MY MOM HAS ALZHEIMER'S - WILL I GET IT TOO?

My mother first showed signs of Alzheimer's Disease probably as early as 2008. She was 82 then. She couldn't remember dates, places and names of family members. She couldn't tell one day from another, and forgot what she just had for dinner or where she had left her purse.

That was 11 years ago. I had not heard of Alzheimer's Disease (AD) then. Like most people with elderly parents at home, I took these signs as part of the normal ageing process. It was commonly accepted that people turned senile (nyanyok) in their old age, so I wasn't too concerned about it. It was only later that I discovered having AD is NOT part of ageing. It does not happen to every elderly person.

My mom would repeatedly ask the same questions even though I had just given the answers. It was almost impossible to hold a simple conversation with her. Her attention would drift off to some distant places in her memory. It was as if a mist had clouded the clarity of the moment. She was there with me but yet not there. I didn't know then how to handle such a situation.

It took a fall at home and subsequent hip surgery for my mom in March 2011 before I learned about Alzheimer's. During the ten days my mom was in hospital, her doctor noticed signs of the disease in her behaviour. He suggested I take her to see a geriatrician for a proper examination. A visit to see Dr Philip Poi at UMMC Specialist Hospital and some tests later confirmed my mom had AD.

Learning more about dementia at Hogeweyk, Amsterdam, and pursuing an MSc degree in Applied Gerontology so I could better understand the ageing process.

Thus began my interest in reading up as much as I could about AD. In December 2013, I signed up for an online course on Living with Dementia: Impact on Individuals, Caregivers, Communities and Societies offered by Johns Hopkins University. In 2015, my passion to learn more about AD took me to Hogeweyk, the world's first dementia village in Amsterdam. In 2017, I enrolled for MSc in Applied Gerontology at NTU, Singapore. At 70, I was the oldest graduand in the pioneer batch. I attended numerous conferences to learn about the latest developments in AD research and treatment. As my mom's primary caregiver, I wanted to know how to provide better care for her. At the same time I could learn how to avoid ending up with AD myself. And as a blogger and founder of a seniors' community, I could share what I have learned with others.

The statistics for Alzheimer's are alarming. According to the World Health Organisation Report (WHO) 2019, there are currently 50 million persons with dementia (PWDs). This number is expected to increase to over 150 million in 2050. The World Health Organisation (WHO) 2014 report put the number of people in Malaysia with dementia in 2015 at 123,000. This number was projected to be 261,000 by 2030 and would continue to increase to 590,000 people in 2050. Alarming statistics!

What's the difference between dementia and Alzheimer's Disease?

I have frequently been asked this question. Put simply, dementia is an umbrella term for a host of diseases that affect the normal functioning of the brain. Depending on which part of the brain is affected, diseases associated with dementia include Alzheimer's Disease, vascular dementia, Lewy bodies (DLB) and frontotemporal dementia. The most common of these is Alzheimer's Disease which affects mostly the elderly. However, early onset dementia affecting adults in their 40s and 50s is on the rise.

Is Alzheimer's Disease hereditary?

This is the golden question for me. Aside from my mom, my great grandmother probably had it too. When I was growing up in the 1950s I recall seeing her playing with a baby doll, and treating it as if it were her own child. Another time I saw her packing a few personal belongings in a sarong, and telling the family she was going to take a trishaw 'home', meaning China. These incidents are etched in my memory. I have at least four members in my extended family who were diagnosed with dementia (AD) in their final years. 

Like my mom, one of my aunts also showed signs of behavioural changes in her old age. She would accuse everyone of conspiracy, of hiding her passport and stealing her money. All not true, of course. But when she told me so-and-so had stolen her valuables, I believed her. It was only later when she was diagnosed with AD that everything she said and did began to make sense.

Does that put me at risk? Yes, but at risk does not mean 100% or even 30% certainty. I may or may not develop AD. There are preventive measures I can take to reduce the risks, such as exercises and activities that promote brain health and cognitive functioning.

Read about the APOE gene that determines whether you may be at risk of developing AD.

I am very forgetful. Is this a sign of early Alzheimer's Disease?

All of us are forgetful, some more than others. How often have we forgotten where we parked our car, the name of someone we have just been introduced to, or the lyrics of songs we used to sing? We refer to these lapses of memory as 'senior moments'. Red flags of AD include repeatedly forgetting recent events and confusion in retrieving them. This Mild Cognitive Impairment (MCI) or lapses in short-term memory may signal early Alzheimer's. Over time as the disease progresses, these memory lapses can potentially have serious consequences. My mom would forget to turn off the gas completely after cooking, forget to lock the front door when she left the house, or forget whether she had taken her medication. The latter could have resulted in a drug overdose. My mom also had mood swings, an obsession with collecting tissue paper and was prone to wandering around the house at wee hours of the morning.

My mom enjoyed browsing through newspapers and magazines. I bought this book for her in the hope the images would trigger recall from the deep recesses of her memory.

We often read in the papers of a missing elderly who later turned out to have forgotten how to get home. There are no statistics on the number of such cases in Malaysia. The Japan Times (June 2019) reported that a record 16,927 dementia patients in Japan went missing in 2018. Alarming indeed. Do not leave an elderly unaccompanied especially in an unfamiliar place e.g. a busy hospital or a noisy mall. My mom had on several occasions stopped midway to our neighbourhood supermarket, unsure whether she was heading in the right direction despite having walked there countless times before. Confusion with directions is common in PWDs.

Can Alzheimer's be prevented?

Thanks to Google and the efforts of the Alzheimer's Disease Foundation of Malaysia (ADFM) over the years to educate the public, we now know more about AD. Not everyone develops the disease in their old age. There are people in their 80s and 90s whose minds continue to remain sharp. 

At present there is no cure for AD despite what we read in the media, from coconut oil to ayuvedic treatment. Prescribed medicines for AD can only slow down the progress of the disease at best. Most of the drugs, e.g. memantine, have side effects. AD is a degenerative disease that can span many years, ultimately ending in death. I have watched my mom slowly change from a lively chatty woman to a shadow of her former self. After suffering a mini-stroke in February 2019, she lost her ability to speak, and her memory completely left her. She did not know who I was nor did she even ask. She would sit in total silence, in a world of her own where visitors were barred from entering.

When my mom was discharged from hospital after her second surgery, she was prescribed expensive drugs by one doctor after another. After several years of seeing little improvement in my mom, and on the advice of a doctor friend, I decided to stop all the medication. My mom remained mostly drug-free till the last couple of years after her stroke when she had to take prescription drugs as and when needed. In general she maintained a hearty appetite and slept well  That was good enough for me.

Here's what I would like to share from what I have learned and practised. Preventive steps for dementia do not cost much money. Follow a regular exercise regime and adopt a healthy diet. Monitor your sugar level, blood pressure and weight. Keep your brain actively engaged with mental stimulation such as learning a new language or a new skill. Travelling broadens the mind, so go on trips whenever you can. Finally, build a network of close friends and avoid social isolation.

What preventive measures do I take?

As I am at higher risk than others of getting Alzheimer's, I make sure I stay active physically and mentally. I have always been active, interested in and curious about a lot of things. I read a lot, especially on ageing-related issues. I write a lot too. Curating for news and events to share on Facebook keeps me mentally busy daily. These activities stimulate the brain. That is why I enrolled for my second masters degree at a late age. I also took up singing, line dancing and learned to play the ukulele. Memorizing lyrics, dance steps and ukulele chords helps to stimulate my brain cells. I have been attending courses offered by the University of the Third Age (U3A) since 2011. Lifelong learning keeps the brain well-oiled and the social connections I make will hopefully keep AD at bay. 'Never too old to learn new things' has become my mantra for living life with a positive mindset.

The Mini Mental State Exam (MMSE) is widely used to test for cognitive function. My mom refused to draw the clock when the doctor told her to. She probably could not remember the order of the numbers.

If you are curious to know whether you or a family member has early AD, you could try taking the Mini-Mental State Examnation (MMSE). It is a popular test for cognitive functioning, and includes tests on memory recall, language and focus. There is even a Malay version. The scores will provide an indication of whether the person has any cognitive impairment. As it is only a simple diagnostic test, it should be followed up with a visit to the geriatrician for a full examination. 

When the pandemic SOP allows it, drop by at ADFM community corner at Wisma Atria, PJ, to find out more about AD. There are weekly group activities there for PWDs (persons with dementia) and their caregivers.

(The above article was first posted in Nov 2019. It has been updated after my mom passed away in February 2021. Her journey with Alzheimer's lasted eleven years from her diagnosis. I am glad most of those years were relatively happy ones for her.)

WHEN COMPASSION ALONE IS NOT ENOUGH

Some people are blessed with all the good things in life, while others struggle every day of their lives. Good luck is always in short supply. Take a walk in the inner city and you will encounter the poor, the sick and the homeless. The compassionate among us want to reach out and help, but do not know where to begin, or how to go about it. The sheer number of those in need is daunting.

But not all who need help are found on the streets and back lanes of the city. There are many middle class families living in suburban homes who are in dire straits. Who can tell what tales of misfortune lie behind the front door and within those walls? Having a car parked in the front porch does not always reflect the true financial situation of the families occupying those houses. The smiling faces we see in social settings may hide untold tragedies in their lives.

It was against this backdrop that Siew Lim and I from SeniorsAloud team visited Elaine Khaw last Friday afternoon (14 July). Two years ago I had read in an online article 'Malaysia's Forgotten Music Man' that well-known musician Datuk Ooi Eow Jin had been diagnosed with Alzheimer's. His wife Elaine had been struggling to look after their elder son who had brain tumour. Now she had the added responsibility of caring for her husband as well. Moved by the story, I made attempts to contact Elaine to see how SeniorsAloud could help. But my efforts were in vain. All my calls went unanswered.

Lovely photo of Ooi and Elaine in happier times. (Photo credit: The Star: 'A Malaysian Musical Legend')

Then out of the blue, about a fortnight ago, Siew Lim said she had met Elaine recently at a teahouse, and had her contact number. We made plans to visit Elaine at her home in Petaling Jaya. Reaching out to Elaine was always on my mind. My mom has Alzheimer's so I knew what she must be going through as a caregiver looking after the two men in her family.

Prized photos. (Left)  Ooi with the legendary P. Ramlee, and (right) receiving his datukship from Yang di-Pertua Negeri Tun Abdul Rahman Abbas in Penang in 2015.

For those not familiar with the story, or with Ooi Eow Jin, his name was synonymous with the RTM orchestra for 17 years in the 1960s and 70s. He gained fame as a songwriter and composer of some of the most popular Malay songs of that era. His checkered career also included 13 years with TV3 and a short stint as a lecturer at Universiti Putra Malaysia, Universiti Teknologi Mara and International College of Music. His last job was with Majestic Hotel where he was the resident pianist for five years.

Ooi entertaining guests at a 2015 charity concert to raise funds for his family.

Those heydays of playing music and recording songs with some of Malaysia's top entertainers like Sudirman, P. Ramlee and Rafael Buang are long gone. The years have passed but Ooi never stopped playing music. It was his only means of supporting his family. Fate dealt him and Elaine a double blow when they lost their younger son, Leong Seng, to leukimia at age 23, and their elder son, Chin Seng, now 53, had brain tumour and required two surgeries. To add to their misfortune, Ooi was diagnosed with early Alzheimer's Disease. This put an end to his piano-playing days at Majestic Hotel in June 2015. He has been jobless since then. He turned 80 last month.

Although able to move about, father and son spend most of the day in bed watched over by Elaine and the maid.

Giving Ooi a shave

The heavy burden of caring for her husband and her sons has left a toll on Elaine. The mental and physical stress is evident. Hanging on the wall of the living room is a portrait of Elaine, still beautiful at age 58. Now, at 78, she has lost much of that joie de vivre. As I spoke with her, I could see the bags under her eyes and the deep lines on her face. I am taking medicine for depression, she tells me.

Elaine has a maid to help her look after the two men during the day, so she could take a break or go out to run errands. But she is entirely on her own at night to watch over Ooi and Chin Seng. Ooi's Alzheimer's has worsened. Chin Seng has problems with his vision after a recent surgery, and has lost his sense of balance. The living room has been turned into a bedroom, and Elaine sleeps on the sofa nearby.

Me, Siew Lim and Elaine - seniors helping seniors whenever we can

Elaine's friends and neighbours as well as Ooi's former colleagues at RTM and TV3 organized two charity concerts in 2015 to raise funds for the family. Without a steady income and with rising monthly expenses for medicine, food and diapers, the funds raised are fast being depleted. Elaine has to fork out RM120 a day for the maid, an expense she can ill afford but necessary as having someone around to help allows her to take a break.

Elaine needs financial help and welcomes donations in kind, especially diapers. If you would like to reach out to Elaine in any way, you can contact Siew Lim for more information

Related article:

Wife of ailing composer shoulders the burden of caring for her sick husband and son
(The Star Metro: 7 May 2016)

A SALUTE TO ALL CAREGIVERS

Today is the last day of World Alzheimer's Month, and tomorrow (1 Oct 2015) is UN's 25th International Day of Older Persons. What better way to spend the day than at Hospital Kuala Lumpur's celebration of Older Persons.

The main lobby was packed with senior citizens checking out the poster exhibition and queuing up for the various free health tests. But it was the forum that drew my interest, in particular, Dr Rizah Mazzuin's presentation on 'Caregiver Stress'. Dr Rizah is a geriatrician with Hospital KL.

Any primary caregiver looking after an elderly person with Alzheimer's can tell you about the STRESS plus FRUSTRATION you will face. You have to look after a person who is often uncooperative, unresponsive and unpredictable. That's the nature of Alzheimer's - a disease which eats away at one's ability to remember, communicate and function normally.

Most caregivers are reluctant to seek help from others as they consider it their filial duty to care for their elderly parents, and they should accept it without complaint. However, caregivers who are overly stressed will do more harm than good not only to the care receiver, but also to themselves. They become impatient, irritable or worse, abusive to the person they are supposed to care for. Their health suffers, and they may end up with serious mental problems like depression.

If you are the sole caregiver of someone with Alzheimer's, do seek help from your siblings, neighbours or part-time nurses. Get them to take over for a few hours a week so that you can have a break to rest, relax and revitalize. (Read how my siblings helped out when I became primary caregiver for my mom after her hip surgery.  To complicate the caregiving, she was also diagnosed with Alzheimer's. (http://www.seniorsaloud.com/2011/03/it-takes-whole-family.html)

In June 2011, my daughters gave me an all-expense paid week-long vacation in Phuket. They called it my 'caregiver break' as they felt I needed to get away and re-energize. More at http://www.seniorsaloud.com/2011/06/caregiver-takes-break-in-phuket.html

Learn to delegate. Also learn to accept that others who help you may not do things exactly the same way as you do. In other words, don't micro-manage. People are more willing to help you if you are reasonable in your expectations.

Take care of your health. Exercise daily, follow a balanced diet, and get suffcient quality sleep. Meditation also helps to calm you as looking after an AD patient can be most frustrating, even exasperating.

Join a support group like ADFM NATIONAL ALZHEIMER'S CAREGIVERS SUPPORT NETWORK MALAYSIA. Nothing helps to relieve stress more than sharing your concerns with others who are on the same caregiving journey as you. There is comfort in knowing that you are not alone.

Remember:

HOGEWEY - A PLACE LIKE HOME FOR THOSE WITH DEMENTIA

Thanks to an unexpected birthday gift of a return air ticket to Amsterdam, I had the opportunity to visit Hogewey Village. It has been on my wish list since I first read about the place two years ago, and watched CNN's Dr Sanjay Gupta's insightful documentary 'Dementia Village'. Now I can happily strike Hogewey off my wish list.

The prime mover behind this innovative concept is co-founder and former nurse Yvonne van Amerongen. I had emailed her earlier requesting permission to visit the facility with Marianne Abbink Lankhorst, my Dutch friend. She wrote back to say we were both welcomed to visit anytime. Excellent!

So there we were at Hogewey on a warm Thursday afternoon of 29 July 2015. Visitors enter and exit via the sliding door which is controlled by the receptionist. The door remains closed to the residents. They are not allowed out of the facility on their own.

We were given a map showing the layout of the place, and several information sheets about Hogewey. We had the freedom to move around and explore but were reminded to respect the privacy of the residents. In other words, no peering into their living quarters or taking their photos without their permission. But we were welcome to use the information and images provided on the Vivium website.

Front view of Hogewey

The homes and the courtyards. So much greenery and flowering shrubs, and benches everywhere.

The Indonesian lifestyle corner. Indonesia was once a Dutch colony.

As we had no access to the homes, this composite image is taken from internet sources. It gives you an idea of the different lifestyle settings. Residents are housed in groups according to the lifestyle they are familiar with. 

Hogewey is the world's first village built specifically for people in the advanced stage of dementia. The concept for it is based on the belief that dementia patients can still enjoy a relatively normal life if they live together with like-minded people in an environment that is familiar to them.

Residents share a common dining room and living room (Images: Daily Mail)

There are currently 152 residents at Hogewey, with six to seven housed in each of the 23 homes. grouped into seven distinct lifestyle settings: urban, homely, cultural, traditional, Gooi (well-to-do), Indonesian and Christian. Residents have their own bedrooms but share a common living room, dining room and kitchen. Each home has one or two staff to look after the residents and do the cooking.

Another view of the homes. 

The staff at Hogewey outnumber the residents 4:1. You will see them as housekeepers, shop assistants and minders, but you won't find them in staff uniform. Volunteers are identified by a nondescript badge they wear. Hogewey takes great pains to avoid any resemblance to a hospital or a nursing home. Instead, it strives to make Hogewey as close as possible to a small gated neighbourhood complete with its own supermarket, cafe, restaurant, beauty salon and theatre. There is a large central square and smaller ones or courtyards with benches and chairs where residents can sit and soak in the sunshine, weather permitting.

(When we were there, there was intermittent rain. That explains why you don't see any residents outdoors in the photos.)

Join me as I take you on a tour of Hogewey.

The main boulevard, with shops flanking both sides.

The cafe is the first outlet you see on your left as you walk along the boulevard.

This is probably where the residents go to work their muscles and limbs.

There's even a repair shop in case anything needs fixing.

Inside the beauty salon. We didn't get to enter so this image is taken from the Daily Mail.

This is The Passage - a spacious hall where the residents gather to enjoy group activities. There is always music playing in the background as the elderly love music from the old days. Expect to see some of them dancing too. We did.

That's Marianne at the door of the Rembrandt Room. This is where the residents enjoy art and craft activities.

The supermarket at Hogewey is well-stocked. Every item carries a price tag. The cashier issues a receipt for purchases but no cash changes hands. All transactions are covered in the residents' payment scheme.

There are no locks anywhere. Doors and elevators open and close as you step on the weight-sensitive floor panel. Residents have the freedom to move around and participate in the daily programme of activities if they wish to. The objective is to make life in Hogewey as normal as possible, and as close to what they are accustomed to.

No need to press any button or turn any door knob. Doors open when you step on the floor panel in front of it.

According to Yvonne in the CNN interview, the concept works. Residents do not need as much medication, they seem happier and are living longer. The Hogewey model has been replicated in Canada, Switzerland and the UK, and that's evidence of its success, aside from the awards it has won since 2010. Apparently those on the waiting list have to wait at least a year before there is a vacancy. That only happens when a resident has passed on. Hogewey is where those with severe dementia come to live out their remaining years in peace and with dignity.



The residents I met while strolling around Hogewey gave me friendly smiles and nods. Except for one resident in a wheelchair cuddling a doll, visitors would not know that the elderly folk enjoying activities in The Passage have Alzheimer's. A group was happily playing a board game, another was setting up pins for bowling.

To the outsider, Hogewey is a microcosm of a make-believe world. But to the residents, it is a reality that is a continuation of life as they know it, in a setting that they are familiar with.

Programme of activities in Dutch, of course.

The burning question readers might want to ask is: How much are the fees? Around USD3600 per resident per month. It's heavily subsidized by the Dutch government, otherwise it would cost upwards from USD8000 a month. At such figures, only the super rich with dementia in Malaysia and Singapore can afford to live out their final days in this utopia.

THE LONG ROAD TO THE FINAL GOODBYE

Alzheimer's purple ribbon 

It's been a week now since the National Caregivers' Seminar up in Genting (see previous post). I continue to receive email enquiries about the seminar and also about the daycare centres that were recommended. Some of you have written to me about the daily challenges you face as a caregiver. I thank you all for writing and for sharing. I am glad many of you have found the post informative and helpful.

Here are two videos I would like to share. The first video was screened during Dr Donald Yeo's presentation at the seminar. It features well-known psychologist Dr Richard Taylor who has dementia. He has made it his mission to change public perception of people who have dementia.



The second video is a BBC interview with singer-songwriter Glen Campbell and his wife Kim after he was diagnosed with AD in June last year. At 76 and battling Alzheimer's, it is incredible that Campbell still remembers his lyrics and guitar chords. Truly an inspiration. Click here for a Youtube video of clips from Campbell's goodbye tour in February 2012. Do view especially if you are a Campbell fan.


In Singapore, it is estimated that about 28,000 seniors aged 60 and above suffer from dementia. This number is expected to increase to 80,000 by 2030. A study called WiSE (Well-being of the Singapore Elderly) is currently underway, led by the Institute of Mental Health, to better understand dementia in order to provide early intervention and reduce the burden on caregivers.

Alzheimer's Disease is the most common form of dementia. There is currently no cure for AD. For this reason, it is often referred to as 'The Long Goodbye'.

CAREGIVERS, KNOW THAT YOU ARE NOT ALONE

Last weekend I attended the National Caregivers Seminar organized by the Alzheimer's Disease Foundation of Malaysia (ADFM). It was time well spent as I learned much and met with caregivers from Johor, Malacca, Penang and Ipoh. As any caregiver will tell you, knowing there are others who are facing the same challenges gives you the vital support to get through each day of care-giving.

For the record, here is a list of the doctors who spoke and their presentations:

• Dr Lee Fatt Soon (General Hospital, KL) - "Managing Medical Conditions in Dementia"
• Dr Donald Yeo Hong Huang (General Hospital, Singapore) - "Person-Centred Dementia Care - The Singapore Experience"
• Dr Ho Bee Kiau (Health Clinic, Klang) - "Mentally Stimulating Activities Can Delay Dementia"
• Dr Gemma KC Law Wong (Hongkong University, HK) - "Caring for Someone with Dementia in Home Environment"
• Dr Lu-Ann Chong (UMMC, PJ) - "Prevention of Alzheimer's Disease - Healthy Brain Initiatives"
• Dr Bharathi Vengadasalam (UPM, Serdang) - "Ain't Misbehaving: Understanding and Managing Difficult Behaviours"
• Dr Tan Maw Pin (Universiti Malaya) - "Fall Risk Assessment on people with Dementia and Effective Preventive Measures"
• Dr Esther Ebenezer (Royal College of Medicine, Ipoh) - "Caring for Someone with AD"
• Mr Thillainathan Krishnan (Hospital Selayang, KL) - "Assisted Daily Living for Person with Dementia"

From left: Dr Gemma, Dr Lee and Dr Esther

Day 1 began on Friday evening with an interactive caregivers' dialogue with Dr Gemma and Dr Esther. Caregivers shared their experiences looking after their elderly loved ones, and nurse managers of care centres also shared creative ideas on how to handle difficult situations with AD clients.

Everyone who spoke had the same advice to share with caregivers:

• Look after yourself. A stressed out caregiver is of little help to the person with AD
• Take a break when you feel overwhelmed, and don't feel guilty about it.
• Adopt a positive attitude and learn to accept little acts of 'misbehaviour'. 
• Know you are not alone. Join an AD caregivers support group.

Strong support from caregivers, members of the medical and nursing fraternity as well as the public.

Some of the caregivers brought along their elderly parents. It was touching to see the loving care and patience shown by these caregivers. These acts of filial piety auger well for the future. Our children learn from us. They follow by example. How we treat our parents is an indication of how our children will treat us in our old age. 

Herbert Chong (right) shares the role of caregiver with his brother Chee Wah. Their father, Chong Kim Swee (left), 85, stays two weeks in rotation with each son. Shared responsibility helps to reduce the stress of care-giving.

Tan Suat Eng (right) with her mother Ng Siew Poh, 83. Mdm Ng lives with her youngest son on the first floor of a condo. Suat Eng is on the third floor so she gets to spend time with her mom daily. A very practical arrangement!

Caring for a parent with AD requires the cooperation  and support of the whole family. Care-giving is not only a drain on your financial resources but also on your energy. So when the whole family shares in looking after mom or dad, everyone benefits.

Here is a selection of slides that might be of interest to our viewers.

Scary figures. Knowledge precedes action. Governments need to intervene and be prepared for the dementia tsunami as the population ages. (Above slides from Dr  Lu-Ann Chong's presentation)

People with dementia have the same wish list as any of us. Why should we treat them differently? (Above slide from Dr Donald Yeo's presentation.)

Dr Bharathi's slides below highlight some of symptoms we should look out for, and offer practical advice on how to care for those with dementia.

All of us experience forgetfulness on a daily basis. Is this part of the ageing process? No, it isn't. It is only when forgetfulness affects our activities of daily living (ADL) that we should be concerned.

Occupational therapist Mr Thillainathan Krishnan explains ADL. Are our elderly parents able to perform all these activities independently?

Dr Tan points out that falls increase dependency on the caregiver, especially in using the stairs, toilets and showers.

Here is a list of registered Dementia daycare and residential care centres in Malaysia:

Nurse managers: (left) Jade Wong who manages the ADFM daycare centre in PJ, and (right) Angela Lee who runs the Dementia Homecare Centre in Telok Panglima Garang, Klang. Both have degrees in Nursing.

Dementia Care Centres:

Rumah Alzheimer's

6, Lorong 11/8E, Petaling Jaya, Selangor

Tel: 603-7956 2008 / 7958 3008

KL Daycare Centre

9A, Lorong Bukit Raja,

Taman Seputeh, Kuala Lumpur

Tel: 603-2260 3158

Dementia Homecare Centre

PT 715, Jalan Pandan 26,

Telok Panglima Garang, Selangor

Tel: 603-3122 6908 

ACE Daycare Centre

115-1, Jalan Mayang 3

Taman Peringgit Jaya, Malacca

Tel: 606-284 7886

JOBADA Activity Centre

43, Jalan Petri, Kampung Tarom, Johor Bahru

Tel: 607 - 222 4016

Dementia Daycare Centre

15, Jalan Foo Choong Nyit, Ipoh

Tel: 605-241 1691 or 019-571 2738 (April Loh)

ADFM Head Office

6, Lorong 11/8E, Petaling Jaya, Selangor

Tel: 603-7956 2008 / 7958 3008

Fax: 603-7960 8482

Email: adfmsec@streamyx.com
Website: http://www.adfm.org.my/