BANDAR SERI BEGAWAN – Dementia patients have had a tough time coping with isolation and loneliness during the COVID-19 pandemic, with their families reluctant to visit over fears of spreading the coronavirus, a health expert said.

Dr Teo Shyh Poh, consultant geriatrician at RIPAS Hospital, said the pandemic has limited dementia patients’ access to physical and mental health support as well as the social interactions they need to delay the progression of the disease.

Government restrictions on public gatherings meant that weekly meetings for a dementia support group had to be cancelled as the majority of attendees are elderly and at a higher risk of contracting severe forms of COVID-19.

Demensia Brunei is a local NGO that promotes awareness and focuses on the rights of persons with dementia and their caregivers.

“Without [the weekly meetings], people are left on their own.

“We heard that because of COVID-19, family members are reluctant to visit [the patients for fear of spreading the virus] and they become more lonely. In turn, they regressed because there is no one to talk to,” Dr Teo added.

Consultant geriatrician at RIPAS Hospital Dr Teo Shyh Poh (L) speaks at the virtual dialogue session on dementia hold in conjunction with the World Alzheimer’s Month on Sept 20 Photo: Rasidah Hj Abu Bakar/The Scoop

In his statement to mark World Alzheimer’s Day on September 23, health minister YB Dato Seri Setia Dr Hj Mohammad Isham Hj Jaafar said social distancing measures have exacerbated dementia patients’ symptoms.

“Public health measures are necessary to limit the spread of the coronavirus, but have made it more challenging for those experiencing loneliness, depression and social isolation,” he said.

The minister had also admitted shortcomings in the provision of daily services and support for dementia patients in terms of pandemic preparedness.

Most dementia cases detected late

Lack of awareness of the progressive brain disease means people with dementia most often do not seek medical help early.

The majority of about 2,000 people suffering from dementia are undiagnosed in Brunei, while another 1,200 people have Alzheimer’s disease.

“When we see people with dementia, it is usually in the advanced stages and there are no curative treatments [for dementia]. The treatments are meant to slow down the progression,” Dr Teo said.

“If they present late and there’s already so much injury or insult to the brain, treatments won’t be as effective and the patients may become fully dependent on their family members,” he continued.

The geriatrician said dementia patients would potentially have 10 to 20 more years of independence if they were diagnosed early.

A workshop organised by Demensia Brunei aimed at increasing community awareness on dementia. Photo: Courtesy of Demensia Brunei

Warning signs of dementia

Dementia is an umbrella term for memory loss and other thinking abilities severe enough to interfere with daily life.

RIPAS Hospital geriatrics senior medical officer Dr Onn Lih Vei said there is a preconceived notion that dementia only affects the old, but early onset of the condition can also occur in young people.

Dementia is caused by conditions that affect the brain, including head injuries or trauma.

“Individuals may exhibit signs of dementia such as forgetfulness but they may still able to remember.

“Dementia is a collection of different symptoms and signs. Therefore in the clinic, we are not just looking at memory as the only dimension but also other aspects of dementia,” she added.

Government data showed that 4.8 percent (22,200 persons) of Brunei’s population in 2019 were aged 65 years and over.

Brunei’s high prevalence of non-communicable diseases (NCDs) is also expected to cause a rising number of dementia cases.

Chronic diseases such as hypertension and diabetes increase the risk of cognitive impairment and dementia.

Caregivers under increasing stress

Dr Onn said caregivers of dementia patients are mostly women – daughters or domestic helpers and they are at higher risk of physical and mental health problems.

Caregivers may experience stress, depression, anxiety or burnout and exhaustion.

They may also face financial strain when they quit their jobs to become primary caregivers.

“It is important to let them know that their health is equally important, and it is important for them to recognise this early and get help early,” she said.

Dr Onn said the families of dementia patients were able to see their behaviour changes on a day-to-day basis as they spent more time at home due to the pandemic.

“Family members who have been working and spending more time at home are able to see new aspects of behavioural manifestation which they have not come across because usually it is the paid caregiver or domestic helper who would be looking after them.

“Now that they are spending more time at home, they realised the stress involved. They are the ones who will come to the clinic asking for an earlier appointment and many [of the patients] need behavioural and psychological management,” she added.