Forgetfulness is common in older people and is not always a cause for concern.
Early intervention can help to identify patients with mild cognitive impairment (MCI), which has been shown to have an annual conversion rate of 10 to 15% to dementia.
More serious and progressive forgetfulness may be caused by a disease of the brain, such as dementia. The more common causes of dementia are Alzheimer's Disease and vascular dementia. Although not reversible, early detection will enable treatment to be started, and this can help improve the patient's symptoms and quality of life as well as reduce the stress on those providing care for the patients.
Our multidisciplinary programme covers caring for patients with memory and cognitive difficulties through the different stages of diseases.
Our expertise is in early diagnosis of dementia and management of complications of dementia in its various stages, using a holistic approach (in line with the geriatric principles of looking at the various interactions of medical, functional and social factors impacting dementia diagnosis) to help patients and caregivers cope with the illness.
There are two main parts to our approach:
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Diagnosis | The early stage of dementia can be difficult to distinguish from age-related memory loss or even depression. A systematic approach is adopted and it involves the following steps: - Comprehensive clinical assessment by the geriatric physician, with detailed background history obtained from the family or caregivers.
- Assessment of the behavioural, functional and social effects of the illness, including caregiver stress, by the nurse clinician.
- Some standard psychometric tests may be conducted to assess the patient's mental functions.
- Radio-imaging of the brain and some blood tests may also be conducted.
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Treatment | Upon diagnosis, a team of healthcare professionals will discuss and propose a treatment plan for the patient and his/her family members: - Medication(s) to slow down the decline in mental functions and reduce the severity and frequency of the behaviour problems.
- The nurse clinician will explain what dementia is and teach caregivers the necessary coping skills and practical tips for frequently encountered problems, including home safety matters. Information on suitable community services will be provided and, if needed, referrals to these services will be made.
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Where necessary and appropriate, we may refer patients for:
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Cognitive re-training programme conducted by a multidisciplinary team and led by
psychologists.
- Assessment of home safety by the
occupational therapist for patients who are staying alone at home or are alone at home for most part of the day.
- Assessment of driving safety by the occupational therapist as part of the Driving Assessment and Rehabilitation Programme (DARP) for early dementia patients who are still driving.
- Referral to the
medical social worker will be made if there are functional or safety issues with regards to the patient's ability to live at home safely. Patients and families with care or financial issues identified will also be seen by the medical social worker who will try to provide aid where appropriate. Patients' family members or caregivers who experience significant caregiver stress or burnout will also be referred to the medical social worker for counseling and help.
- Referral to the
physiotherapist would be made if the patient is assessed to have unsteady gait or increased risk of falls. Appropriate exercises and rehabilitation would be prescribed by the physiotherapist.
- Referral to the
dietician would be made if the patient is assessed to have decreased nutrition or poor feeding. Evaluation of patient's dietary habits and appropriate nutritional advice will be given.
- The cognition nurse clinician will continue to follow-up on specific cases where there is significant caregiver stress or behavioural issues in the patients. They will be available in some cases to provide phone counseling and advice.
For patients with cognitive or memory difficulties who are non-ambulant, they will be assessed by the Geriatric Assessment Clinic in the Department of Geriatric Medicine, Tan Tock Seng Hospital for a comprehensive geriatric assessment of their geriatric syndromes and functional difficulties.
In view of the comprehensive and detailed nature of the cognitive assessment, the Memory Clinic will only be able to address the cognitive and memory difficulties of the individual. The other concomitant medical problems are best addressed by the patient's attending doctor or family physician.
Download Memory Clinic brochure (255 kb, PDF)