The early signs of dementia

According to the 2013 Well-being of the Singapore Elderly (WiSE) study, 1 in 10 persons in Singapore aged 60 years and above has dementia, which according to the WHO definition, is a “syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities”.

To suggest that someone with dementia “may” have memory loss, is misleading. Dementia is a condition in which people with dementia encounter problems with memory. But it is of course worth noting that the “symptoms of dementia are not limited to forgetfulness and memory loss“, as the author of this 2015 Institute of Policy Studies (IPS) Commons article points out. The ability to plan and make decisions, as well as solve problems, are other cognitive difficulties faced by someone with dementia.

Recent research efforts offer relatively quicker ways for clinicians to diagnose dementia and identify individuals at risk for dementia. According to a recent study published in 2015, researchers have developed a brief questionnaire, known as the QDRS comprising 10 items, which can accurately identify if someone has very mild, mild, moderate, or severe dementia. And a 2014 study has found a time-efficient method for identifying those at risk for dementia — through their ability to track a moving target with a computer mouse which moves in the opposite direction to what they see on the screen. Those diagnosed with Mild Cognitive Impairment (MCI) (and who are at risk for dementia) made many more errors than the control group. A more recent study also points to the tendency for those with amyloid plaques associated with dementia to have walk at a slower pace compared to healthy peers.

But you’re concerned that you may be developing dementia. Or you’re concerned about someone you know being at risk for dementia…

So here are 3 questions to answer:

1. Have you noticed any of these early warning signs?

The local Health Promotion Board has a print-friendly fact sheet, while the local Alzheimer’s Disease Association offers a checklist and describes the stages of dementia. No? Move on to Question 2!

2. Are you aware that you have difficulties remembering things?

A recent study which tracked over 2,000 individuals for 10 years reported that awareness of memory problems is a good clue as to whether they have dementia or not. In this study, those who were eventually diagnosed with dementia stopped being aware of their memory problems about 2.5 years before showing signs of dementia. So being aware that you have memory problems is actually a good thing. But read on…

3. How often do you have problems remembering things?

The US Alzheimer’s Association distinguishes behaviours which are characteristic of dementia from behaviours associated with healthy ageing in their list of early warning signs. Forgetting the names of things and/or the names of people is something that happens to most of us. Some of us experience the tip-of-the-tongue phenomenon quite often in fact. We can also be prone to forgetting appointments. But we’re usually able to retrieve these words and/or names later on, and we typically realise that we missed an appointment at a later time.

But a 2014 study also found that those who reported a change (more difficulties) in their ability to remember things were much more likely to subsequently develop dementia. So if you’re concerned that you might have cognitive issues, you can take an online assessment — Self-Administered Gerocognitive Exam or the SAGE test. But it’s also important that you consult with a medical professional if memory and thinking problems are a concern for you. 

Learning, it’s no child’s play

Our children’s learning starts early. These days, preschoolers are not only learning the fundamentals of maths and science, they’re learning to code. Parents who advocate the role of play in children’s development are likely to find themselves a somewhat rare and endangered species. Even though there are numerous benefits to encouraging children to play. Social and communication skills are some good examples.

But let’s not get distracted. Parents want to their kids to do well in school. And we know the home environment does contribute to children’s academic achievements.

It’s also important for parents to have high expectations of their kids.

Only thing is that, well, that might not be entirely true. A study hot off the press finds that unrealistically ambitious aspirations of parents can adversely impact their children’s academic performance. The findings of this 2015 study of 12,000 US school-aged students mirror those from an earlier study conducted on 3,530 school-aged students in Germany. So apparently, “unrealistically high aspiration may hinder academic performance“. And parental academic pressure appears to be leading to more and more children and teenagers experiencing chronic stress, burnout, and depression.

So, what else are parents to do? Well, we can suggest a few relatively painless ways to boost your child’s performance:

1. Help them develop a homework habit 
A 2015 study finds that school-age students in Spain perform better on a standardized maths test when they complete their homework on their own and when their teachers set homework on a regular basis. In fact, these high achievers only spent 1 to 2 hours a day on their homework.

So, less is more (but only if homework is also a daily habit).

2. Encourage community and sports participation
It’s no surprise that exercise helps children learn better. Children concentrate better when they’re physically active, and their academic performance improves when they play sports. A more recent study finds that children who are lean and active perform better on cognitive tests.

But it may not just be about the physical health benefits of exercise. Even though exercise does help children sleep earlier and get better quality sleep (because tired children stay up late less, which according to a 2015 study, costs teenagers as many as 9.3 GCSE points per hour spent on youtube, TV, and computer games.

It could be that gaining better body awareness somehow helps our brains retain information better. In fact, a recent study finds that dancing not only alleviates depression, stress, fatigue, and headaches, but boosts self-esteem and self-confidence about solving everyday problems among young Swedish teenagers.

But there may be another reason why children involved in extracurricular activities in the community perform better in school. Experts argue that extracurricular opportunities work because they give children a chance to experience “a sense of accomplishing something“.

3. Eat breakfast with your kids
A 2015 study on 5,000 children 9- to 11-year-olds provides unequivocal evidence that healthy breakfasts make a difference to children’s academic performance. Having breakfast was found to be better than not having any. But having a breakfast of diary foods, cereal, fruit, and bread produced better students than a breakfast of empty calories — sweets (candy) and/or crisps (chips). And having fruit and veggies during the day was also associated with better school performance.

4. Spend time with your kids
It’s common sense. But there’s research evidence to back this one up. A 2015 study finds that successful children come from families who recognised their children’s talents early, but also helped to motivate their children to work hard at practising and improving their skills.

Conversely, another recent study finds that children’s mental well-being is associated with time pressures experienced by their parents — children whose parents have difficulties fitting everything they need to be do into their day, are more likely to have mental health concerns.

Spending time with children, especially teenagers, also helps parents understand their children’s daily experiences. As a result, their children have less likely to have behavioural problems and more likely to be better psychologically adjusted.

Autism: What have we learnt so far?

Autism is a neurodevelopmental disorder in which individuals have difficulties with social interactions and communication and a reliance for routines and/or repetitive behaviours (Read this NIH fact sheet for more information). Individuals with autism also tend to display sensory seeking behaviour and according to more recent scientific endeavours, experience high rates of gastrointestinal issues.

It’s a disorder which receives much attention in both the press and in research. But research findings, despite advancing at the pace of greyhounds chasing a bunny on the race track, don’t always accompany news stories. The public’s understanding and awareness of this disorder is still work-in-progress, even though local resources for autism has vastly improved.

Research links the use of joint attention — the ability to use gaze and gestures to share attention — to autism, but a recent study points to a more accurate red flag for autism — a social smile during joint attention. This 2014 study observes that infants at 8 months tend to look at an object of interest and then smile at the person they are interacting with, before looking back at the object of interest, during joint attention. In contrast, infants at risk for autism tend not to direct the social smile at the other person in between looking at object and at the other person.

Other research has established that individuals with autism find faces aversive, and as a result have difficulties recognising the emotions of others (more about their difficulties with empathy here). In fact, a hot-off-the-press study finds that individuals with autism focus on areas of contrast and colour of real photographs and the centre of the image, whereas those who don’t have autism look almost exclusively at faces in the same photographs. And this tendency emerges at a young age: a 2014 study observes infants at 6 months to fixate on faces when someone is speaking. In contrast, infants diagnosed with autism later look away from the eyes and mouth when someone is speaking.

Recent research has also identified two other markers useful for screening autism among children aged 9 to 12 months. A 2014 study finds that babies with a head circumference that is at or higher than the 75th percentile at 9 months and infants who fail the tonic neck reflex (also known as the head tilt reflex) are at a higher risk for autism.

With slightly older children, nonverbal screening tools may be useful. A 2015 study proposes a novel way of screening for autism: It turns out that individuals with autism don’t reduce their sniffing of unpleasant smells (and conversely increase their sniffing of pleasant ones). In contrast, their peers who don’t have autism “stop” a wiffy smell in about 305 ms. Another 2015 study finds a higher proportion of children who are subsequently diagnosed with autism among families where parents voiced concerns about their child’s sensory and motor abilities from the age of 6 months, and their child’s language and social communication abilities from the age of 12 to 15 months. So although autism cannot be diagnosed till 2 years of age, there are clear indications and red flags which are proving to be effective for screening autism at a much younger age.

Screening for autism aside, there are still no clear answers to what contributes to autism. Recent research does however indicate differences in brain structure between individuals with autism and peers who don’t have autism. Apart from differences which have been observed in the brain structures which connect the two brain hemispheres to each other, a 2014 study observes a lack of neural pruning — the process by which neural connections which we don’t use are eliminated — among children with autism (for a more in-depth discussion, read this article). Genetic factors are acknowledged to contribute to autism, but environmental factors are also considered to play an important role. Increasing evidence that the composition of gut bacteria differs in individuals with autism from that of their peers who don’t have autism, has led some to suggest that gut bacteria to be a possible contributing factor to autism. While a 2015 study definitively excludes MMR vaccines as a contributing factor to autism (read more about the study here), another 2015 study speculates that other chemicals, such as solvents and pesticides, to which expectant mothers may have exposure, can adversely affect foetal development.

Despite the mixed findings about the cause of autism, more recent research does offer some promising news about effective interventions and strategies found to be useful for helping children and adolescents with autism. Just as children who don’t have autism can be trained to enhance their ability to identify emotional expressions and young preschoolers with autism can be taught social skills, recent research demonstrates that early intervention programmes play an important role in helping children with autism improve their social skills, as well as cognitive and language abilities.

One 2012 study has reported that an intensive programme comprising 20-hours-a-week one-to-one training with interpersonal exchanges over a period of 2 years, yields improved brain responses to faces among infants with autism aged 12 to 30 months. Use of this therapeutic intervention by parents has been shown to be effective on even young infants with autism. In this 2014 study, at-risk 6-month-olds, who showed signs of autism at the start of intervention (e.g., a lack of interest in social interactions and communication), had better cognitive and language skills 12 to 30 months later. In a follow-up study of these infants, further improvements were observed after 2 years of intervention. Infants’ cognitive, communication, and adaptive skills (skills for everyday living) were observed to undergo greater improvement compared to peers with autism who attended a preschool programme and who were given speech therapy.

Other groups of researchers have also shown that parent training is also an effective way to improve the quality of social interactions between parents and infants with autism. A 2014 study has shown that teaching parents to support their children’s learning during everyday activities results in better language and social communication among toddlers with autism. In another recent study, one-year-olds with autism whose parents received coaching on how to attract their infant’s attention and interest their infant in social interaction games produced better outcomes than peers receiving community-based early intervention and monitoring. A separate 2015 study has also shown that the benefits of parent training over a period of 24 weeks to include a reduction in disruptive and aggressive behaviours among children with autism aged 3 to 7 years (Supernanny also some useful tips…). It’s evident that there are various effective therapeutic options available to families of children with autism.

Interventions which reduce the severity of children’s autistic behaviours are important. But support for families are as, if not more, important. This is particularly true for caregivers and parents of children with autism, who experience a high level of caregiving stress on a daily basis and can be at risk for caregiver burn out. Journal writing has been found to help mothers manage their stress levels, while mothers are less likely to experience depression if their partners share the burden of caregiving. But it’s often easier said than done. Respite care — which provides parents and caregivers with time off to take of themselves — can play an important role for helping parents and caregivers manage their stress. And more public awareness won’t do anybody any harm either.

World Autism Awareness Day is a few months away but there’s no time like the present to support a greater public awareness of autism.