AM I JUST FORGETFUL OR DO I HAVE DEMENTIA?

Me, my mom, my elder daughter and my
mom's four great-grandkids at Dementia
Homecare Centre during a recent CNY visit,

When the doctor told me last March that my mother had dementia, the news wasn't exactly a shock. My mother had become increasingly forgetful over the past months, and acting peculiar. Initially I put it down as part of ageing. After all, she was 85 at the time. Moreover, she could answer all three questions I asked her. This was a tip from my neighbour, a retired registered nurse. If my mom could give her age, full name and the names of all her children, she was okay.

My mom passed this simple test, and so I let the matter rest. Everything changed after she fell and broke her hip on 6 March 2011. During her 10-day stay at the hospital after the hip surgery, the doctors and nurses noticed signs of dementia in my mother. One of her doctors recommended that she see a geriatrician. To cut the story short, Dr Philip Poi of UMSC confirmed my mom had dementia.

My mother was subjected to several tests. One of them was the clock test. It's simple and can be done at home. If you suspect your elderly parent might have AD, ask him to draw a clock and fill in all the numbers. You may be surprised at the result.

If you have noticed certain signs of absent-mindedness, but you are not quite sure of these are early signs of Alzheimer's, you can take this test below. A ‘yes’ is given a score of one or two and a ‘no’ always scores zero, giving a maximum possible score of 27.

A score of less than five suggests there is no cause for concern, five to 14 suggests mild cognitive impairment or early stages of Alzheimer's, and a score higher than 14 could denote the person may already have AD.

21-question test for Alzheimer's. Click on Daily Mail for a bigger and clearer image.

By the way, what's the difference between dementia and Alzheimer's Disease? Dementia refers to symptoms of forgetfulness that may impact a person's daily functioning (see table above). AD is a specific type of dementia. It is the most common and affects mainly people aged 65 and above.

In my mom's case, she was constantly checking the calendar and the clock, wandering around the house even in the middle of the night and repeating stories umpteen times to the extent I had to rescue whoever she happened to be chatting with. She couldn't remember if she had taken her pills, showered or washed her hair. She forgot where she kept her things and often blamed the maid for stealing them. Fortunately the maid took her accusations as a symptom of dementia. These were some of the changes I noticed in my mom as her dementia progressed.

AD is incurable. But there are ways to slow down the advance. Do a Google or Youtube search, and you will be inundated by the number of links and videos that show up. The challenge is finding the most reliable recommendation. I can only share what the doctors have recommended for my mother.

You can check out the daycare centre where my mom spent three months last year at the link below. Lots of pictures of the place. If you have a loved one who has dementia, I highly recommend this centre in PJ. It is in Section 11, across the road from Universiti Hospital. Email me at seniorsaloud@gmail.com if you want to know more about the facilities and the caregiving services there.

The centre is holding a talk by a caregiver this Saturday at its premises. It is a good opportunity to learn more about dementia and AD, and also check out the place.

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A DAYCARE CENTRE THAT'S LIKE A SECOND HOME

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HOPE FOR DEMENTIA PATIENTS?

I once asked my mom's cardiologist which diseases doctors feared most for themselves. His immediate answer: stroke and dementia. I had expected him to say cancer.

Dementia is incurable, irreversible and terminal. At least that is what doctors and medical researchers claim. The disease doesn't concern us much until it strikes our elderly parents and they start showing signs of deteriorating mental health.

After my mom was diagnosed with dementia in March last year, I read anything I could lay my hands on about the disease. I now having a better understanding of what it can do to the patient, and can empathize with caregivers of dementia patients.

Prescription drugs only help to slow down the ravages of the disease. Do a search on Google and Youtube and you will be amazed at the myriad of miracle cures for dementia. The video below is one example.



Researchers say the ketones found in coconut oil have slowed the progression of Alzheimer's disease in some people and may actually prevent it. Do you know of anyone who has tried this cure with encouraging results?

A word of caution. This video is posted here for educational purposes only. What works for some people may not work for others. Consult a doctor before experimenting with any alleged remedies.

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DEMENTIA - ARE WE AT RISK?

I'm glad I decided to go ahead with my plan to attend the just-concluded Asia Pacific Conference on Ageing organized by the Gerontological Society of Singapore in conjunction with its 25th anniversary celebrations.

Given my mother's condition, I was particularly interested in the presentations on dementia and caregiving of the elderly with dementia. I picked up some really useful information that helped me understand my mother's dementia and my role as her primary caregiver. It was comforting to know about the existence of support groups and options available for homecare and nursing services.

There is currently no pharmaceutical cure for dementia. The risk of dementia increases with age. That puts most of us aged 65 and above at risk. The statistics below are certainly alarming:





By 2030, 20% of Singapore's population will be aged 65 and above.

Fortunately, there are steps we can take to reduce the risk. Seek treatment if you have high blood pressure, high cholesterol and diabetes. You are at risk if you have had a stroke or suffer from depression.

Here are the 10 warning signs of Dementia to look out for. We may experience similar situations from time to time. The difference with dementia is that these behaviours will progressively get worse and affect the patient’s ability to live and function safely and independently.

1.Memory loss that affects day-to-day function
2.Difficulty doing familiar tasks
3.Confusion about time and place
4.Problems communicating
5.Difficulty planning or solving problems
6.Poor or decreased judgment
7.Misplacing things
8.Changes in mood or behaviour
9.Changes in personality
10.Withdrawal from work or social activities
(Source: Health Promotion Board, Singapore)

Conference attendees were each given a copy of the award-winning short film "Ah Kong" written and directed by Royston Tan. It's a story of a young man's attempts to help his grandfather remember his past as he struggles with dementia. However, it is not the past that the old man forgets, but the present.

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IT TAKES THE WHOLE FAMILY

My mother was discharged on Monday evening 21 March. The final bill for 15 days of hospitalization, angioplasty and bipolar hemiarthoplasty came to RM45,532.90. There's still weeks if not months of follow-up medical examinations and physiotherapy, not to mention a supply of expensive pills for the rest of her life. By no means is the final bill truly the last one. (Pic: mom taking her first steps on the stairs in the physiotherapy room)

Looking after an elderly parent who's just had hip surgery can be very demanding. Many times more so when she has dementia. Whatever advice or precaution you give doesn't sink in. A lot of time and patience is needed to explain and repeat instructions given by the doctors. As soon as you have done explaining one simple instruction, it's forgotten within the next minute.

It is this dementia that complicates an otherwise smooth transition to full recovery for my mother. It is also this that wears down the caregiver, yours truly, who has to keep an eye on her almost every minute of the day. Fortunately, everyone at home helps out. My 5-year old grand-daughter watches over mom while I am in the kitchen preparing a glass of milk for her. "Make sure great grandma doesn't try to get up from her bed," I tell her. She nods her head, feeling important and proud to be a member of the homecare team.

The nights are the most stressful for me. I have to be alert for every sound or move that my mom makes. There's the constant fear that she might try and get up on her own. So I fight sleep to be on guard. My mom doesn't fully comprehend the dire consequences of a second fall, even though the doctor has repeatedly reminded her. In fact she stubbornly insists that she's never had an operation in her life, even when we show her the x-rays and medical reports.

That's the challenge of caring for my mom. And it looks like the family's in for the long haul.

If it takes a village to raise a child, it takes the whole family to care for an elderly parent, especially one with medical problems. At least, that's the way it should be. Not only should family members contribute towards the medical expenses, but also share in the caregiving. More helping hands means less stress for the primary caregiver.

Siblings can take turns to spend time with their aged parent. It shouldn't always have to be the daughter who is not married, or who has no children, or who is widowed, to be the primary caregiver, as is the general practice. This is making presumptions that she is the best person to take care of their aged mother or father. Everyone has to make sacrifices, not just one sibling. It should not be that life goes on uninterrupted for all, except the caregiver sibling who has to make drastic adjustments to her lifestyle.

I am pointing this out because I know of many cases where the unmarried daughter is often the sibling who bears the heavy responsibility of caring for an ailing parent all on her own. It's time the other siblings woke up to the fact that it's a shared responsibility. Those who can't provide the physical caregiving, can contribute financially towards the care of their elderly parents. So, ladies, you are no less filial if you appeal to your other siblings for some assistance, financial or otherwise. Their empathy alone is not enough. (Pic: I picked this up at the National Library Singapore last month. A good read for daughters who are caregivers of their elderly parents.)

I am fortunate that my siblings are supportive. My younger sister from Batu Pahat is relieving me for the next few days so that I can attend the Asia Pacific Conference on Ageing in Singapore. I have cancelled all my scheduled activities and appointments for the coming months, except for the APCA. Hopefully I might pick up something useful that will help me to better understand my mom's dementia and provide her with the care that she needs.

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MARKING TIME IN HOSPITAL...

Today is Day 7 of my mother's hospitalization. She had an angioplasty done on her last Tuesday. She's doing fine, eating well and enjoys being pampered by her visitors and the nurses. Still, she is impatient to go home. She has been lying in bed 24/7, unable to move much as her right leg is in traction. The doctors are waiting till her heart is strong enough for the hip surgery. Although she is generally cheerful especially when she has visitors, I know she feels depressed sometimes. That's when she talks about joining my younger sister who has passed on. We haven't told her about the hip surgery scheduled for next Tuesday, or she will worry no end about it.

Blocked arteries are not the only setback that my mother has. Dr Tiang suspects she also has early signs of dementia. She can't differentiate between night and day. She sleeps more during the day than at night. Her room-mates have complained that she keeps them up during the night. She's either snoring loudly or pleading with the nurses to allow  her to go home. Having a family member stay the night with her compounds the problem, as she keeps up a running conversation with whoever is by her bedside. Mom just loves to chat.

To solve the problem, every night at about 11pm, the nurses move mom to the treatment room next to the reception counter. She has the room all to herself, and the nurses are close enough to hear her when she calls for assistance. In the morning before the doctors make their rounds, the nurses move her back to her 2-bed room across the hallway. I have told the nurses I am not too happy with this arrangement.

Mom says the smile is to let family and friends know that she's fine except for her immobility.

It didn't surprise me at all to hear that mother is in the early stages of dementia. In the past two years, I've noticed she's become increasingly confused about dates, faces, and places. She can't remember where she leaves her things, and accuses people of stealing them. She is easily suspicious.

To understand my mother's ailments better, I have been reading books on caring for elderly parents, in particular, parents with Alzheimer's Disease. Looking back, I wonder if in my sub-conscious mind I was perhaps preparing myself for a time when my mother would be needing specialized care-giving beyond what I am able to provide on my own.

If you are looking for an insight into the ageing process, and how to cope with elderly parents with special needs, I would recommend the above books. I am not sure if "You and Your Aging Parent" is available now. I bought my copy years ago. "The Alzheimer's Caregiving Puzzle" is on loan from the National Library Singapore. I'm still reading it.

I shall be sharing what I've gleaned from my readings in future posts on this blog.

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