The VCAT is carried out by a pharmacist and is based purely on images, so no language skill is required. — Handout
How do you know if those lapses in memory are part of ageing or a symptom of dementia?
Seniors, and even some young people, may laugh off being forgetful and absent-minded as associated with the normal ageing process, but these incidents could actually lead to a more serious cognitive health risk.
ALSO READ: When your forgetfulness is no longer normal
Cognitive health involves our brain’s ability to perform key functions like learning, remembering, judgement and communicating.
Studies suggest that a significant portion of the elderly population globally may be experiencing mild cognitive impairment (MCI).
The scientific term for MCI is mild neurocognitive disorder, but lately, experts have started labelling it as pre-dementia.
In Malaysia, it is estimated that the occurrence of MCI ranges from 21% to 38% among those aged 60 and above.
Unfortunately, MCI frequently goes undiagnosed.
This is due to the fact that despite having difficulty in forming words, losing things and being forgetful, individuals with MCI are generally able to care for themselves and continue with their daily activities.
In contrast, dementia patients often struggle with self-care and may exhibit severe symptoms such as hallucinations and paranoia.
Screen at the pharmacy
“Most individuals with MCI – a transitional state – will not develop dementia, although there are certain types of MCI that can increase the risk of developing dementia.
“But there are effective strategies to either delay the progression or reverse MCI, which then potentially prevents dementia.
“However, because our population is ageing at an unprecedented rate, it poses a huge statistical problem as we can’t possibly send everyone to a specialist for a memory test,” says consultant geriatrician Professor Dr Tan Maw Pin, who is also the founder and managing director of ACT4Health Sdn Bhd, a social enterprise spin-off under Universiti Malaya.
As older people tend to frequent pharmacies to get their medications, that is the best place for them to get screened for MCI.
So, to raise awareness and help people evaluate their risk of MCI, ACT4Health has teamed up with pharmaceutical company A. Menarini and Caring Pharmacy to launch a campaign called “Catch MCI Early: Act Now, Remember More”.
During this campaign, a screening test called the Visual Cognitive Assessment Test (VCAT) will be offered at selected Caring pharmacies nationwide.
It’s free, easy to do and does not cause distress to the patient.
“There are no blood tests or scans, you only have to do mental tasks to see if you’re performing at a level we would expect of a normal adult,” says Prof Tan.
It involves a series of visual and cognitive tasks that measure aspects of cognitive function, such as memory and attention.
The tasks involve pattern recognition, spatial reasoning, memory recall and decision- making.
Once the test is completed, the results are analysed to provide the individual’s cognitive health status and determine whether a doctor’s involvement is necessary.
The VCAT was developed by Singapore’s National Neurological Institute, which worked together with researchers from Malaysia, the Philippines and Indonesia to validate it.
Prof Tan says: “The test is good because it’s all picture- based and doesn’t need to be translated into another language.
“We took about seven years to come up with the test and if the results show you just have MCI, we can put in interventions and you don’t need to consult a doctor.
“But if it shows you could have dementia, then the pharmacist will recommend you see a specialist to confirm the diagnosis, which can take a long time.”
Confidential test
With VCAT, the confidentiality of the individual is protected, as they don’t need to tell their family members they have taken the test.
“If you see a doctor in the hospital, it’s hard to hide it from family members.
“In our Asian society, there is a huge stigma associated with being demented.
“People are afraid that if they’re labelled as having dementia, their rights will get taken away,” observes Prof Tan.
VCAT is recommended for those above 60, but if you are younger and feel you have a memory issue, please get screened.
It takes about 15-20 minutes to complete the test, but if you’re really good, you can do it faster.
She says: “Everybody’s brain ability is different, but this is not a test of intelligence.
“It’s highly unlikely you will get 100% on this test!
“So, do the test to get a baseline assessment at 60 years, and if the results are normal, you don’t need to retest for another year or two.
“If the results are abnormal, we suggest you return in six months and retake the test.
“If the results drop further, then we can start intervening.
“We’re currently doing research across international borders to develop the VCAT online – and that will probably be the answer for mass MCI screening.”
Based on the results, the pharmacist will counsel the individual to make lifestyle changes or suggest a supplement for MCI, which is the EGb 761.
EGb 761 is approved as symptomatic treatment for cerebral insufficiency that occurs during normal ageing or that may be due to degenerative dementia, vascular dementia or mixed forms of both, and for neurosensory disturbances.
“The supplement is an extract of gingko biloba leaves, which has scientifically been proven to reduce the risk of someone with MCI or who has mild to moderate dementia.
“But don’t go and buy just any gingko and eat the seed, nut or fruit thinking it’s going to help – that’s not how it works!” cautions Prof Tan.
Maximise brain function
She offers the following tips, which have already been widely publicised, to reduce MCI and keep the brain sharp.
Bingo, a game of chance, has been scientifically proven to stimulate cognitive health, but as it is not so popular in Malaysia, seniors can instead opt to play mahjong or congkak.
They can also do crossword, grid or jigsaw puzzles.
Brisk walk at least five times a week, 30 minutes each time, to achieve the recommended 150 minutes of moderate-intensity exercise a week.
The three proven diets are the Mediterranean diet; the fish oil diet (e.g. salmon, mackerel, tuna or sardine; other local fish include kembung and selar, but you have to consume more as they’re not as oily); and the rainbow diet, comprising colourful fresh vegetables, tofu, a little meat and some fish.
“And please eat only until you’re half full!” says Prof Tan.
Meet up with friends twice a week or so, go for a cup of coffee and chit chat or hike together.
Learn a new skill or language, play an instrument or pick up dancing.
For those who are religious, try to memorise religious verses.
“Older people are wise, and since we’re so short of labour, they can go around visiting sick people, provide food for the homeless or needy, etc.
“All these activities give them a sense of belonging and force them to be out and about because they have something to do,” points out Prof Tan.
Ultimately, we are all responsible for our own health.
She adds: “As caregivers to older family members, we must also remember to empower them to seek help early.
“This means that besides going in for regular eye and dental check-ups or blood tests, cognitive health can benefit from regular medical check-ups, especially if we notice early signs or have relatives with MCI.”
