Over the weekend, I attended a symposium on dementia, for primary care physicians, organised by Khoo Teck Puat Hospital and chaired by Dr Philip Yap.
There were many interesting conversations, in particular during the Q&A session, especially centred around the screening and prevention of dementia. It is a very pressing problem indeed.
The situation today
It is estimated that approximately 10% of the population above the age of 65 has dementia. Taking one of our ‘townships’ in Singapore as an example – Chong Pang :
- There are approximately 320 patients with dementia in the KTPH dementia registry.
- Given that there are about 10,000 people in Chong Pang above the age of 65, a reasonable estimate of the number of patients with dementia in Chong Pang would be about 1000.
- This means that there are 680 (1000 – 320) people with dementia who are undiagnosed in Chong Pang, and do not receive help.
And so the question was posed – how then can we improve awareness and case-finding of dementia in the community?
I was surprised to hear the honest answer. Which is that if we were to find all the cases of dementia in the community today, our healthcare system will not be able to cope. There are not enough geriatricians (it’s not a sexy specialty, like opthalmology) to handle the load, and primary care physicians are too burdened with managing other problems to be able to spend the extended amount of time required to diagnose and manage the dementia patient. The waiting times for the memory clinic at KTPH is about 3 months, and in other hospitals it is often 6 months. Perhaps it might be better to keep one eye shut and let it be – not presenting to the doctor may mean that patients with dementia (and their families) do not recognise it as a problem to them. Very sobering.
Which means that the only choice we have is to focus on the longer-term solution of prevention, while muddling our way through the problem in the meantime. The FINGER stick done by the Finnish was very interesting – multidomain intervention involving a healthy diet, exercise, cognitive training and social support was proven to improve/maintain cognitive function in the at risk population. Definitely need to have a closer look at this.