Malaysia

Clinical recommendations suggest using mini-Cog, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), as well as Abbreviated Mental Test Score (AMTS). Researchers in Malaysia have also developed and validated culturally appropriate tools, such as the comprehensive Malay version of the Addenbrooke’s Cognitive Examination III (ACE-III), and the language-neutral Visual Cognitive Assessment Test (VCAT). There are efforts to validate the IDEA cognitive screen and the rapid, Picture-Based Memory Impairment Screen (PMIS), which performed well in urban Malaysia, and can be potentially valid cognitive tools.

The National Dementia Action Plan 2023-2030 ambitiously calls for annual cognitive screening for 80% of at-risk older adults. However, there is still no systematic, nationwide screening programme in place.

As of 2018, all state hospitals were reported to have MRI facilities, though 15 major specialist hospitals still lacked them. CT scanners can be found across public hospitals. However, data indicates a stark public-private divide, with 99 CT units in the government sector compared to 192 in the private sector.

As of 2021, there are more than 10 government facilities in Malaysia providing Nuclear Medicine services and almost an equal number of facilities in the private sector offering either Positron Emission Tomography (PET)/CT or general nuclear medicine services. Within the Ministry of Health system, for example, Hospital Kuala Lumpur and the National Cancer Institute are equipped with PET/CT services. Private hospitals, such as those in the Pantai, SJP Medical Centres, and Sunway groups, also offer PET services for oncological, cardiac, and neurological conditions, including dementia.

Amyloid-PET is not an available clinical diagnostic option for people in Malaysia.

The official clinical guidelines in Malaysia does not include routine genetic testing for Alzheimer’s disease as part of a standard diagnostic workup. However, a commercial market for predictive genetic testing exists through private healthcare providers and direct-to-consumer companies.

Cerebrospinal fluid (CSF) biomarkers are not currently available for routine clinical use in Malaysia. Blood-based and urine biomarkers are not yet available for routine clinical use; they are currently in the research and development phase.

Specialist diagnostic services are offered at several key public and private hospitals in Malaysia. Public institutions providing these services include Universiti Malaya Medical Centre in Kuala Lumpur, and a dedicated Memory Clinic at the Hospital Universiti Sains Malaysia in Kelantan. In the private sector, several centres offer comprehensive assessment packages and specialised Alzheimer’s disease diagnosis services. Additionally, major private hospital chains offer Alzheimer’s disease assessments through their geriatric and neurology departments.

For day care, a prominent centre is the Alzheimer’s Disease Foundation Malaysia’s Rumah Alzheimer’s. For residential care, private providers operate multiple centres. Palliative care for advanced dementia is less common and is primarily offered through private hospitals or as part of the services in residential homes.

Access to specialised Alzheimer’s disease care services is not uniform across the country. There are significant geographical inequalities, with services heavily concentrated in urban centres. This leaves individuals in rural and remote areas, such as the East Coast of Peninsular Malaysia, with inferior service distribution and inadequate information on how to access what little care is available. This disparity inevitably leads to the significant underdiagnosis of dementia in rural populations, effectively cutting them off from the specialised care they need.

Donepezil, Rivastigmine, and Memantine are on the Ministry of Health Medicines Formulary (FUKKM), which means they are available for subsidy within the public healthcare system.

The most substantial financial burden for families comes from direct, non-medical long-term care, which is almost entirely paid for out-of-pocket. Other expenses like in-home private nursing and community daycare centres are also paid out-of-pocket.

Direct government cash aid is minimal and generally targeted at destitute seniors rather than specifically at caregivers. The primary financial lifelines for many families are statutory withdrawal rights, such as accessing the patient’s or caregiver’s own Employees Provident Fund (EPF) for healthcare costs related to critical illnesses like Alzheimer’s disease, or the patient qualifying for an Invalidity Pension from PERKESO if they are unable to work. While the Department of Social Welfare offers aid like the Bantuan Orang Tua, it is targeted at destitute seniors, not specifically at caregivers. Modest additional benefits are available at the state level in places like Selangor, Penang, and Sarawak.

In addition, within the Non-Governmental Organisation (NGO) sector, the Alzheimer’s Disease Foundation Malaysia provides the most comprehensive services, including daycare, skills training, and peer support networks. However, these services are concentrated in urban centres, creating a significant “postcode lottery” of care.

The launch of the National Dementia Action Plan 2023-2030 (NDAP) marks a significant commitment by the Malaysian government to prioritise dementia as a public health issue and to work towards creating a more dementia-inclusive society. The plan is built upon four key pillars aimed at improving the lives of people living with dementia, their families, and caregivers, while also strengthening the country’s capacity to manage the condition effectively. The primary goals of the NDAP are:
1. Empowering healthy and active communities: this foundational goal focuses on creating a society that is not only aware of dementia but is also supportive of those living with the condition. Key initiatives under this pillar include extensive public awareness campaigns to reduce stigma and promote a better understanding of dementia. The plan also emphasises the development of dementia-friendly communities, which are designed to be safe, inclusive, and accessible for individuals with cognitive decline, thereby encouraging their continued participation in social and economic life.
2. Strengthening a sustainable healthcare and social support system: recognising the significant strain dementia places on healthcare and social services, the second pillar aims to build a robust and adaptable support system. This involves enhancing the capacity of the healthcare workforce through specialised training in dementia care and promoting a multidisciplinary, person-centered approach to treatment and management. The goal is to ensure that individuals living with dementia have access to integrated and high-quality care throughout their journey with the condition.
3. Fostering research, innovation, and information sharing: to ensure that Malaysia remains at the forefront of dementia care, the third pillar is dedicated to promoting scientific advancement and knowledge exchange. This includes encouraging local research into the prevalence, risk factors, and effective interventions for dementia within the Malaysian context. The plan also seeks to foster innovation in dementia care practices and technologies and facilitate collaboration with international bodies to share best practices and data.
4. Enhancing monitoring and evaluation of health programs: To guarantee the effectiveness and accountability of the action plan, the fourth and final pillar establishes a framework for the continuous monitoring and evaluation of dementia-related programs and dementia inclusive environment.

Researchers at the National University of Malaysia conducted a groundbreaking clinical trial on Ulam Raja (Cosmos caudatus), a traditional Malaysian herb. They developed a supplement from the herb’s extract and found that it improved global cognitive function, memory, and focus, while reducing emotional stress in older adults living with mild cognitive impairment.

Malaysian researchers developed the Demensia KITA mobile application, which is currently in the evaluation phase. The app’s content was created through a user-centric process involving both caregivers and medical experts to ensure it meets their specific needs. Available in Malay (the national language), it provides a comprehensive, culturally relevant resource on topics ranging from patient care and stress management to service directories, representing an innovative digital solution to a critical social challenge in dementia care.