Understanding Mild Cognitive Impairment: Causes, Detection, and Ways to Improve Memory

WORDS PROFESSOR DR TAN MAW PIN

FEATURED EXPERT
PROFESSOR DR TAN MAW PIN
Geriatric Medicine Consultant
Founder and Managing Director of ACT4Health Sdn Bhd
WHAT IS MILD COGNITIVE IMPAIRMENT (MCI)?

Mild cognitive impairment, or MCI, occurs when people notice memory problems that are confirmed by tests, yet they can still manage their daily activities independently.

CAUSES OF MILD COGNITIVE IMPAIRMENT

The most common cause of MCI is Alzheimer’s disease, which also leads to dementia. However, many other factors can contribute to MCI, including:

  • Strokes or cerebrovascular disease
  • Lewy body disease (also linked to Parkinson’s disease)
  • Certain infections
  • Head injuries
  • Vitamin B12 deficiency
  • Side effects of certain medications
  • Imbalances in body chemistry

While some causes of MCI are reversible, others can worsen over time. It’s essential to address these issues early to improve or maintain cognitive function.


Common symptoms of MCI. Click on the image for a larger, clearer version.

HOW MILD COGNITIVE IMPAIRMENT DEVELOPS

MCI occurs when the brain doesn’t work as well as it should due to the various underlying conditions shared earlier.

  • In some cases, like Alzheimer’s or Lewy body disease, abnormal proteins build up in the brain.
  • For those with cerebrovascular disease, stroke damage can often be seen on an MRI.
  • In cases related to infections or vitamin deficiencies, there may not be visible changes in the brain, but chemical imbalances are present.
MILD COGNITIVE IMPAIRMENT IN MALAYSIA
  • In Malaysia, studies show that 1 in 4 people over the age of 60 have mild cognitive impairment.
  • While many improve, 10% to 25% of those with MCI will eventually develop dementia.
  • Older individuals are more likely to have MCI, but it can also affect younger people.
HOW IS MILD COGNITIVE IMPAIRMENT DETECTED?

Detecting MCI can be tricky. Common tests include the Montreal Cognitive Assessment (MoCA), although it has limitations for Malaysians due to cultural and language differences.

A more regionally adapted test, the Visual Cognitive Assessment Test (VCAT), is now being used. VCAT was tested in Malaysia through collaborations with Dr Nagaendran Kandiah and his team when he was working at the National Neurological Institute in Singapore.

These tests are designed to detect mild memory problems and often take longer than traditional dementia screenings. Newer digital tests are also being developed to make detection faster and more accessible.

CAN ONE PREVENT MCI FROM GETTING WORSE?

The good news is that people with MCI can improve their chances of preventing memory decline by making lifestyle changes. Here are some proven methods:

Mental Exercises
  • Engaging the brain through memory exercises, puzzles, and learning new skills can help.
  • Activities like crossword puzzles and recall games are excellent for keeping the mind sharp.
Physical Exercise
  • Regular exercise, which should include strength training, should be done for at least 30 minutes, 5 days a week.
  • Physical activity is crucial for maintaining brain health.
Diet
  • Certain diets, like the Mediterranean or Okinawan diets, have been linked to lower risks of cognitive decline.
  • Consuming oily fish (salmon, mackerel, tuna) at least once a week, along with whole grains, fresh fruits, vegetables, and reducing red meat and fats, is highly recommended.
Social Participation
  • Staying socially active, whether through family, friends, or volunteering, is essential for cognitive health.
  • Volunteering is particularly effective as it provides a sense of purpose and responsibility as well as a morale boost when things are difficult.

Learning New Skills

  • Continuing education, whether learning a new language, picking up a musical instrument, or even pursuing higher education, helps maintain brain function.
  • Many older adults now take postgraduate degrees after retirement to keep their minds active.
  • The University of Third Age, Malaysia (link opens in a new tab) is a good place to get started. This is a programme by the Institute of Gerontology, Universiti Putra Malaysia with the support of our government and the United Nations Population Fund (UNFPA).
IN CONCLUSION

Mild cognitive impairment (MCI) doesn’t have to be a step toward dementia.

By recognizing the signs early, addressing underlying causes, and making lifestyle changes, we can protect our memory and brain health. So, stay proactive by staying active—mentally, physically, and socially!

  • ACT4Health has partnered with A. Menarini and CARiNG Pharmacy to launch the ⁠’Catch Mild Cognitive Impairment Early: Act Now, Remember More’ campaign.
  • This campaign aims to encourage Malaysians to get early screening to address potential MCI issues.
  • At the time of writing, free VCAT screening tests are available at selected CARiNG Pharmacy outlets.

Healthy Ageing Through Post-Retirement Employment: A Path to Active Living

WORDS LEE YIN LAN

FEATURED EXPERT
LEE YIN LAN
Lecturer
School of Accounting and Finance
Taylor’s Business School

As life expectancy increases, the concept of retirement is evolving. Healthy ageing has become a crucial focus for individuals and societies alike. This article explores how employment after retirement can contribute to healthy ageing, discussing both the benefits and challenges of this approach.

THE CHALLENGE OF HEALTHY AGEING IN RETIREMENT

Malaysia is transitioning into an ageing society, with the Department of Statistics reporting an average lifespan of 74.8 years in 2023.

The extended lifespan presents challenges. A 60-year-old retiree in Malaysia must support themselves for nearly 15 additional years, potentially straining public resources for medical and welfare aid.

Over the past decade, government expenditure on pensions and gratuities has averaged RM14.8 billion annually, reaching RM32.01 billion last year.

Projections suggest this figure could escalate to RM46.36 billion by 2030 and a staggering RM120 billion by 2040.

Retirement, a significant life transition, prompts reflection on how to embrace active ageing practices and maximize this phase of life. Many retirees are now considering continued employment as a strategy for healthy ageing and financial stability.

BENEFITS OF POST-RETIREMENT EMPLOYMENT FOR HEALTHY AGEING

Faced with a rapidly ageing population, encouraging seniors to supplement their incomes through active employment is emerging as a viable solution. This approach not only eases the financial burden but also contributes significantly to healthy ageing.

Countries with substantial ageing populations, such as Japan, Singapore, and Germany, actively promote post-retirement employment through tailored programmes. These initiatives stem from the belief that remaining active in the labour market yields multiple benefits for healthy ageing.

  • Maintaining good physical and mental condition
  • Fostering social connections
  • Enhancing individual financial security
  • Contributing to overall health and happiness

Research supports the positive impact of post-retirement employment on healthy ageing.

Studies across various countries have linked later-life employment to reduced risks of dementia and lower mortality rates from conditions often exacerbated by social isolation, such as strokes and heart disease.

A 2021 study by University of St Andrews scholars, published in a leading health journal, found that delaying retirement until 67 or older can reduce cognitive decline by up to 34% compared to earlier retirees. This finding underscores the importance of extended workforce participation in promoting healthy ageing and cognitive well-being.

ADDRESSING THE CHALLENGES OF RETIREE EMPLOYMENT

Despite the benefits, retirees may encounter challenges such as age discrimination and skills mismatch when re-entering the workforce.

Older workers often face bias from employers who favour younger candidates, viewing them as more adaptable and tech-savvy.

Additionally, older employees may be unfairly labelled as stubborn or resistant to change due to their extensive and longstanding experience.

Retirees

To address these challenges, retirees should proactively update their skills to align with current industry demands and tailor their resumes to highlight relevant experience.

Leveraging professional networks can also provide valuable job opportunities. Removing age identifiers from resumes, such as graduation dates, can help combat age discrimination, while adopting a modern resume format enhances competitiveness in the job market.

Employers

Employers can further contribute to creating an age-friendly workplace, offering flexible options such as remote work or part-time hours for older employees, while also implementing health programmes like screenings and fitness classes to support their well-being and boost productivity.

Additionally, using age-neutral recruitment and promotion practices ensures decisions are based on skills and qualifications, promoting fairness and inclusivity for all employees.

IN CONCLUSION

While ageing has traditionally been associated with declining productivity and viewed as a burden on society, this perception is evolving. With advancements in healthcare and a culture of lifelong learning, it is now recognized that individuals can maintain productivity and contribute to society well into their later years. Therefore, middle-aged and older adults approaching retirement or who already retired may consider exploring opportunities for continued engagement and fulfilment in the latter stages of life.

References:

  1. Department of Statistics Malaysia. (n.d.). Life Expectancy. OpenDOSM.
    https://open.dosm.gov.my/dashboard/life-expectancy
  2. Kivimäki, M., Walker, K. A., Pentti, J., Nyberg, S. T., Mars, N., Vahtera, J., Suominen, S. B., Lallukka, T., Rahkonen, O., Pietiläinen, O., Koskinen, A., Väänänen, A., Kalsi, J. K., Goldberg, M., Zins, M., Alfredsson, L., Westerholm, P. J. M., Knutsson, A., Theorell, T., Ervasti, J., … Lindbohm, J. V. (2021). Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies. BMJ (Clinical research ed.), 374, n1804. https://doi.org/10.1136/bmj.n1804
  3. Hale, J. M., Bijlsma, M. J., & Lorenti, A. (2021b). Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors. SSM – population health, 15, 100855. https://doi.org/10.1016/j.ssmph.2021.100855

Reimagining Your Retirement with Entrepreneurship in Your Golden Years

WORDS PROFESSOR DR CHONG WEI YING

FEATURED EXPERT
PROFESSOR DR CHONG WEI YING
Deputy Director
Active Ageing Impact Lab
Taylor’s University.

The word “retirement” conjures images of endless days of relaxation, hobbies pursued at leisure, and perhaps occasional travel. However, this traditional view of retirement is rapidly evolving.

RETIREMENT IS JUST THE BEGINNING OF A NEW PHASE OF LIFE

Today, retirement is increasingly perceived not as an end but as a beginning—a phase of life during which individuals can leverage their decades of experience, skills honed over a lifetime, and a wealth of knowledge to contribute to society in meaningful ways.

The appeal of entrepreneurship has never been greater to individuals, attracting those who desire greater autonomy, choices, and possibilities for unlimited growth in their golden years.

WHY ENTREPRENEURSHIP?

The reasons for this shift are manifold.

Longer lifespan. For one, a longer lifespan has prompted individuals to redefine retirement. With the accumulated resources, such as financial savings and extensive professional networks, individuals might want to expand their activities to include continued work in some capacity, engaging in lifelong learning, pursuing new hobbies, or even starting new businesses after retirement.

Greater access to digital media. Additionally, the advent of the digital era has made access to information, resources, and networks easier than ever for individuals to start businesses from the comfort of their homes.

New goals. Individuals are encouraged to remain engaged, mentally alert, and physically active during their retirement years. Launching a business can offer a renewed sense of purpose, providing a compelling reason to greet each morning with enthusiasm and a goal to work towards. It embodies the pursuit of continued growth, learning, and self-challenge.

Leaving a legacy. In certain cases, embarking on entrepreneurship in later life serves as a powerful means to impart wisdom to the younger generations. This exchange across ages not only narrows the divide between the young and the elderly but also cultivates a culture of ongoing learning and cooperation. Embracing an entrepreneurial spirit in one’s retirement years not only enhances personal fulfilment but also benefits the economy and society at large through job creation, innovation stimulation, and economic growth.

IGNITING YOUR ENTREPRENEURIAL SPIRIT

Before deciding to jump into a business and get caught up in the excitement, it’s crucial to adopt a sober view of potential problems. You first must ask some questions early that might mitigate or prevent potential problems and avoid unnecessary grief.

Here are some practical questions designed to help you determine if starting a business during your golden years is the right decision for you:

  1. Do I have the skills and strengths required to start and manage a new business, or is it primarily seen as a hobby? How does this interest align with the practical aspects of running a business?
  2. Am I financially stable enough to start a business without jeopardizing my retirement savings? What funding options do I have in place?
  3. Do I have the physical and mental stamina required to start and manage a new business? How might this impact my health and lifestyle?
  4. How comfortable am I with taking risks at this stage in my life? Am I prepared for the possibility of failure
  5. Am I looking to build something that leaves a legacy, or am I interested in a venture that meets immediate goals? Who can provide advice and assistance?
  6. How can I leverage my professional and personal connections for support and growth opportunities? Who can be my mentor in the entrepreneurial journey?
  7. Is there a real demand for the product or service I plan to offer? How saturated is the market?
  8. Are there any cost-effective business models that can lower the business risk? How can these models significantly reduce financial exposure and operational risks?
  9. What is my exit strategy if the business doesn’t go as planned? How will this impact my future and finances?
  10. What are the legal implications of my business structure (for example: sole proprietorship, partnership, corporation), and how does it affect my liability and tax obligations? How do I ensure that my business practices comply with stated laws?

As you approach your golden years, it is you that will make the crucial decisions about whether to have a phase of relaxation or a stage for active participation, personal fulfilment, and societal contribution. Starting a business will not only transform your life but also enrich society, showcasing the untapped potential of your later years.

Experts Pave the Way to Improve Outcome of Osteoporosis in Malaysia

WORDS LIM TECK CHOON

On January 17, 2023, Malaysian Osteoporosis Society (MOS), the Academy of Medicine Malaysia, and our Ministry of Health launched their jointly-published 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis.

In the media briefing held in conjunction with this launch, our Director General of Health Tan Sri Dato’ Seri Dr Noor Hisham Abdullah shares that:

  • Malaysians are now growing older and living longer. As a result of this, many of us will be affected by age-related non-communicable diseases, which includes osteoporosis.
  • Osteoporosis results in bone fractures, which are associated with disability and premature death.
An illustration of osteoporosis. Click on the image for a larger, clearer version.
WHY IS OSTEOPOROSIS SUCH A CONCERN?

A 2020 study revealed that all people with hip fractures, upon treatment and discharge from the hospital, need walking aids.

6 months later, only 24% (that’s about 1 out of 4 people) regain their mobility and their ability to live independently.

Another 26% die within one year after the fracture.

Tan Sri Dato’ Seri Dr Noor Hisham Abdullah voices his concern that osteoporosis is a serious disease that requires early detection, intervention, and management even at later stages.

This is especially relevant, as the incidence of hip fractures is projected to rise from 5,880 in 2018 to 20,893 in 2050, a 3.6-fold increase!

THE KEYSTONES TO IMPROVING THE AWARENESS OF & TREATMENT OUTCOME OF OSTEOPOROSIS

Dr Yeap Swan Sim, the current President of the Malaysian Osteoporosis Society, states that the cornerstone principles in ensuring that Malaysians can age healthily and gracefully while minimizing the threat of osteoporosis are:

  • Understanding the disease
  • Taking preventive measures
  • Good management of osteoporosis
  • Knowing the appropriate surgical options, should these options become necessary
FRACTURES & OSTEOPOROSIS ARE NOT “NATURAL” AGEING PROCESS, SO TAKE THEM SERIOUSLY!

Dr Terence Ong Ing Wei points out that osteoporosis usually happens in older people and is almost as common as diabetes. “Diabetes evokes fear and concern, yet most people wouldn’t give osteoporosis a second though,” he muses.

Many people often assume that bones weaken and falls and fractures become more common because all these are a ‘natural’ part of ageing.

Dr Terence disagrees, stating that there is nothing natural about osteoporisis.

In fact, it is actually a very complex condition influenced by many factors. “Some things that we do not think too much about in our everyday lives have a huge impact on our bone health. These include physical inactivity, fad diets, cigarette smoking, and age-related hormonal changes such as oestrogen in ageing women and testosterone in men. All these increase the rate of bone loss at a time when strong bones are most needed.”

DIAGNOSIS AT LATE STAGE OSTEOPOROSIS FORCES DOCTORS TO RULE OUT IDEAL TREATMENT OPTIONS 

Dr Yeap says, “We usually only see osteoporosis at its late stages—after a fracture has occurred. By then, the patient would have incurred significant amounts of bone loss. At that stage, it is no longer possible to offer treatments to replace the lost bone, which is the ideal scenario. Instead, treatment options will instead attempt to minimize the detrimental effects of a fracture experienced by the patient.”

“Clearly, we should be giving more emphasis to screening and early detection, followed by suitable interventions so that we can protect the most vulnerable persons from this terrible illness,” she adds.

EARLY DETECTION CAN ALLOW FOR EARLY PREVENTIVE MEASURES 

Professor Emerita Chan Siew Pheng concurs with the other experts. “This is because mainly because you don’t even realise osteoporosis is there until you suffer from a fracture. So, the only way to know if you have osteoporosis before a fracture occurs, is by going for a bone density scan, also called dual-energy x-ray absorptiometry, DEXA or DXA.”

More about bone density scan
Prof Chan explains that the bone density scan is a quick and painless X-ray procedure that allows doctors to find out whether osteoporosis is present.

It also allows doctors to predict the risk of future fractures in order to provide timely and suitable treatment. “This would save you so much trouble in the future!” she says.

According to Prof Chan, women aged 65 years or older and men 70 years or older should have a DXA scan done every two years.

Younger individuals may also need to be screened if they have certain conditions such as diabetes, thyroid disorders, nutritional malabsorption, eating disorders, rheumatoid arthritis, or are taking certain medications (like steroids) long term.

If you fall into any of these categories, you should consult your doctor for more information as to how you can benefit from a DXA scan.

With the right steps at the right time, osteoporosis can be effectively managed 
Prof Chan explains: “There are effective medicines that can be tailored to suit all sorts of patients based on their disease stage and lifestyle. Moreover, whenever pharmacological treatment is necessary, the medications that are available in Malaysia can reduce the risk of fractures from 15% up to 70%!”

She adds that these anti-osteoporosis medicines are generally well-tolerated and effective.

THIRD-EDITION CLINICAL PRACTICE GUIDELINES LAUNCHED TO IMPROVE SCREENING, DIAGNOSIS, & TREATMENT OF OSTEOPOROSIS

Dr Yeap Swan Sim shares that this clinical practice guidelines, meant for healthcare professionals in Malaysia, consists of evidence-based statements intended to assist healthcare providers in optimizing patient care.

“We must first recognize the fact that osteoporosis is a multi-factorial condition,” she says. “Nutrition, age, hormone, lifestyle and the presence of pre-existing disease are some of the aspects that can affect bone health. All these requires not only input from one profession but multiple of them in order to provide patients with proper and effective care.”

She adds: “As such, the clinical practice guidelines had to be written by a panel of experts from all the related disciplines, such as nutrition, geriatrics, endocrinology, orthopaedic surgery, obstetrics and gynaecology, rheumatology, primary care and pharmacy. The wide variety of expertise involved in the writing of the clinical practice guidelines ensures extensive coverage so that the guidelines will be able to inform all types of healthcare professionals who would be involved in the screening, diagnosing and treatment of osteoporosis.”

The 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis was the fruit of the labour of the CPG Working Group comprising:

  • Dr Yeap Swan Sim (Chairperson)
  • Dr Terence Ong Ing Wei (Co-chairperson)
  • Associate Professor Dr Lim Lee Ling (Co-chairperson)
  • Professor Emerita Dr Chan Siew Pheng
  • Professor Datuk Dr Sabarul A Mokhtar

Interested healthcare professionals can download the 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis by clicking here. This link will open in a new tab.