By Sarah Zulkifli, Manager, Science Writer, Communications & Outreach
“Do research that benefits patients. Likewise, see patients that benefit research.” This is the mantra Associate Professor Nagaendran Kandiah lives by. A/Prof Kandiah holds a dual role as a Senior Consultant Neurologist at National Medical Research Council and Director of LKCMedicine’s upcoming Dementia Research Centre (DemRC) where its main mission is to discover strategies to prevent dementia.
Dementia is a disease in which there is deterioration in cognitive functions. Patients suffering from dementia face issues with their memory, thinking, and social abilities. Someone with mild dementia may have forgetfulness for six months or longer. Some other signs include not being able to perform well at work and tasks that require planning become problematic.
A/Prof Kandiah said, “DemRC is set to launch this April 2022 and is going to focus on individuals that show very early signs or symptoms of dementia – those who are deemed to be at an early stage of this neurological disease.”
A/Prof Kandiah’s plans include setting up the Biomarker and Cognitive Impairment Study (BioCIS) cohort at DemRC. The aim is to recruit 1,500 subjects all of whom are in the early stages of dementia, specifically mild cognitive impairment. This study is important as the risk for patients with mild cognitive impairment developing dementia increases by 10 to 15 per cent every year. He added, “If we can identify high-risk patients, we can potentially help them. At DemRC, we can perform comprehensive cognitive assessment – magnetic resonance imaging (MRI) of the brain and state-of-the-art blood biomarkers. We can understand how the brains of these individuals function and provide interventions to delay dementia.”
Another focus of DemRC is the term he coined: Asian dementia – suffered by patients who have multiple mini-strokes in the brain due to reduced blood flow. “My goal is to help them find ways to increase blood flow to the brain so that they will have a lower risk of dementia. When we perform MRI brain scans, we often see evidence of reduced cerebral blood flow in patients from Southeast Asia. This is higher in our region compared to other parts of the world.”
He added, “I would like to bring in clinical neuroscience research that focuses on the aspects of cognition, neuroimaging, and biomarkers in human subjects. I hope to enrich the neuroscience community at LKCMedicine with clinical research data that will help advance neuroscience research.”
For some patients, it is evident that they show signs of dementia. For others, they may need some persuasion from loved ones or more signs to be convinced that they require medical help. With empathy, he said, “It is not an easy situation to tackle. We need to give them time to come to terms with their condition. Typically after one or two visits, patients do realise that they require medical help. Getting patients’ loved ones in the diagnostic and management process can be greatly beneficial.”
Before this, A/Prof Kandiah was the Director of Singapore’s National Neuroscience Institute (NNI) Dementia Programme and a Senior Consultant there. For the past 18 years at NNI, he had seen a lot of patients with cognitive problems. “I hope to use my clinical experience to further translational research in cognitive disorders. This is important for research – to focus on the problems in humans so that we can find solutions to these problems.”
Twenty years ago, dementia was not a disease that was well understood in the Singapore community. It is thought that dementia patients were individuals who were severely affected cognitively and could not manage independently. He added, “What we are seeing now are patients who come to the clinic at a very early stage which gives us the opportunity to explain the brain changes they are experiencing. Working together with the patients, we find ways to reduce the progression of the disease. This is rewarding for me because when you see patients in their early stages, it is often possible to help them find a way to slow down the disease.”
His career inspiration is Professor Howard Feldman – the master of dementia as named by The Lancet Neurology – who lives by the same mantra A/Prof Kandiah abides by. In his free time, he enjoys doing carpentry work and his most gratifying work was a plant house he built together with his 11-year-old son, which now stands proudly in his home.