How does dementia affect Asians and Caucasians differently

Most of us believe that Alzheimer’s and dementia are no respecters of persons, meaning that the conditions don’t skip over or target certain types of individuals. Apart from long-proven contributors such as stroke, diabetes, and high blood pressure, researchers have recently identified one more risk factor: race

Here's what multiple studies[1] have concluded about race (for those aged 65 to 90) and dementia risk in the US:

Local[2] studies have also shown that the prevalence of dementia in Singapore is much lower than seen in the West. In Singapore, just 1 in 10[3] individuals (10%) above the age of 60 suffer from dementia. Similarly, in Hong Kong, the prevalence rate of dementia is only 5-8% for persons aged above 65, and 20 to 30% for those aged 80 and above[4].

However, this does not necessarily mean dementia is far more widespread in Europe and America – dementia is a complex condition that might not be recognised in certain countries; its statistics depend on the willingness of people to present themselves to be diagnosed. 

In fact, newer research suggests that Asians are genetically far more at risk of developing dementia. Let’s find out why. 

What is the difference between Alzheimer’s Disease and Dementia?

Although the terms are often used interchangeably, they refer to different things.

Dementia is a syndrome of acquired cognitive impairment which is severe enough to interfere with one's work and social lives.

The most common disease mechanisms causing dementia include 

  1. Alzheimer Disease which is theorised to be caused by accumulation of abnormal toxic amyloid proteins and 
  2. Vascular dementia, due to damage to blood vessels in the brain.

The 2 can also co-exist in the same person who is then thought to have "mixed dementia"

ConditionRisk factorsWhat it isHow it affects us
Vascular dementia (VAD)High blood pressure, obesity, smoking, diabetes, and more.A common subtype of dementia that leads to a reduced supply of blood, oxygen, and nutrients to the brain, as a result of damaged blood vessels.VD can lead to progressive memory loss, intellectual decline, and personality changes. It affects one’s ability to think, learn and make decisions.
Alzheimer’s Disease
(AD)
A combination of genetic and lifestyle factors. The nerve cells of the brain are destroyed, causing the shrinking of the brain.Alzheimer's disease is another common type of progressive dementia.

How common is Alzheimer’s and vascular dementia in Asians?

Nearly half (45.5%) of dementia cases in Singapore are vascular dementia cases. This corresponds to roughly 41,000 VAD cases in 2018. The number of vascular dementia cases is set to increase to approximately 76,000 by 2030.

Other less common types of dementia include:

Dementia: Ethnic comparison of Asia with the United States

In a recent article by The Straits Times[5], research by Dementia Research Centre Singapore (DRCS) sheds light on “Asian dementia”. Here are the findings:

Next, it was initially thought that in the Asia-Pacific region, most people with dementia live in developed or higher income countries[6].

CountryPublication YearSample SizeAge range yearPrevalence %
India[8]20102,466> 553.77
China[9]2010> 552.99
Japan[10]2009> 6511.0
Korea[11]20081,118> 656.3
Thailand[12]20082,311> 452.35
Sri Lanka [13]2003703> 653.98
Australia [14]20011463.6
Taiwan [15]19982,915> 653.7

However, when making comparisons with developing countries, we need to account for factors such as education, responses to diagnostic tests and even cultural influences. For example, dementia symptoms may be normalised due to the traditional Chinese belief that old people return to a childish state. 

Further, functional disability associated with cognitive decline may be underreported due to;

All these possibly account for lower prevalence of dementia in developing countries.

CountryPublication YearSample SizeAge range yearIncidence reportedIncidence, % (annualized)
Japan[16]2009828> 653.23/100 person-years3.23
China[17]20081,553> 600.9% at 2 years0.45
Australia[18]2003377> 7516.7% at 6 years2.78
India[19]20012,698> 550.17/100 person-years0.17
>650.32/100 person-years0.32
Taiwan[20]19982,507> 651.28/ year1.28

Lastly, in general, studies[7] suggest that Asian populations appear to have a larger proportion of vascular dementia (VAD) cases, while Caucasians suffer more from Alzheimer’s Disease (AD).

Japan[8] was initially thought to have a substantially lower prevalence of AD and a higher prevalence of VAD. However, more recent[9] studies have shown decreases in VAD and increases in AD amongst the Japanese. This could reflect the following:

This suggests that on top of genetic risks, our diet and lifestyle also plays an important role in relation to developing and managing dementia.

What other factors increase one’s risk of dementia?

While Alzheimer’s is linked to genetic factors, researchers have found links between dementia and the following factors*:

FactorAffected demographic(s)How it affects Singaporeans
High Blood PressureStudies have concluded that African Americans are most likely to have high blood pressure, thus placing them at greater risk of dementia.
In Singapore, 1 in 4 people aged 30-69 has high blood pressure. Every day, 17 people die from heart disease and stroke.

Type 2 DiabetesBoth African Americans and Hispanics have a higher prevalence of diabetes compared to Whites.
Interestingly, African Americans and Native Americans with type 2 diabetes have a 40-60% higher risk of developing dementia than Asian Americans with type 2 diabetes.

Over 400,000 Singaporeans live with Type 2 Diabetes, and this number is set to surpass one million by 2050.
The lifetime risk of developing diabetes is one in three[10] among Singaporeans.

Stroke
African Americans are 2.7 times more likely than other races to get a stroke, which in turn results in an increased risk of vascular dementia.

The number of stroke episodes in Singapore increased from 5,890 episodes (2010) to 8,849 episodes in 2019.

Lower education and income levelsA study found that among 5,055 Shanghai Chinese residents aged 65 and above, the prevalence rate of dementia was 4.6%, with only 65% of these individuals having a clinical diagnosis of AD. Nearly half (47%) of those diagnosed had no formal education, while 29% had no more than 7 years of it.
Three risk factors for dementia include:
> Living in rural areas
> A lower education level
> Having a lower income level

The lack of education is a significant and independent risk factor for the prevalence of dementia.


Whatever your race, culture, or country of origin, it is crucial to have a keen knowledge of how Alzheimer’s and dementia might affect you and your loved ones. If you suspect that someone you love might be dealing with the condition, contact us today for the help you need.

References 

  1. https://www.verywellhealth.com/ethnic-disparities-how-your-race-impacts-your-risk-of-dementia-3986388
  2. Sahadevan, S., Saw, S. M., Gao, W., Tan, L. C. S., Chin, J. J., Hong, C. ye, & Venketasubramanian, N. (2008). Ethnic Differences in Singapore’s Dementia Prevalence: The Stroke, Parkinson’s Disease, Epilepsy, and Dementia in Singapore Study. Journal of the American Geriatrics Society, 56(11), 2061–2068. https://doi.org/10.1111/j.1532-5415.2008.01992.x
  3. https://www.healthhub.sg/programmes/160/AAP/dementia 
  4. Legislative Council of the Hong Kong Special Administrative Region - Care services for elderly persons with dementia. (n.d.). Www.legco.gov.hk. https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm#:~:text=According%20to%20the%20Hospital%20Authority
  5. https://www.straitstimes.com/singapore/health/ntu-launches-centre-to-study-how-dementia-develops-in-asians 
  6. Venketasubramanian, N., Sahadevan, S., Kua, E. H., Chen, C. P., & Ng, T. P. (2010). Interethnic differences in dementia epidemiology: global and Asia-Pacific perspectives. Dementia and geriatric cognitive disorders, 30(6), 492–498. https://doi.org/10.1159/000321675 
  7. Jorm A. F. (1991). Cross-national comparisons of the occurrence of Alzheimer's and vascular dementias. European archives of psychiatry and clinical neuroscience, 240(4-5), 218–222. https://doi.org/10.1007/BF02189530 
  8. Shadlen, M.-F., Larson, E. B., & Yukawa, M. (2000). The epidemiology of Alzheimer’s disease and vascular dementia in Japanese and African-American populations: the search for etiological clues. Neurobiology of Aging, 21(2), 171–181. https://doi.org/10.1016/s0197-4580(00)00115-9
  9. Yamada, M., Sasaki, H., Mimori, Y., Kasagi, F., Sudoh, S., Ikeda, J., Hosoda, Y., Nakamura, S., & Kodama, K. (1999). Prevalence and Risks of Dementia in the Japanese Population: RERF’s Adult Health Study Hiroshima Subjects. Journal of the American Geriatrics Society, 47(2), 189–195. https://doi.org/10.1111/j.1532-5415.1999.tb04577.x

Dr. Wee Chee Keong: Is it normal ageing, or dementia? How to tell and warning signs to look out for

Lapses in memory, changes in habits and slower responses – while many individuals are prone to withdrawing and slowing down as they age, this has created an alarming tendency in both families and individuals alike to dismiss dementia symptoms as common age-related problems. 

Granted, dementia affects only about 1 in 10 Singaporeans1 above the age of 60. While this number may seem small, keep in mind that: 

There is also no cure for dementia, a progressive disease that can advance in as fast as a few months. 

As biomedical researchers around the globe continue to work hard to uncover the various aspects of Alzheimer’s disease and other dementias, the hope is that a better understanding of this debilitating condition will lead to new treatments. 

As it already is, we have treatments that manage dementia and allow elders to feel, look, and stay better for much longer. 

Knowing the symptoms and causes of dementia can be all the difference between a peaceful and trouble-ridden seniorhood. In this article, we’ll cover:

Dementia and Alzheimer's: What’s the difference?

Dementia is an umbrella term. Instead of being a single disease, it is the end product of multiple conditions affecting the brain that result in cognitive failure in a person. These disorders, such as Alzheimer’s and stroke, are caused by abnormal brain changes and will gradually deteriorate one’s:

Dementia doesn’t only critically impact an individuals’ relationships and quality of life, but can also overwhelm the loved ones of sufferers.

The causes of dementia

While there are many causes of dementia, the most common causes in Singapore are: 

Alzheimer’s disease (AD)

AD accounts for 60 to 80% of all dementia cases and is the most common form of dementia. It results in short term memory, changes in thinking, judgement, behaviour and feelings, and a gradual decline in one’s cognitive abilities.

Vascular dementia (VaD)

VaD refers to changes to one’s attention, memory, thinking, and behaviour resulting from conditions that affect the blood vessels in the brain (eg. stroke). VaD also leads to impairment of neuronal function and a gradual decline in a person’s cognitive ability.

Frontotemporal dementia (FTD)

In the early stages, FTD impacts an individual’s personality, behaviour, and speech. FTD patients may behave aggressively or rashly while keeping their memory and sense of direction intact.

Lewy Body Dementia (LBD)

LBDis a type of progressive dementia that results in noticeable changes in a person’s attention and daily ability to function. LBD sufferers may appear to have a lively imagination or even hallucinate. The symptoms of LBD resemble those of Parkinson’s Disease.

Often, these conditions present simultaneously. This is otherwise known as mixed dementia.

Uncle suffering from dementia

What are the 3 stages of dementia?

We categorise dementia into 3 stages4

StageSymptoms
Early stage dementiaLosing track of time5 Everyday forgetfulness (eg. constantly losing items) Confusion about directions and getting lost in familiar places
Middle stage dementiaForgetting recent events and the names of others Getting lost in or failing to recognise familiar places Increasing difficulty when communicating Neglecting or being unable to maintain personal hygiene Behavioural changes 
Late stage dementiaBeing unaware of time and place  Memory disruptions and disturbances Finding it difficult to recognise friends and family Behavioural and mood changes that may be aggressive  Requiring increasing assistance for personal care, or even heavy or total dependence (eg. dressing and eating) Cognitive failure (eg. having trouble walking)

As symptoms progress slowly, dementia is often overlooked in its initial stages. So if you or someone you love are experiencing any of the above symptoms, please see a neurologist as soon as possible - In the most debilitating and severe of cases, dementia can even result in a vegetative state.

Dementia – not just an old person’s disease

While age is commonly associated with dementia and is the greatest risk known factor for the disease, dementia is not a normal part of the ageing process. 

There is also an increasing number of patients with young-onset dementia, generally accepted as dementia affecting individuals below the age of 654.

Other risk factors for dementia include: 

*Diabetes is a risk factor for both stroke and atherosclerosis, both of which contribute to the onset of VaD.

**Atherosclerosis is the buildup of plaque in an artery’s inner lining. It is a significant risk factor for vascular dementia because it compromises delivery of blood to the brain, which can cause a stroke. Habits such as smoking drastically increase the risk of Atherosclerosis.

Dementia treatment options available in Singapore

While there is no cure for dementia, it is possible to provide holistic, personalised care to dementia patients in all stages of the disease, and crucial support to their loved ones. Here are a few dementia treatment options available in Singapore today:

TreatmentWhat it entailsEfficacy
Pharmacological management
Two cognitive enhancers that offer significant therapeutic benefits and cognitive function maintenance include: Acetylcholinesterase inhibitors, and N-Methyl-D-aspartate (NMDA) receptor antagonists

Other examples with proven efficacy include: Donepezil Rivastigmine capsules or patches Memantine Gingko biloba (EGb 761)

Do ensure that your doctor offers you a good understanding of both the pros and cons of any recommended medicines and treatments.

While Alzheimer’s drugs may help individuals temporarily manage symptoms such as thinking and reasoning impairments, memory loss, and daily functions, they are not to be viewed as theremedy for dementia.

However, symptomatic drugs can definitely help delay the progression of a patient’s condition.

Combined with psychosocial interventions, these pharmacological solutions may also increase a patient’s quality of life.

Introduce good sleep hygieneIn patients with dementia, insomnia is common and can prove to be distressing to families. This is why having good sleep hygiene is so important - It helps both patient and caregiver face their daily demands better.

Some tips include: Addressing any underlying conditions that might interfere with quality sleep (eg. heartburn, chronic itch, anxiety) Introducing regular sleep times and ensuring a good sleep environment Helping patients to relax before bedtime

Researchers in Europe found that for individuals aged 50 to 70, consistently sleeping 6 hours or less was associated with a 30%6 higher risk of dementia.

Sleep hygiene is not only a good form of prevention against Alzheimer’s, but early death.

The good news is that may reduce your risk of dementia or manage your condition by getting a solid six to eight hours of sleep nightly.

A healthy sleep routine will also help persons with dementia to feel better, be less confused, more coordinated, and more energetic.

Reminiscence and other activities
As many dementia patients often present with short-term memory loss whilst retaining older memories, reminiscing can be a powerful tool. It can help sufferers feel positive and peaceful, and reduce stress, which can improve their mood, reduce agitation, and minimise challenging behaviours.

Some tips include: Listening to the patient’s favourite music Looking through old items or photos Tactile activities such as painting or pottery, which can help spark good memories.

For decades now, research has shown that dementia patients react well to their favourite music, as it improves their brain function and even slows the progress of the disease.

Reminiscence7 in the form of humour, words, photos, and more, have been proven to evoke memories, stimulate mental activity, and improve a patient’s overall well-being.
Cognitive impairment-related safety provisions
Since many dementia patients face safety issues such as forgetting to switch off the gas at home, or getting lost, it is crucial that patients and their families address these challenges by designing an environment that allows patients to continue living safely.

Some simple tips include: Placing clear words or symbols around the patient to help them re-orientate location and date-wise. Having the patient wear an identity necklace or bracelet with contact details. Linking the patient’s mobile phone to a GPS tracking system to locate them.

Such solutions, while not having a direct impact on an individual’s condition, will help prevent them from getting into stressful or dangerous circumstances that could have larger consequences.

Psychogeriatric servicesThere are hospitals that provide psychogeriatric services that aid dementia patients.

With the help of multidisciplinary teams consisting of geriatric psychiatrists and nurses, clinical psychologists, medical social workers and more, outreach programmes, assessments, and interventions are provided for elderly individuals in communities around Singapore.

These teams also run community outreach programmes that provide training for community partners.

Maintaining a healthy and active life is a key challenge8 for elderly individuals, especially when psychological complications come into play.

Psychogeriatrics allows dementia patients to improve the quality of their relationships, self-esteem, and subjective well-being, as well as to reduce any overwhelming loneliness that they might be experiencing as a result of their condition.

Group programmes are especially useful in helping patients maximise their daily cognitive functions, enhance their mood, and manage their behaviour.

From the stress of treatments to having to face debilitating cognitive decline, dementia is no light matter. If you suspect you or your loved one might be displaying symptoms, it is crucial that you stop the disease from progressing too quickly.

Do you have any questions? Feel free to drop me a message and I’ll be happy to help.

References 

  1. https://www.moh.gov.sg/news-highlights/details/speech-by-dr-amy-khor-senior-minister-of-state-for-health-at-the-13th-international-congress-of-the-asian-society-against-dementia-held-on-thursday-29-august-2019-at-the-shangri-la-hotel-singapore
  2. https://www.straitstimes.com/singapore/community/new-initiatives-including-resource-portal-and-assisted-living-for-dementia
  1. Kuruppu, D. K., & Matthews, B. R. (2013). Young-onset dementia. Seminars in neurology, 33(4), 365–385. https://doi.org/10.1055/s-0033-1359320
  2. https://www.alz.org/alzheimers-dementia/stages
  3. https://www.who.int/news-room/fact-sheets/detail/dementia 
  4. https://www.health.harvard.edu/blog/sleep-well-and-reduce-your-risk-of-dementia-and-death-2021050322508
  5. Woods, B., O'Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. The Cochrane database of systematic reviews, 3(3), CD001120. https://doi.org/10.1002/14651858.CD001120.pub3 
  6. Molinari, E., Spatola, C., Pietrabissa, G., Pagnini, F., & Castelnuovo, G. (2014). The Role of Psychogeriatrics in Healthy Living and Active Ageing. Studies in health technology and informatics, 203, 122–133.