When Dementia Strikes In The Prime Of Working Life

Ismail (not his real name) was once recognised by his employer as one of the company’s most capable employees. However, over the past few years, the senior executive began experiencing a range of problems that affected his work performance.

At times, he would forget important appointments with clients, struggle to understand simple instructions from his employer and find it increasingly difficult to articulate certain words that had once come easily to him. Harsh reprimands from his employer and cynical remarks from colleagues only added to his distress.

Initially believing that his condition was caused by work-related stress, the 50-year-old was shocked to discover that he was actually suffering from a more serious health condition – early-onset dementia (EOD).

EARLIER THAN USUAL

The above case was shared by Hospital Canselor Tuanku Muhriz (HCTM) geriatric medicine specialist Dr Hazlina Mahadzir in a recent interview with Bernama. She said EOD refers to dementia that develops before the age of 65.

“Dementia commonly occurs among older people, but EOD develops at a younger age,” she said.

Geriatrician at Hospital Canselor Tuanku Muhriz (HCTM) Dr. Hazlina Mahadzir (right), pictured when interviewed by Bernama recently.

Dementia is an umbrella term covering a group of symptoms that cause a decline in cognitive function, or brain function, such as memory, thinking, comprehension and decision-making abilities, to the extent that it affects daily life.

Dr Hazlina said Alzheimer’s disease is one of the most common conditions that cause dementia as well as EOD.

“Other causes are vascular dementia, which is associated with impaired blood flow to the brain or can occur following a stroke, as well as brain injuries caused by accidents,” she said, adding that frontotemporal dementia (FTD) is another type that is more commonly seen among people with EOD.

“FTD usually affects the frontal and temporal regions of the brain and can cause significant changes in a person’s executive functions, which include mental skills such as planning, time management and solving everyday problems,” she said.

Data on EOD in Malaysia remains limited. Globally, however, a recent study published in the medical journal ‘JAMA Neurology’ found that EOD prevalence was about 119 cases per 100,000 individuals aged 30 to 64.

The 2025 ‘National Health and Morbidity Survey: Elderly Health’ recorded a dementia prevalence of 9.8 percent among Malaysians aged 60 and above, up from 8.5 percent in 2018.

From a broader perspective, EOD is not merely a clinical issue but also affects an individual's standing in their job, family, and society. (Image for illustration purposes only; unrelated to EOD patients).

However, the survey did not provide a specific breakdown for those below 65, highlighting the need for the government to collect more comprehensive data on EOD cases.

Dr Hazlina said although about 95 percent of dementia patients at HCTM were aged 65 and above, the hospital’s geriatric clinic has recorded at least one new EOD case every six to 10 months.

“The number of EOD cases may appear very small compared with dementia cases among older people, but we cannot dismiss the possibility that many EOD cases may remain undiagnosed or may be overlooked,” she said, adding that this is due to a lack of data on EOD in the country, as well as the age factor which does not align with the commonly recognised profile of dementia patients.

She also did not rule out the possibility that patients themselves might refuse to acknowledge they are facing cognitive issues because they are young and of productive working age, in addition to fearing dismissal from their jobs if diagnosed.

RECOGNISING THE SIGNS

Regarding recognising the signs of EOD, Dr Hazlina said family members and those close to the individual play an important role in monitoring changes in the patient.

“Family members should be alert if the individual starts frequently forgetting newly learned information, has difficulty finding the right words during conversations, or shows drastic personality changes, such as becoming easily irritable.

Although Malaysia has taken initial steps through the Dementia Action Plan 2023–2030—which focuses on early detection and the development of a more holistic care ecosystem—building a society better prepared to face dementia requires the cooperation of all parties. (Image for illustrative purposes only; unrelated to EOD patients).

“They may also become increasingly anxious and experience excessive worry. Physical signs include sleep problems and frequent aches and pains, such as headaches and body aches.

“They may also have difficulty managing routine daily tasks, such as calculating bills or driving to familiar places. Problems with balance may also serve as an important warning sign that should be brought to the doctor’s attention,” she said.

Social signs may include withdrawing from friends or family, as well as neglecting personal health and appearance.

“If these signs are present, caregivers are advised to ensure that the individual sees a specialist,” she said.

However, not everyone experiencing cognitive difficulties has EOD.

“Among the signs that are often misinterpreted are depression and severe stress, vitamin B12 deficiency, thyroid problems, excessive alcohol consumption and sleep disorders such as sleep apnoea,” she said.

For a more accurate diagnosis, doctors need to conduct several assessments, including cognitive tests and blood tests, as well as more detailed examinations such as brain computed tomography (CT) scans or magnetic resonance imaging (MRI).

DEMENTIA MANAGEMENT

On dementia management, Dr Hazlina said there are two main approaches commonly used.

From a medical perspective, one of the commonly prescribed treatments is the cholinesterase inhibitor group of medicines, such as donepezil, which is also a cognitive-enhancing drug. These medications aim to slow the progression of cognitive decline and help patients maintain their independence.

The non-pharmacological approach includes occupational therapy, cognitive stimulation activities such as puzzles and chess, as well as vocational assessments based on the patient’s needs.

Occupational therapy is an intervention or rehabilitation approach provided by trained occupational therapists in hospitals and clinics to help patients maintain their ability to carry out daily activities, including work.

The therapy also helps patients manage their work through task modifications and teaching techniques to compensate for cognitive difficulties, such as using notes and brief reminders or breaking larger tasks into smaller steps. Therapists may also advise employers on tasks that are appropriate for the patient’s abilities.

“If necessary, the therapist may recommend that employers modify the patient’s responsibilities or transfer them to a less stressful position or unit that does not require a high level of cognitive or executive functioning.

“Employers may also consider offering more flexible working hours and avoid assigning them tasks involving machinery or hazardous materials,” she said.

Employers can also implement a ‘buddy system’ by pairing an EOD patient with an employee who can provide guidance, while educating other workers about their colleague’s condition so that appropriate support can be provided in the workplace.

IMPACTS THE ECONOMY

From a broader perspective, EOD is not merely a clinical issue but one that can affect an individual’s employment, family and place in society, according to Alzheimer’s Disease Foundation Malaysia (ADFM) executive committee member Dr Dinesh Sangarran Ramachandram.

He said when EOD occurs during a person’s productive years, its impact extends beyond the individual, who may lose their job, directly affecting their family’s financial stability.

Dr Dinesh Sangarran Ramachandram.

“Therefore, employers need to first assess what the employee is still capable of doing, rather than immediately viewing the diagnosis as grounds for terminating their employment. We do not want someone diagnosed at the age of 50 to suddenly lose their job, their friends and, eventually, their connection with society,” he said.

In this regard, he said dementia should no longer be viewed solely as a healthcare issue but also as a loss for the country’s economy and workforce.

Citing a recent study involving 793 individuals with EOD in Finland, published in the ‘Neurology’ journal in July 2026, he said the study found that differences in work productivity compared with individuals without dementia could be detected as early as 15 years before diagnosis.

“When researchers examined their work performance records in the years leading up to the diagnosis, they found clear differences in productivity compared with the control group, with the gap becoming more pronounced as the year of diagnosis approached.

“This shows that the effects can emerge gradually, even before a person realises they are experiencing cognitive difficulties,” he said, recommending that a similar study be conducted in Malaysia to enable appropriate measures to be taken to mitigate the potential economic impact.

While not all cases of dementia can be prevented, he said several measures can be taken to reduce the risk.

He said according to the World Health Organization, up to 45 percent of dementia risk is associated with modifiable factors, including physical inactivity, smoking, excessive alcohol consumption, social isolation and air pollution, as well as health conditions such as hypertension, diabetes and high cholesterol.

“All these are factors that can be modified or controlled as part of efforts to maintain brain health, just as we recognise the importance of maintaining heart health,” he said.

BUILDING AN INTEGRATED SUPPORT SYSTEM

Dinesh Sangarran, who is also a lecturer at the School of Pharmacy, Monash University Malaysia, stressed the importance of establishing a comprehensive support system encompassing social protection policies and employment legislation.

“Because EOD symptoms often affect cognitive functioning rather than a person’s physical appearance, employers may mistakenly perceive them as being lazy or underperforming and dismiss them before a proper diagnosis is made.

“This can, in turn, expose the patient’s family to the risk of a sudden financial crisis as they lose their main source of income without a strong safety net,” he said.

He, therefore, suggested that the Social Security Organisation’s (PERKESO) Disability Management Programme serve as a foundation for extending appropriate support to people with EOD.

“While PERKESO’s existing framework includes vocational rehabilitation, work ability assessment and job accommodation for eligible insured persons, consideration should also be given to how these mechanisms can be appropriately applied to people with EOD, enabling them to continue contributing to the workforce according to their capabilities rather than having their employment terminated prematurely,” he said.

Health experts recommend that the existing mechanism under the Social Security Organisation's (PERKESO) Disability Management Programme be considered as a basis for extending appropriate support to individuals with EOD.

He said although Malaysia has taken an initial step through the National Dementia Action Plan 2023–2030, which focuses, among other things, on early detection and developing a more holistic care ecosystem, building a society that is better prepared to deal with dementia requires a concerted effort from all stakeholders.

“Dementia literacy must continue to be strengthened so that people can recognise the symptoms earlier and more accurately. We also need to create dementia-friendly communities that allow patients to continue their daily lives with greater dignity and without being isolated from society,” he said.

He also stressed that support for patients must go hand in hand with support for their families, particularly spouses who are still working and raising children while also taking on caregiving responsibilities.

“Caregivers of people with EOD, in particular, need access to respite care, counselling services and financial assistance,” he said.

He added that an effective support system would also require clearer clinical pathways, from early detection through to long-term care, as well as stronger multidisciplinary collaboration involving doctors, therapists, social workers and community organisations.