By Vincent D’Silva

JOHOR BARU: With the world aging rapidly, Malaysia will also experience this shift. By 2035, 15% of its population is expected to be elderly, putting Malaysia in the list of aging countries.

The deterioration of our body’s tissues and organs is one effect of aging. Dementia is the outcome when brain cells are affected.

In an exclusive interview with ApaKhabar TV, Dr Suraya Yusoff, an expert on mental health said dementia is a syndrome that shows memory loss, behavioural abnormalities, and a decline in cognitive function.

“Over time, it causes victims to become dependent and incapacitated,” said Dr Suraya who is a senior consultant psychiatrist.

Dr Suraya Yusoff

While dementia is associated with older age, Dr Suraya said it can also appear in younger people.

She made it clear that there is no cure for dementia, but dementia is preventable.

Meanwhile, research indicates that addressing the 14 modifiable risk factors identified by the Lancet commission in 2024—namely, insufficient education, hearing impairment, untreated vision impairment, hypertension, elevated LDL cholesterol, tobacco use, obesity, depression, lack of physical activity, diabetes, excessive alcohol intake, traumatic brain injury (TBI), air pollution, and social isolation—could potentially lower the likelihood of developing dementia.

She went on to say that the presence of three or more risk factors double up your chances of getting dementia. (Source: Malaysia’s CPG Management of Dementia 3rd Edition 2021).

However, according to Dr Suraya, an earlier health survey showed that 8.1% (1.7 million) people in Malaysia currently live with the three major cardiovascular (hypertension, diabetes and hypercholesterolemia) risk factors for dementia. (Source: Infographic NHMS 2019). Risk factors that cannot be modified are age, being female and genetics (apo-E and presenilin).

She said a national health survey carried out in 2018 among individuals aged 60 years and older estimated that approximately 8.5% of older adults, equating to about 260,000 individuals in Malaysia, are affected by dementia.

She stressed that the findings indicated that the prevalence was greater among females, individuals without formal education, and those residing in rural regions of Malaysia.

Additionally, she said the survey revealed that the quality of life for caregivers of individuals with dementia is significantly poorer, primarily due to the deteriorating functional abilities and insufficient social support.

“Caring for a person with dementia needs to involve the whole community,” she asserted.

The Malaysian government, she mentioned, considers dementia to be a significant public health issue of utmost importance.

As a participant among the 194 Member States of the World Health Organization (WHO) Global Action Plan addressing the public health response to dementia, she said WHO aims for a minimum of 75% of countries to formulate or revise their national policies, strategies, plans, or frameworks concerning dementia by the year 2025.

Malaysia, she noted has accepted the challenge to tackle this pressing issue facing the nation.

The Ministry of Health officially launched the National Dementia Action Plan (NDAP) for the years 2023-2030 on October 1, 2024.

She said the action plan delineates four key priorities aimed at addressing the complex aspects of dementia and its impact on individuals, families, and society as a whole. The strategies and activities associated with each priority are comprehensively outlined within the action plan.

The primary focus, “Empowering Healthy and Active Communities,” is dedicated to fostering environments that enhance overall well-being and address the specific requirements of individuals impacted by dementia.

“The focus will be on dementia awareness, health promotional activities and the enhancement of dementia friendly environment,” Dr Suraya said.

She said dementia awareness and understanding are crucial elements that motivate individuals affected by dementia to pursue medical care and intervention, as well as to engage in preventive measures.

“Insufficient awareness and knowledge can result in stigma associated with dementia, including labelling, stereotyping, social isolation, diminished social standing, and discrimination against both the individuals experiencing dementia and their caregivers,” said Dr Suraya who is currently an associate professor of Psychiatry (Clinical) at Newcastle University Medicine Malaysia.

She admitted there is a general lack of awareness regarding dementia among Malaysians, including healthcare providers, which may result in the inadequate implementation of timely secondary prevention strategies.

There are currently seven registered organisations dedicated to supporting individuals with dementia across the country, specifically located in Kuala Lumpur, Selangor, Perak, Penang, Johor, Sabah, and Sarawak.

She said these organisations primarily operate in urban areas, with limited outreach to rural regions. Their activities encompass advocacy, public awareness campaigns, educational initiatives, and support services for caregivers of those affected by dementia.

However, not all of these organisations offer daycare services for individuals with dementia. Collaboration between the government, local councils, and private agencies with these organisations would undoubtedly enhance community support.

A notable example of such an initiative is the Atria-ADFM Community Corner (AACC), situated on the third floor of the Atria Shopping Complex.

She said this dementia-friendly space provides essential support to local communities, aiming to increase awareness of dementia and facilitate a more normal and fulfilling daily life for individuals with dementia.

Additionally, it seeks to combat stigma, reduce social isolation, enhance understanding of dementia, and empower those affected, while also recognising the challenges faced by caregivers.

The second priority, “Enhancing a Sustainable Healthcare and Social Support System for Dementia,” signifies the creation of a comprehensive framework designed to meet the changing health and social needs of individuals affected by dementia.

This encompasses initiatives that promote integrated, person-centered quality care and management, utilising multidisciplinary approaches for those living with dementia. It is essential that healthcare professionals and stakeholders, particularly caregivers and care partners, receive adequate training and skill development in dementia management.

In 2016, WHO partnered with the Ministry of Health and the Alzheimer’s Disease Foundation Malaysia (ADFM) to offer Dementia Care Skills training. This programme is intended to equip caregivers with the necessary skills to support dementia patients both at home and in specialised care facilities.

Since its inception, nearly 1,000 caregivers have completed the training. There is a need to further enhance this course by integrating the clinical practice guidelines for dementia management (3rd edition) into the curriculum, along with the issuance of certificates upon successful completion, she said.

A scoping review conducted by Lai et al. and published in the journal ‘Aging and Health Research’ in 2022 has identified a total of 16 research gaps within the extensive field of dementia studies.

These gaps encompass various domains, including economic, demographic, public policy, and social and cultural issues related to dementia.

This identification serves as a guide for future dementia research in Malaysia and emphasizes the need to establish a robust research infrastructure to address these gaps effectively. It is fitting that the third priority of the National Dementia Action Plan (NDAP) focuses on “Research, Innovation, and Information Sharing on Dementia.”

“The aim is to promote the creation of new knowledge, innovative solutions, and essential information exchange, thereby positioning Malaysia alongside global scientific communities,” she said.

The renowned advocate on dementia said the creation of the NDAP lacks significance if the critical aspects of accountability and effectiveness are not acknowledged.

Therefore, she said the fourth priority, “Enhancing Monitoring and Evaluation of Health Programs for Individuals with Dementia,” aims to guarantee a comprehensive and thorough assessment of the action plan’s impact and sustainability.

Dr Suraya said the creation of the NDAP lacks significance if the importance of accountability and effectiveness is not acknowledged. Therefore, the fourth priority, “Enhancing Monitoring and Evaluation of Health Programs for Individuals with Dementia,” aims to guarantee a comprehensive and thorough assessment of the action plan’s impact and sustainability.

The formulation of NDAP is relatively straightforward; however, the subsequent implementation poses significant challenges.

“A primary concern that threatens the success of the NDAP is the absence of a designated budget for the outlined activities,” said Dr Suraya.

To facilitate the government’s commitment to the NDAP, a provisional committee known as the Dementia Alliance of Malaysia (DAMai) has been established, consisting of healthcare professionals and various stakeholders.

The inaugural dementia workshop is scheduled to take place from February 15 to 16, 2025, in Kuala Lumpur.

“Although achieving the targets set forth in the NDAP within five years may appear daunting, it represents a crucial initial step towards unifying all sectors, agencies, organisations, and other entities involved in dementia care to work collaboratively towards a common objective,” she added.

NOTE: Dr Suraya set up the first elderly mental health services and memory clinic in Malaysia in 1998. Her contributions include the ‘National Mental Health framework, 2003’, the ‘National Mental Health Regulations 2007’, and the development of the fellowship psychogeriatric subspecialty training in Malaysia. She was also the Chairperson for first two Malaysian CPG for Management of Dementia. She founded the Johor Baru Alzheimer’s Disease Support Association (JOBADA) and is an executive member of Asian Society Against Dementia (ASAD).

Ends.