Skip to playerSkip to main content
  • 5 weeks ago
above is now living with dementia, up from 8.5% just seven years ago. Yet, dementia remains one of the least discussed economic and public policy challenges facing the country.

Beyond healthcare costs, dementia affects workforce participation, productivity, household finances and the millions of hours of unpaid care provided by families. Women also account for roughly two-thirds of dementia cases globally and while continuing to shoulder most caregiving responsibilities.

At the same time, new scientific advances are changing how Dementia and Alzheimer’s disease is diagnosed and treated, raising important questions about access, affordability and whether Malaysia’s healthcare system is prepared for an ageing population with increasing rates of dementia.

Category

🗞
News
Transcript
00:10Hello, a very good morning and I'm Tamina Khosju. Welcome to Niaga Spotlight.
00:14Today on Future Affairs, our spotlight falls on building a dementia-ready Malaysia.
00:19Now just to situate us, Malaysia is aging faster than ever before. By 2041,
00:24in seven Malaysians will be aged 65 years and above and dementia is also rapidly emerging
00:29as one of the countries defining health, social and also economic challenges.
00:34The latest National Health and Morbidity Survey, NHMS 2025,
00:39found that 10% of Malaysians aged 60 and above are now living with dementia,
00:44up from 8.5% in 2018, a significant increase in just seven years.
00:49So, at the same time, dementia and Alzheimer's disease is already estimated
00:54at a social cost for Malaysia anywhere between 7 billion to 8.5 billion ringgit annually.
01:01Now, dementia is not experienced equally either.
01:05Women account for roughly two-thirds of dementia cases globally,
01:08while also carrying much of the responsibility for caring for aging parents,
01:12spouses as well as relatives.
01:13Despite this, dementia is still too often discussed as a generic aging issue
01:19rather than one which is shaped by gender, longevity and also the realities of the care economy.
01:24Now, scientific advances are beginning to reshape what may be possible.
01:29This year, Malaysia also approves its first disease-modifying therapy for early Alzheimer's disease,
01:35underscoring the growing importance of early diagnosis as well as intervention.
01:38But innovation alone is not quite enough.
01:41As Malaysia's National Dementia Action Plan 2023-2030 moves into its implementation phase,
01:48the question is whether healthcare systems, caregiver support and also community services
01:54are keeping pace with the scale of the challenge.
01:57Today, we ask what will it take to build a dementia-ready Malaysia?
02:01Welcoming to the studios, Professor Dr. Tan Maupin, who is President of the Dementia Alliance Malaysia
02:07and also Professor in Geriatric Medicine at the University of Malaysia
02:12and together also with Kam Aiteng, Managing Director with ASI Malaysia.
02:17Hello.
02:18Hello.
02:19Fantastic to have you both with us.
02:20Professor Dr. Tan, perhaps if we could get started by, of course,
02:24referencing the increase in dementia cases which have been identified in Malaysia by the NHMS 2025.
02:31Further to that, dementia organisations, advocacy such as yours as well,
02:36have also said that the Dementia Action Plan, it still lacks dedicated, visible national budget funding.
02:44So, to begin with, what should our government be prioritising within the next, let's say, 12 to 24 months?
02:52Yes.
02:52So, the figures that you mentioned just now, an increase from 8.5% in 2018 to 10% in
03:012025
03:03comes alongside increased number of older people in our country.
03:07So, we estimate that at that time in 2018, we estimated there were 200,000 people living with dementia
03:15at that time because 8.5% of 2.5 million was 200,000.
03:20But now, our total number of older people, aged 60 years and over, is now 4 million.
03:27So, 10% of 4 million is 400,000.
03:31So, it's literally doubled in that time.
03:34That's right.
03:34And that's a really scary statistic.
03:36So, what we actually have been trying to do is to actually increase awareness of the statistics
03:44because we understand that society and the government have many competing interests.
03:49That's right.
03:49And we do have existing dementia societies that have been around for the last 20 years or so.
03:54But the problem is that the lack of visibility of dementia has led to not enough donations to these societies,
04:01not enough people who are willing to volunteer.
04:04In fact, we see the same volunteers working with the same societies for years on year on year.
04:09And what we really want to do is to bring in younger, young blood, young people, including students, to actually
04:16understand this issue.
04:18So, we've actually formed the Dementia Alliance of Malaysia.
04:21Right.
04:22So, it's not really a new society per se.
04:24Today, what it's supposed to do is to bring together new people as well as existing stakeholders in dementia to
04:32try and advocate for this dementia space.
04:34So, it's not going to replace the good work that's been done by all the societies so far.
04:41But because of the rapid increase in cases of dementia, the needs of these people are actually not being met.
04:50They weren't being met before, but the increase in services actually is outpaced by the increase of cases.
04:56So, they're being met even less now.
04:59So, the longer waiting lists, poorer access to good care, those sort of things, and we're all feeling it.
05:06Absolutely.
05:07So, the mismatch, of course, it can definitely be moved towards progressively closing the gaps.
05:12Yes.
05:12With that in mind, Aiting, so on ACI Malaysia's behalf, so with a lot more greater awareness around Alzheimer's disease
05:20and also the importance of early diagnosis,
05:23what type of healthcare infrastructure and referral pathways, in particular, would Malaysia really benefit from at this point in time?
05:32Yeah.
05:33So, I think in terms of that per se, the gap is really how do we help to support earlier
05:40diagnosis for Alzheimer's disease in Malaysia.
05:44So, I suppose there are three key priorities that we can focus on to help improve the situation.
05:50Sure.
05:51I think the first one, like what you have mentioned, right, the earlier awareness effort, earlier conversation needs to take
05:59place.
06:00We all know today 80% of older Malaysians, they perceive dementia as part of, like what you mentioned earlier,
06:07normal aging.
06:08But we know today, Alzheimer's disease, by the time the symptom appears, the patient probably have developed that disease like
06:17years ahead, years earlier.
06:20So, given that, I think…
06:22That's a very large intervention window, right?
06:24Exactly.
06:25So, once we get the patient identified earlier, the next issue that we may potentially see is actually the referral
06:33pathway.
06:35So, I think strengthening that referral pathway is crucial to help more Malaysians with Alzheimer's disease.
06:42So, what I meant is really strengthening the pathway from primary care doctors to the specialists treating dementia, the dementia
06:51expert.
06:52And for Malaysia, we have dementia experts like a geriatrician, like Prof Tan herself, and then we have neurologists.
07:00But we even have like neuropsychiatrists, psychiatrists specialising in neurology.
07:05Right.
07:06So, this has to be strengthened.
07:08But once the patient is referred to the system, we have to ensure that the specialist centre has the capability
07:15to help to actually assess the patient well, earlier stage.
07:21Brain health assessment can be done broader.
07:24Second part would be, I think, the diagnostic tool to diagnose Alzheimer's well, correctly, given all the paradigm shifts.
07:32And I think thirdly, the treatment care journey.
07:36Alzheimer's disease is really a long journey for both the patient and caretaker.
07:40So, how do we actually strengthen the capability of not only the specialists, but the other healthcare profession within the
07:50ecosystem to make sure patient and family are supported throughout their journey.
07:55Absolutely.
07:56And also, perhaps, a really important dimension of that would be regardless of where the individuals live.
08:03That brings me back to Prof Dr Tan.
08:05Now, of course, the dementia action plan emphasises earlier detection.
08:09That's always better for everyone involved, patient as well as caregivers, but also routine cognitive screening.
08:17That would be a really important part of it.
08:19Perhaps to look at expanding that, should such cognitive assessments then maybe become a standard part of older adult care,
08:28perhaps at our clinic kesehatans,
08:30because those are far more widespread across all borders of Malaysia than, of course, the public health hospitals and services,
08:38which can be a little more scattered comparatively.
08:40Yes.
08:41So, to be able to conduct cognitive screening, you need good screening tools.
08:46So, for the moment, to detect dementia early, the tools that we use are very time consuming.
08:53It can take up to 20 minutes and people who administer the tool need specific training.
08:58So, it's not something that can be delivered in a clinic kesehatan setting.
09:03So, there needs to be new innovations to enable maybe digital tools that can be actually self-administered even within
09:11the person's home or tests that are shorter but more sensitive so that they can also widen the access.
09:22So, we don't only need to just rely on clinic kesehatans.
09:25We could do a number of things. We call it opportunistic screening.
09:29So, when they come into the hospital, for instance, at the University of Malaya Medical Centre, we have an electronic
09:34medical record system.
09:35So, the nurses do a screening test for what we call cognitive impairment.
09:41It's not a diagnostic test for dementia. It just identifies there is a problem with the brain function.
09:47Right. But you can also increase access through community healthcare services such as pharmacies and you can also make it
09:57accessible through community centres, etc.
10:00If you can actually make this test so simple that just the trained individuals can administer it or it can
10:09be administered by a, you know, through a computer or a smartphone, etc.
10:13So, improving access isn't just overburdening our clinic kesehatan which is already overburdened but also making it a multi-pronged
10:22approach towards increasing access to screening.
10:26And then, screening is dangerous if you identify cases and then they have nowhere to go.
10:30Right.
10:30But also then to increase the capacity for people to have further testing once they've been identified.
10:36Exactly. So, there is much to be done which can be done but also it needs to be done in
10:41a manner which is not just logical but fitting the current parameters available to us.
10:47Yes. And also by multiple agencies concurrently because you will run into trouble when you screen, identify cases, nowhere to
10:54go.
10:54The people won't come forward for screening and the people screening don't want to screen anymore.
10:58And the people who are overloaded down the receiving end are going to go crazy.
11:02Exactly. Everybody should receive care promptly as well.
11:04Yes, that's right.
11:05Understood. Thank you very much, Prof.
11:07Now, Aiteng, managing Alzheimer's disease of course requires timely diagnosis, there's multidisciplinary care, quite a lot of factors involved.
11:15There's caregiver support and even, of course, long-term follow-ups.
11:18So, from your perspective, what are some of the biggest challenges looking at Malaysia's current care pathways and how can
11:26we go about making the best of what we currently are faced with?
11:30Yeah. So, thank you for the question.
11:32I think the current challenges for Malaysia in identifying Alzheimer early and treating Alzheimer.
11:39One is screening, I think Prof Tan has already mentioned clearly, but the second part to it is really the
11:45diagnostic capability.
11:46So, in the past, historically, Alzheimer's disease is being diagnosed through cognitive assessment or clinical assessment.
11:55But today, we all know from Alzheimer's association diagnostic criteria, they have actually established a biological definition, which means patients
12:05today, if they want to know if they have risk for Alzheimer's, they could go for a test to actually
12:12determine the amyloid pathology of the patient.
12:17And this means they have options of amyloid pathology of the patient, CSF, or even a blood biomarker.
12:26Yeah. But given all these are new, so the other challenges would be, like I mentioned, the capability itself within
12:34the ecosystem to conduct such testing to make it available broader and more affordable.
12:40So, at ISAI Malaysia, what we believe, to actually transform the Alzheimer's ecosystem in Malaysia, we need to collaborate strategically
12:50with the right stakeholders like Damai and the HCP and the labs and the hospital and maybe policymakers to make
12:58sure that this situation improves.
13:00So, for now, what we have done is really partnering with labs, for example, to make sure such testing is
13:07available broader and also affordable for Malaysians.
13:12I'd just like to clarify that this has to be done alongside actual cognitive testing and also imaging.
13:19Because we do know that if you just randomly test and then you find out that you test.
13:24Without the lab diagnostics.
13:26If you randomly test and get the lab diagnosis and you then have, they say you're at high risk of
13:32Alzheimer's disease, but your brain, your memory is absolutely fine.
13:35Right.
13:35Then you, what do you do about it?
13:37Yeah.
13:37So then we do need to do cognitive testing and monitoring alongside and also there's a need for imaging, scans
13:44of the brain, not just blood tests.
13:47Because it's so easy to just turn up to a lab for a bullet test and some people are willing
13:51to do it, but then we can't interpret the test without the whole history as well as an imaging, a
13:57picture of the brain.
13:58So you need to also have coordinators who are looking at this step by step.
14:02And of course, once that is confirmed, let's say you need a care plan and the associated support for it.
14:09Yes, because with early diagnosis, you're looking at preventing progression of disease.
14:14So actually we are so excited because, you know, previously we have to tell the patients that, you know, it
14:20will progress.
14:21And all we can do is to try and train individuals to how to adapt, prevent, how to potentially slow
14:30down the progression by changing their lifestyle, managing the blood pressure, managing the diabetes, for instance.
14:37But now we actually have a drug that can clear, clear the substance that is linked to the disease to
14:43reduce, to slow down the progression.
14:44But that has to be still done alongside all the care.
14:48Absolutely. So that is very promising indeed.
14:50Thank you very much, Dr. Tan, as well as Aiting.
14:53We take a quick brief break. Don't go anywhere.
14:55We'll be back with the rest of the interview right after this short break.
15:19Welcome back to Niagara Spotlight. Still with me, Tamina Kausji.
15:22And today we're focusing on building a dementia ready Malaysia with our guest live in the studio, Professor Dr. Tan.
15:29So moving into speaking a little deeper about Malaysia's dementia action plan.
15:34So it identifies our usual boatload of NCDs, the diabetes, hypertension, obesity, high cholesterol, et cetera, as also being modifiable
15:47risks.
15:47So that is very interesting. Now, aside from that, women are also disproportionately impacted by dementia, both as those who
15:57may eventually develop the disease, are living with the disease,
16:00and also as the ones who perform much of the unpaid caregiving for dementia sufferers.
16:05So looking at all of this information, what are your perspectives around dementia prevention, incorporating NCDs, and also the gendered
16:15impacts?
16:16Yes. So the modifiable risk factors for dementia, we're looking at the third version of the Lancet Commission report.
16:24Right.
16:25And we now know that the disease is most modifiable in midlife.
16:30So overall, globally, 45% of all cases of dementia are potentially preventable, modifiable.
16:38So, and there's this early life risk factor, which is mainly education, but then most of the risk factors are
16:45actually accumulated in the midlife.
16:48So before you turn up, we're talking about head injury, hearing loss, because hearing loss doesn't happen in late life,
16:54it happens usually in midlife.
16:56Right.
16:56And, you know, we listen to loud music and, you know, work in noisy environments, heart disease, you know, high
17:04blood pressure, cholesterol, and mental illness, depression, and also alcohol, smoking, those are all midlife risk factors.
17:18Right.
17:19And then we have late life risk factors, which have been identified as visual loss, and as well as social
17:26isolation.
17:27And the one that is very alarming is environmental pollution.
17:32So those are all modifiable risk factors of dementia.
17:35So you can already sense that this is going to be hugely a whole of society approach.
17:40It's not just health, it's not just a health sector alone that needs to be responsible towards modifying risk factors
17:46for dementia.
17:46And it starts, we call it a life course approach, at early life.
17:52So when you come to us at the age of 70 with memory problems, the focus is, of course, lifestyle
18:01approach.
18:01Sure.
18:02But we actually have to also think about reducing the risks even at midlife.
18:10So a lot of the damage has already been done by the time they turn up to us.
18:14Mm-hmm.
18:15So there's also then other compounding factors.
18:18Yes.
18:18You just mentioned social isolation.
18:20A lot of older adults also develop hearing loss.
18:23Mm-hmm.
18:23Reading the Lancet report too, it estimates midlife hearing loss.
18:27Yes.
18:27Can then lead to up to 7% of those cases.
18:30And it's really high, isn't it?
18:31Yes.
18:32Very high indeed.
18:33Into dementia, full blown.
18:34So hearing assessment and even proper hearing aids are still rather unaffordable across the board for many Malaysians.
18:44So should hearing care also become part of a national integrated care priority then?
18:51It should be.
18:52Mm-hmm.
18:52So we're talking about sensory loss.
18:55Yes.
18:55Or sensory capacity.
18:58And a lot of people will go and have their eyes tested.
19:01We love eye tests.
19:02But yet visual impairment is a late life risk factor.
19:05Mm-hmm.
19:06And we have neglected the hearing impairment part which happens in midlife.
19:10Right.
19:11So particularly if there are occupational risks, you do need to get your hearing tested just like you need to
19:17get your eyes tested.
19:20Yes.
19:20And as soon as you detect any issues, you need to address it.
19:23So you can do things to reduce the deterioration of your hearing loss.
19:27So stop listening to loud music.
19:28Make sure that if you're operating noisy machinery like the leaf blower in your garden.
19:35Mm-hmm.
19:35Or you're protecting your hearing.
19:36Or you're protecting your hearing.
19:37Right.
19:37And then if you need to, don't be shy.
19:41Get a hearing aid.
19:42Mm-hmm.
19:42And the reason why hearing aids end up potentially very expensive is because people tend to go for it when
19:48they have already got very severe hearing loss.
19:50Profound hearing loss, yes.
19:50So then you need very expensive hearing aids.
19:52But if you start early, you can actually cope with more basic models.
19:58Yeah.
19:58Absolutely.
19:59Great advice there.
20:01Aiting.
20:01Now, what would you say is ASAI's vision for the future of Alzheimer's disease care?
20:06And how do you hope that this can contribute to better outcomes for not just patients but also caregivers together
20:14with the wider healthcare system in Malaysia?
20:16So at ASAI, in fact, our corporate philosophy is to help alleviate anxiety of both patient and family.
20:24Mm-hmm.
20:24So with that philosophy, I think for the last past more than three decades, ASAI has been investing in terms
20:32of R&D to find a solution for Alzheimer's disease patients.
20:37So what we want to focus is really to change the cause of the disease.
20:41And given that, we hope, of course, a cure for Alzheimer's someday.
20:47But for now, what we aim is also like what you mentioned, right, how can we support the ecosystem?
20:55How can we help patient and family, right, to have a good patient journey?
20:59So that's when we would love to collaborate with various partners, including Damai, to see how we can make the
21:08patient journey and the caretaker journey a much better one.
21:12So those are ongoing.
21:14Yeah, absolutely.
21:16So something which has already been in progress for the past 30 odd years or so, what would you say
21:20has perhaps changed about public awareness, maybe only in the past few years, as more and more people from even
21:28the sandwich generation now take on the care burdens for their parents?
21:32Yeah.
21:34Yeah.
21:34So I think what have changed is I think now, because of all the effort, the conversation for Alzheimer's and
21:42dementia has increased, right?
21:44But this has to continue with intensity because it's not as simple as the patient being impacted.
21:51But the caregiver actually faced with a lot of stress, stress taking care of the patient, but also there are
21:59components where they have to limit their career, they have to maybe stop working or absenteeism.
22:07So all these things that we have to look at as we collaborate with other stakeholders to improve the situation.
22:15Absolutely.
22:15And our services have become very congested because remember, awareness means more people coming forward.
22:20That's right.
22:21More diagnoses.
22:22But our services, we are already struggling with the increased number of older people requiring the services, but the number
22:27coming forward has increased so much, our increase in services have not kept pace.
22:33Our services have not actually increased much because of the lack of investment in specialist dementia care services.
22:43And so we have congestion in our services because dementia, people living with dementia do live with a disease for,
22:50you know, a decade or so.
22:51Yes.
22:52And if they have to stay within the tertiary care system, it's unpleasant for them because a journey to hospital
22:58can take an army.
22:59But at the same time, it congests our clinics so new people with symptoms can't access healthcare.
23:06So what we really need to do is to decongest our specialist clinics and move care to the community, engage
23:13our GPs.
23:14So we have an increasing number of private GPs out there who are interested in actually participating with care of
23:20people living with dementia.
23:21So we'd like to identify these people, help them upskill themselves in order to make care accessible, affordable, and also
23:30improve the quality of life of the older person living with dementia,
23:33because then they will have better quality care in close proximity to their own places.
23:38Absolutely. And also the lack of qualified caregiving also leads to the other dimension which Aiting had brought up earlier,
23:46leading to absenteeism from work, et cetera, having to give up career.
23:49And of course, disproportionately, that once again has a rather gendered impact.
23:54And of course, Malaysia-wide, there is a strong focus on wanting to ensure that women in particular, those who
24:01are in professional arenas,
24:02they do stay and progress in the workplace. So definitely this ought to be a wider priority.
24:09Dr. Tan, I'd also like to pick up on something which we touched on briefly earlier.
24:15So given the fact that there clearly requires a lot of coordinated, perhaps even cross-ministerial work that needs to
24:25happen for dementia care,
24:27for Alzheimer's care to be prioritized, what do you think about a funded cross-ministerial mechanism?
24:34And would that be the ideal sort of pathway or a near-future pathway which would actually help ease all
24:44the bottlenecks which you've been pointing out?
24:46That agency has been stipulated in the National Dementia Action Plan.
24:50How is it working out so far?
24:53It's not been operationalized because there's a lot of change in government.
24:58And we understand, you know, the government does need to restructure and restructuring takes time.
25:04But the National Dementia Action Plan has always been nearly getting there in terms of priority,
25:11but then kind of pushed aside a little bit because other priorities have taken place.
25:17So we really hope that this year we can see, now with the disease modification, with hope really coming in,
25:25we can really see an investment in the center that we are talking about.
25:30We like to call it the DREAM Center, the Dementia Research and Innovation Center.
25:35The DREAM Center.
25:37Yeah, so, and we will actually be able to then fully operationalize the National Dementia Action Plan.
25:47But remembering that this is going to save money, it's not going to be a big cost.
25:51That's right.
25:51Because it's not going to be a sunken cost either.
25:53No, because we're going to actually reduce the number of people who actually need expensive treatment.
25:58We're going to reduce the cost of care by actually treating people early
26:01so that they will not be needing as much care as they would have otherwise.
26:05And to actually release valuable productive workforce back into the workplace.
26:13And that is actually exactly what our country needs right now.
26:15Exactly.
26:17I'd like to ask one last thing, Prof Tan.
26:20Are any concerns considering geographically those who may be left out or left behind
26:26from wider dementia care or dementia assistance?
26:29And how can we assist them?
26:31Yeah, we know that dementia is a problem of the rural areas.
26:34So if you live in a rural area, your risk of having dementia is double that of a person in
26:38an urban area.
26:39Exactly, that's staggering.
26:40Yes, but yet all our care is focused on the urban areas.
26:43And people living with dementia are not very transportable because if you remove them from the normal environment,
26:50they become more confused.
26:51So these people actually have very limited access to care.
26:56And the family are worried about removing them from the normal environment.
27:01So we really need to look at how we can be delivering care to everybody throughout Malaysia,
27:08particularly in places like Sabah and Sarawah or Pahang where it's very sparsely populated.
27:12And we're talking now about innovations such as video consultations, virtual consultations,
27:19shared care models with existing healthcare systems in the area.
27:24So perhaps we could have many multi-disciplinary team meetings through the internet,
27:32through video calls.
27:34But then we can also be having them deliver care but then doing intermittent virtual consultations
27:40with people in the main centres so that they can actually still benefit from specialist care
27:46but delivered by their local healthcare team.
27:49Exactly.
27:50So something which at the end of the day, it does reach those who are often left out of the
27:54conversation.
27:55Yes.
27:55So the digital revolution needs to also reach people living with dementia.
28:00Absolutely.
28:01Thank you, Dr Tan.
28:02I think so to land the conversation, some perspectives around the fact that of course,
28:07Malaysia's Alzheimer's burden, it's been pointed out from a societal cost angle,
28:11it could already be amounting to close to 8.5 billion ringgit a year.
28:16That's around 0.4, 0.5% of the overall total GDP.
28:21So, so much of the impact that actually arises from informal caregiving, lost productivity.
28:26Some closing thoughts on that and what else should policy makers now be focusing on
28:32now that such figures are public knowledge and accessible?
28:35Yes.
28:36I think both of you have mentioned it correctly.
28:39We should not be evaluating investment in Alzheimer's or dementia from just clinical outcome.
28:46So we have to look at it at a broader perspective.
28:49We have to include the societal perspective that comes together with this disease.
28:54So given that I think today, investing in Alzheimer's or dementia is not only purely about the healthcare outcome,
29:02but it's about urging the policy makers to consider this as part of making sure
29:08Malaysians can actually age well in the coming future.
29:13I think this is really important because we already hear it will release the pressure of the family members,
29:19especially the caretakers, and this will help them to contribute more productively to the nation.
29:26And as such, in turn, we will have a better economy.
29:30Yeah.
29:30It's all an interconnected infrastructure.
29:33Yes, exactly.
29:33Well, thank you so much for the conversation, Prof. Dr. Tan, as well as Aiting.
29:38Well, overall, in closing now, dementia is not simply a healthcare issue.
29:43It is a demographic, economic, as well as a social challenge that will be shaping Malaysia's future.
29:48To summarise the choices we make today on prevention, care and support,
29:52will determine how we will age and age well as a nation.
29:56I'm Tamina Kausjee signing off for now.
29:58We'll see you again next week, only on Nyaka Spotlight.
Comments

Recommended