioural problems.
Treatment to slow down the progression of Alzheimer’s includes prescribing medication,
says Dr Yao

"Caregivers can also help to slow down the progression by helping the patient maintain good diabetic and blood pressure control, engaging them with activities and exercise, and stopping their alcohol intake and smoking."

Dr Shah explains that symptomatic treatments boost and adjust chemicals in the brain without changing disease trajectory. Also, there is a new class of drugs that slow down disease progression by removing amyloid, the culprit protein.
Alzheimer’s disease is thought to be caused by the abnormal build-up of amyloid proteins in and around the brain cells, which eventually leads to brain shrinkage.
Because people with Alzheimer’s disease often have difficulty communicating their unmet needs, they may act out or show behaviour problems.
Dr Yao says treatment to manage these behaviours include medication and behaviour-management strategies such as teaching caregivers how to communicate with patients effectively.
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Support for caregivers
Dr Yao cites the Well-Being of the Singapore Elderly (WiSE) study conducted by IMH, which showed a decrease in the prevalence of dementia among older adults aged 60 years and above – from 10% (1 in 10 persons) in 2013 to 8.8% (1 in 11 persons) in 2023.
However, the actual number of older adults with the condition rose from 51,934 in 2013 to 73,918 in 2023. This is largely due to the increase in the local older adult population during this period.
As Singapore's population continues to age, the number of people with dementia will grow,
he says.
Dr Yao recommends bringing your loved ones to a doctor early to check for dementia, if you see them showing any symptoms.
Early detection of any form of dementia allows family members to prepare for the person's care as his or her condition progresses,
says Dr Yao.

"Additionally, persons living with dementia often have difficulty communicating their unmet needs. Hence, they may act out or have behaviour problems and these may exacerbate caregiver stress and can lead to caregivers experiencing burn out."

If the caregivers understand the patient’s condition early and learn how to communicate with them, the patients are less likely to act out, and this can help alleviate caregiver stress,
he adds.
To assist caregivers, IMH launched the Play2Care mobile app last year, which helps them improve communication in dementia care through interactive gameplay.
Available for free download on Google Play Store and Apple Store, the app contains videos explaining the five basic principles to communicating with persons living with dementia, using the T.A.N.G.O communication strategy.
Developed by IMH’s clinicians based on their clinical experience, the T.A.N.G.O framework is also an acronym for Tender approach, Acknowledge, No challenging, Get into simple conversation, and Optimise environment.
Caregivers can then apply these communication techniques in five commonly-encountered scenarios where the person with dementia is having behaviour issues,
says Dr Yao.

"The app also has mini games, which caregivers can play together with the persons living with dementia, engaging them in the process."

Importance of understanding what Alzheimer's is
Valerie from MWS Senior Care Centre – Eunos wants people to know that Alzheimer’s isn’t just about memory loss – it fundamentally changes the way a person experiences the world.
It can affect their emotions, behaviour, communication, and sense of security,
she says.

"Familiar places may suddenly feel strange, simple tasks can become overwhelming, and words they’ve known their whole life may no longer come easily. These changes aren’t a reflection of who they are at their core. They’re the result of a disease that alters the brain."

Having patience, compassion, and understanding when engaging someone with Alzheimer's can make an enormous difference,
she adds.
And while there’s no known way to prevent Alzheimer’s, it’s crucial to keep minds active to improve cognitive function. It’s equally important to look out for our loved ones and get medical intervention early when any worrying signs begin appearing.
Dr Shah stresses that Alzheimer’s disease is “not a normal part of ageing”. Also, the impact of Alzheimer’s disease is significant on both patients and caregivers.
Memory is what makes us human, and Alzheimer's steals those very memories away,
he says.

This article is part of a series on invisible disabilities, an umbrella term that refers to types of disabilities, chronic conditions, or medical/neurological conditions that are not immediately apparent to others. We seek to understand more about these invisible disabilities and how we, as loved ones or as general members of society, can better support others going through it.

The Agency for Integrated Care (AIC) provides resources to empower caregivers to better care for their loved ones while taking care of themselves. Visit AIC’s website for more information.

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