Let’s Talk Public Health With Saima Hilal

After completing my medical training in Pakistan, I came to Singapore to undertake a Master’s in Public Health and subsequently completed a PhD in medicine. I have also undertaken post-doc studies at the Erasmus University Medical Centre in Rotterdam, the Netherlands.

My work focuses on improving our understanding of dementia and cognitive impairment through analysis of biomarkers (like blood, MRI brain scans, and genetic analysis).

Through analysis of biomarkers, we can work towards developing tools to try and identify people at risk of dementia.

Singapore has an ageing population and the number of people with dementia is expected to increase from around 86,000 people to 130,000 or more by 2030.

Dementia not only impacts the individual through the inability to undertake daily activities and reductions in quality of life, but also affects carers and the wider society. By the time someone reaches the age of 80, one out of two will have dementia.

In 2016, it was estimated that Singapore spent $532 million on dementia and the government has recently focused more resources on this key health priority.

Dementia Singapore and the Agency for Integrated Care have identified dementia as a key priority. Among other initiatives, they have rolled out DementiaHub.SG where people and professionals can access resources and tools. This allows the public to easily access information about dementia.

Often, we see people diagnosed with dementia at a very late stage. Dementia is irreversible and the deficits that have occurred at that point are permanent.

If there is earlier diagnosis, then there will be greater understanding of what to expect. This ensures that help and support can be in place to enhance quality of life for the person and their family.

There are also treatments that can delay further declines. Early diagnosis can also help in the management of other conditions, such as supporting the person in remembering to take medications for heart disease, diabetes and other medical conditions.

There is also the perception that forgetfulness is a normal part of ageing due to a lack of awareness between ageing and dementia. When we look back at the clinical history, often there were tell-tale signs of dementia, six or seven years before someone was diagnosed.

The Saw Swee Hock School of Public Health supports medical students to undertake community health projects. One of my recent groups of students looked into knowledge, attitudes and perceptions of dementia. About half of the survey respondents could not tell the difference between dementia and normal cognitive declines from ageing and 75% didn’t know all the common symptoms of dementia.

Raising awareness and identifying dementia earlier is very important so that support and tools can be put in place to improve the quality of life for individuals and families.

Society awareness of the condition and symptoms is a key issue, as is acceptance. A Singapore study found that 45% of older adults refused to get screening for dementia and of those that did, 33% refused to be referred to a specialist.

I’m involved in a number of studies; most are looking into prediction modelling and developing prediction tools to identify those at risk of dementia early, such as in their middle age. This could enable them to make lifestyle adjustments to reduce their risk.

A dementia prediction tool could be similar to the HeartScore tool, which is an interactive tool for predicting and managing the risk of heart attack and stroke.

In Singapore, which has a predominantly Asian population, we see more vascular causes behind dementia and cognitive decline. The population is at higher risk of systemic diseases such as high blood pressure, cholesterol, and diabetes. Identifying these risk factors early and acting on them can hopefully delay the onset of cognitive decline.

Much of my teaching is around epidemiology, study designs, study biases, and research interpretation and communication. I teach students in undergraduate courses and also mentor those undertaking PhDs and post graduate study.

I also provide lectures on dementia, with a focus on the situation in Singapore.

Due to COVID-19, much of my teaching is currently online. We have tried to make this as interactive as possible through break-out sessions and tutoring of small groups.

We are seeking to ensure that students still achieve the skills and competencies around research design, delivery, analysis, and communication similar to pre-COVID times. The main difference is a transition from face-to-face research to online. For example, the community health project on attitudes and perceptions of dementia was via an online survey.

The latest group of medical students I’m mentoring recently undertook an online survey around resilience during the COVID-19 situation. Around 400 participants completed the questionnaire which was publicised on social media platforms.

The study found that while women and those who are single were less likely to be mentally resilient, a strong familial support is a protective factor against stressors. People who are naturally optimistic and hopeful were more resilient, and those that knew someone who contracted COVID-19 knew what to expect and were less fearful.

Both pieces of student-led research have been of value and were shared with relevant organisations and agencies as part of the School’s advocacy work. Both studies will also be published as journal articles.

I am a strong multitasking woman who can manage both family and work efficiently. I am also competitive, particularly when I play board games with family such as crazy tower, scrabble and monopoly as these are challenging and forces us to think. It is also one of the best ways to bond with your family!