How do you remember things? When I was eight, my Nan would tie a string around my finger so I wouldn’t forget to pack my school bag, drink my milk or do something else I wasn’t fond of. By the end of the day however, I’d somehow lose the string itself! These days, I set reminders using my smart phone for just about everything: work meetings, tea with former schoolmates, annual health check, drink water… you name it. I only need to remember one thing: where my phone is (which admittedly, I have forgotten before!).
Funny anecdotes aside, I think it’s time we paid more attention to our mental health and started looking after our brain as much as we look after our heart, eyes, lungs, kidneys, skin and other body parts. I’ve been consuming more fish and soybeans because I’ve read that a traditional Japanese diet could help preserve brain function and stave off cognitive decline.
Why should we bother about something like cognitive decline, which mostly occurs during old age, while we’re in our 30s? Because every lifestyle choice we make at this stage will go a long way towards keeping cognitive decline away. The plans we make today could also enable us to make the most of life if the unexpected happens.
In this article, I’ll explain what you need to know about cognitive decline, as well as how you can protect yourself and your loved ones against the financial impact of cognitive decline.
What is cognitive decline?
Cognitive decline is the slowdown or loss of mental abilities such as learning and remembering things, reasoning and keeping attention on an activity. It’s more apparent later in life, when the rest of the body may also start showing subtle signs of reduced functional capacity. Aside from age, here are some things that can influence when cognitive decline begins and how quickly it progresses:
- illnesses
- accidents
- lifestyle patterns
- genetics
Don’t mistake forgetfulness for cognitive decline, though. While absent-mindedness is a common sign of ageing, cognitive decline is a medical condition that requires a doctor’s diagnosis and intervention.
What is dementia?
Dementia is an umbrella term for conditions characterised by cognitive decline and other symptoms like:
- confusion with places and time
- changes in personality and behaviour
- trouble with planning and communication
- withdrawal from favourite activities
- repeating oneself
As dementia progresses, individuals find it harder and harder to carry out everyday tasks.
There are different types of dementia, the most common of which is Alzheimer’s Disease, and it tends to affect seniors more. However, contrary to popular belief, dementia is not a “normal” part of growing old that should simply be accepted and left alone. While there’s no cure for dementia, if it’s detected, treatment can help mitigate its deterioration.
How common is dementia?
Being a fast-ageing society, it’s no surprise that there’s a high number of dementia cases in Singapore. According to Dementia Singapore, one in 10 Singaporeans aged 60 years old and above has dementia1. As the population of seniors grows, there might be more individuals and families affected by dementia around us.
Turning 60 might sound far off, but when it comes to protection against dementia and cognitive decline, it’s always better to act early, when you still have full mental capacity.
3 things you need to know about cognitive decline
If you’re in your 30s or older or you have parents who are young seniors in their 50s or older, being aware of these facts about cognitive decline could save you and your family from potential mental, physical, emotional and financial distress.
1. Dementia doesn’t target seniors. Young people can be diagnosed too.
According to Dementia Singapore, dementia can affect people as young as 40 years old.1 More than 100 individuals are diagnosed with young-onset dementia in Singapore every year.2
Young-onset dementia is dementia that develops in people younger than 65 years old. Causes can range from illnesses to accidents, and the symptoms can be quite different from that in an older adult. Treatment options and care needs might also be different.
Compared to a diagnosis during the retirement years, being diagnosed with dementia in the 40s or early 50s could have a bigger financial impact on an individual. Individuals might have to stop working and become unable to support themselves and their children and/or elderly parents. Meanwhile, as they gradually become unable to carry out their parental responsibilities, their young children will lose a caregiver. Older children may have to step forward as “parents”.
Take the case of Madam Yeo*, for example. Once an active working mum, she began showing signs of dementia in her early 50s. Her daughter K Yeo* was thrust into a caregiver and medical proxy role – she was only in her early 20s, a time when most would be socialising, travelling and making future plans.
K shares, “My mother was a very strong career woman during my growing-up years. She was a hero to my brother and me. I was in my early 20s when we both became her caregivers. We didn’t know how to manage when she started throwing tantrums and becoming aggressive – behaviours she never displayed before dementia. We were like new parents, learning through trial and error and looking for answers on the internet. My daily focus was taking care of my mum and constantly being around in case she needed me. As her medical proxy, I also managed her medical needs and appointments.”
Read K Yeo’s story about caring for someone with young-onset dementia.
So, if you’re in your 30s or 40s and notice (or have been told) that there are significant changes in your cognitive functions, speak to a medical doctor.
2. One of the first signs of dementia is depression.
Major depressive disorder is a common mental health condition that can stem from various causes, but did you know that depression could lead to dementia and vice versa?
This might be surprising because people tend to look for more obvious signs of dementia like hallucinations and dramatic mood changes. In fact, the illness can sometimes masquerade as something quieter like depression.
K, whose mum has been living with dementia for 15 years now, says, “In the months leading up to her dementia diagnosis, my mum kept forgetting things. She had just been retrenched and because of her forgetfulness, it was harder to hold on to jobs. She became depressed over her forgetfulness and would have emotional outbursts. My brother and I thought it was just normal forgetfulness which happens to all of us, but the crying was unlike my mum and a red flag. That's when we decided to bring her to a doctor. In the initial stage of my mum's dementia, there would be times when she was still cognitive and I think that's when she probably struggled most. Some days, she wouldn't know what's going on because of dementia but on the days when she knew, she felt helpless about not being able to do anything."
As patients with dementia and patients with depression may experience similar things like loneliness, withdrawal and isolation, the two conditions are often mistaken for each other. In fact, depression could be an early sign of dementia.
This is why anyone suffering from depression should be evaluated for dementia if they also display certain signs and symptoms, like:
- they appear disoriented
- their writing, speaking and motor skills are affected
- their short-term memory is impaired
- they appear unconcerned about their short-term memory issues
If dementia is detected early, individuals can undergo treatment to help slow its progression. Early detection also gives individuals and caregivers time to learn about the condition, set realistic expectations about the future and make plans to maximise their quality of life.
3. Mental health conditions can lead to physical disability.
When a person’s mental function is impaired, their physical mobility can also be reduced, making everyday activities increasingly challenging. Sometimes, these physical symptoms can be extensively disabling.
In the later stages of dementia, for instance, individuals could become unable to walk, stand or transfer from a bed or chair. They may also be prone to falls.
In Madam Yeo’s case, she went from being confused, irritable and unable to recognise her children to becoming unable to perform basic activities on her own.
“Initially, I didn’t know how to physically take care of someone else… bathe them, help them with toileting and so on. It was difficult for my brother and me to see our mother go from an independent woman to someone fully dependent on us,” K shares.
When an individual is unable to perform at least three of the six Activities of Daily Living (ADLs) – they’re considered severely disabled.
They’ll have to undergo a Severe Disability Assessment and once diagnosed as “severely disabled”, they’ll receive payouts from long-term care insurance schemes like the national CareShield Life and private insurer-provided supplements or add-ons.
Keep in mind that not all individuals with dementia or cognitive decline meet the definition of “severely disabled”, in which case, only plans which cover cognitive decline would come in handy.
Ways to protect yourself and your loved ones against the financial impact of cognitive decline
With a greater understanding of cognitive decline, we can plan better for the possibility of needing long-term care.
- Pay more attention to mental health.
Aside from maintaining a healthy lifestyle – eating balanced meals, exercising, maintaining a healthy weight, getting adequate rest, and giving up alcohol and smoking – keep stress levels in check and stay socially engaged. Pursue hobbies that stimulate the mind like reading, doing puzzles and learning new things. It’s also important to go for regular health checks and speak to a doctor early if you (or someone else) notice changes in your cognitive function.
- Get adequate financial protection for long-term care and dementia.
Living with dementia is costly. In the event that cognitive decline leads to severe disability, having enough long-term care insurance payouts can be extremely useful. By adding a CareShield Life supplement to your basic CareShield Life coverage, you can get a higher monthly payout for severe disability as well as other payouts. But what if dementia doesn’t result in severe disability? There also dementia-specific plans that give a payout for cognitive decline, regardless of whether an individual can or cannot perform the ADLs. Personally, I’d not only enhance my CareShield Life with a supplement for higher monthly payouts but boost that with dementia coverage for more holistic long-term care protection. Most importantly, I’d make sure my loved ones know how to make a claim. It’s reassuring to know that insurers now better support individuals and their families during health setbacks like dementia. For instance, Singlife Care Collab is a one-stop hub for access to a range of support services from trusted partners like Dementia Singapore, Helping, Immortalize and more.
- Ensure your dependants will be financially supported.
Managing the cost of your own long-term care is one thing. Avert a potential crisis situation at home by ensuring your spouse and children will be adequately supported and won’t have their quality of life jeopardised should cognitive decline leave you unable to work. Put in place financial plans that will give your loved ones a financial resource to tap and continue having the comforts and lifestyle they’re accustomed to if you’re no longer able to provide for them. Aside from having an emergency fund, consider growing your savings by putting it into an investment plan.
Conclusion
Cognitive decline can limit us and our loved ones in unexpected ways. So, before it can even happen, it’s important to make plans to mitigate the impact of cognitive decline so that life can continue to be meaningful.
Looking after our mental wellbeing from now is paramount for optimal brain health and keeping mental conditions like dementia at bay. Aside from that, having appropriate financial plans and coverage gives us the financial freedom to afford the type of long-term care we want without putting financial burden on our loved ones or depleting funds meant for their future education, retirement or inheritance. To protect our loved ones’ quality of life, it’s also wise to have other financial resources which they can draw from for day-to-day needs if we’re no longer able to be the breadwinner.
By making a few plans today, you can give yourself greater certainty about future care arrangements and protect your family’s lifestyle should dementia set in.
Notes
*Names changed to protect the family’s privacy.
1. Source: Dementia Singapore, “Dementia in Singapore”, accessed on 19 April 2024.
2. Source: Dementia Singapore, “What is young-onset dementia?”, accessed on 19 April 2024.
