Reducing risk of dementia

AROUND 8.7% of Malaysia’s population aged 60 and above, or 300,000 individuals, currently live with dementia.

Malaysia does not have official data on individuals who experience dementia at a younger age, such as in their 30s, or even during childhood. This misconception has led to the false belief that dementia only affects older adults, although it is important to note that ageing is a risk factor but not the sole cause of dementia.

Given that Malaysia is an ageing nation, with a high prevalence of dementia risk factors and the neurological consequences of Long Covid, we are facing a looming dementia-related crisis, which will not only impact the well-being of individuals but also have significant repercussions on society, economic productivity and healthcare services.

However, strong evidence indicates that as much as 40% of dementia cases can be prevented or delayed with the adoption of healthy lifestyles and the creation of supportive environments at various life stages.

Dementia is associated with 12 modifiable risk factors, including physical inactivity, smoking, excessive alcohol consumption, exposure to air pollution, head injuries, limited social interactions, lower levels of education, obesity, hypertension, diabetes, depression and hearing impairment. By proactively addressing these factors, we can mitigate these risks while promoting brain health and overall well-being.

Dementia initially manifests as a decline in high-level cognitive functions. The concept of “cognitive reserve” refers to the mental abilities we accumulate over our lifetime, which act as a protective buffer against cognitive decline resulting from ageing, diseases or brain injuries. Enhancing our resilience can provide us with a greater cognitive reserve as we age.

The idea that our cumulative life experiences contribute to building cognitive reserve is derived from long-term studies involving large populations. These experiences can reduce the risk of Alzheimer’s disease by approximately 35% to 40%.

Contributing factors

Individuals with less education are at a higher risk of losing their cognitive reserve. While the majority of children and young individuals in Malaysia have access to both formal and informal education, 5% have never had formal schooling, and 18% have discontinued their education before completing Form Five.

During middle age, the factors contributing to dementia include obesity, hypertension, hearing impairment, alcohol consumption and traumatic brain injury. Obesity is prevalent among adults, with one in two being overweight or obese.

Obesity is linked to two dementia-related risk factors: hypertension and diabetes. Three in 10 adults, or 6.4 million Malaysians, have hypertension.

Negative attitudes and societal stigma around weight issues can erode self-esteem and confidence, leading to depression and isolation. These factors can increase the risk of dementia later in years.

There are 7.6% of Malaysians with hearing difficulties. Hearing loss contributes to 8% of dementia cases worldwide. Hearing loss can cause the ageing brain to shrink faster. Verbal and emotional information in speech is a critical mediator of complex social interactions. Less access to that mediator can reduce the quality of social interactions. Poor social interactions are a risk factor for dementia.

Depression, especially in later life (over 65), is linked to an increased risk of dementia and is a contributing factor in up to 4% of global dementia cases. Dementia risk is higher for men than women.

Excessive alcohol consumption can also contribute to dementia risks.

Incidents of road crashes that result in head injuries can elevate the likelihood of developing dementia. Malaysia records over 500,000 road traffic injuries each year.

Physical attacks (14.8%), fights (16%) and domestic physical abuse (7.5%) can cause traumatic brain injury, affecting mental health, causing depression and be a risk factor for dementia in later life.

More than 90% of adolescents and adults have unhealthy dietary patterns. Diabetes, a risk factor associated with dementia, is prevalent among one in five Malaysians aged 18 and above, affecting approximately 3.9 million individuals.

Malaysians are generally physically inactive. Nearly 60% of individuals aged 75 and above maintain a sedentary lifestyle.

Furthermore, one of four adults aged 16 and above, or 80%, are not actively engaged in physical activities, and around 66% follow a sedentary lifestyle.

In all age groups, there is a worrying prevalence of mental health issues. Before the Covid-19 pandemic, approximately half a million adults had depression and one in 10 adults over 60 reported being depressed.

Around 8% of children aged five to 15 have had mental health problems, and one in four teenagers have experienced depression.

In addition, 41% of youngsters have experienced verbal abuse at home, and 8.6% have been victims of bullying. These negative experiences often lead to social isolation, a risk factor for developing dementia.

Globally, smoking is linked with dementia and an estimated 5% of smokers have dementia. Thus, it is worrying that around 4.8 million Malaysians aged 15 and above are smokers.

Among adults aged 60 and above, 10% are smokers. Smoking elevates the risk of developing diabetes, thereby increasing the likelihood of smokers having diabetes and dementia.

The significant rise in vaping by adolescents and youths in Malaysia adds to this concern. In a study of over 18,000 US high school students, adolescents who smoked tobacco or used e-cigarettes reported higher levels of difficulty in concentrating, remembering or making decisions.

Malaysia has “moderate” pollution levels that can cause respiratory and cardiovascular diseases, leading to death. The “moderate pollution levels” are no cause for complacency: long-term exposure to air pollution is linked with a risk of developing dementia as highlighted in a Lancet study.

Proactive measures

We can take action to prevent and delay cognitive decline. These include exercising regularly, eating a healthy diet, consuming alcohol in moderation for those who do and refraining from smoking.

Engaging in intellectually stimulating activities, such as learning languages can help maintain cognitive abilities and promote brain health.

Participating in social activities with family and friends, joining community groups and having support networks are crucial for brain and mental health.

At the policy level, we must ensure that every child in Malaysia has access to quality education. Lifelong learning, such as the University of the Third Age Malaysia, which facilitates and supports older persons in learning for leisure that benefits health and well-being, should be expanded and made more affordable and accessible.

It is time for health promotion initiatives to integrate messages about a healthy brain, for example, “what is good for the heart is good for the brain”.

Sharifah Tahir, care partner, Teepa Snow Positive Approach to Care© certified independent consultant and trainer, founder of UMI-UniquelyMeInitiatives, Yuenwah San, co-founder-member, The OKU Rights Matter Project, disability rights activist-care partner and Datuk Dr Amar-Singh HSS, consultant paediatrician and child-disability activist. Comments: letters@thesundaily.com

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