DESPITE having the ability to impair daily functioning and drastically affect the quality of life, vascular dementia (VaD) remains relatively misunderstood.
Recognised as the second-most common type of dementia after Alzheimer's, VaD differs as it is caused by impaired blood flow to the brain, often following strokes or heart conditions. This lack of adequate blood flow deprives brain cells of oxygen and essential nutrients, leading to cognitive decline.
Symptoms of VaD include problems with decision-making, lapses in concentration, and memory impairment.
Unlike Alzheimer's, where memory loss is often the first and most prominent symptom, VaD patients typically have a stepwise progression that presents issues more noticeably after a stroke or heart attack.
A PROBLEM AMONG LOCALS
In Malaysia, a 2020 study revealed the prevalence of dementia among older adults above the age of 60 to be at 8.5 per cent, roughly around 260,000 of the total population.
Speaking on the issue of VaD among Malaysians, a consultant neurologist at Sunway Medical Centre in Sunway City, Dr Mohamad Imran Idris, explained that the nature of the typical Malaysian lifestyle contributes to a higher prevalence of risk factors associated with VaD.
"Among Malaysians, the common risk factors include high blood pressure, obesity, and high cholesterol levels.
"This ties into the epidemiology of dementia among Malaysians. While Alzheimer's may be the leading form of dementia in Western countries, the risk factors in Malaysia may very well cause VaD to be the most common locally," Dr Mohamad Imran said.
AN IMPACT ON DAILY LIFE
In most cases, VaD has the ability to affect a patient's daily life in negative ways.
Individuals with VaD typically have problems managing everyday tasks, and will often require assistance when performing things like commuting outdoors or making major financial decisions.
However, as the affliction worsens, another potentially devastating aspect of suffering from VaD is the loss of sense of self.
"If you think about it, your memory is who you are. If you lose your memory, you can be physically healthy, but you're not the same person," Dr Mohamad Imran said.
SUPPORTING PATIENTS WITH VAD
For those already afflicted with VaD, proper support from caregivers is crucial for day-to-day living.
Speaking on the behavioural side of things, Dr Mohamad Imran stressed the importance of understanding how VaD patients understand and perceive things when appearing to be difficult.
"It is not that they purposely want to act this way. They may have cognitive impairments, which are coupled with behavioural problems that can arise from dementia, such as depression and apathy. These are often interpreted as the person being difficult," he said.
He also addressed the issue of stigma relating to patients with dementia, pointing out the tendency for families to keep things hush when a loved one experiences dementia.
"In Malaysia, people tend to hide affected individuals away, no longer allowing them to function in society. This is unfortunate, and it's something that I hope to tackle," he said.
PREVENTION IS KEY
With the risk of VaD relatively high among locals, Dr Mohamad Imran emphasised the need for preventive measures.
"Probably the single most important thing you can do is to monitor your blood pressure regularly. If it is high, you need to manage it properly to avoid other complications, such as heart attacks or strokes, which can lead to VaD," he said
For those already with VaD, he explained that there are methods to help manage the symptoms, although most of them only confer modest benefits.
"There are medications, such as acetylcholinesterase inhibitors, which can improve alertness and memory retention.
"But these are only symptomatic treatments that don't really halt the progression of the disease. Dementia itself is costly, both in terms of the cost of medical care for the patient, but also due to lost earnings on the caregiver's part. So, prevention is always better," he said.
A HOLISTIC APPROACH TO TACKLING VAD
Dr Mohamad Imran believes that raising awareness and providing the right resources are key steps in tackling the issue of vascular dementia in Malaysia.
Early diagnosis, comprehensive care, and ongoing support can make a significant difference for patients and their families.
"Education is essential. We need to better equip our healthcare system to manage dementia cases and give families the tools to help their loved ones navigate the challenges of living with vascular dementia," he said.
While the condition may not yet be fully curable, Dr Mohamad Imran believes that focus on prevention, proper diagnosis, and compassionate caregiving offers hope for many.
For now, the best approach is to focus on prevention, maintaining good cardiovascular health, and breaking the stigma around dementia, ensuring that no one faces this journey alone.