eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Alzheimer Disease in Individuals With Down Syndrome: Follow-up

Author: Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Contributor Information and Disclosures

Updated: Jan 10, 2008

Follow-up

Further Inpatient Care

  • Inpatient care is not necessary except when the patient presents with acute medical complications.
  • In the advanced stage of the disease, institutionalization may be required.

Further Outpatient Care

  • Most services are provided in the outpatient setting.
  • Consult a team that is experienced in managing Alzheimer disease (AD) patients with Down syndrome (DS).

Transfer

  • When the severity of the dementia creates dangerous situations, individuals with AD need to be transferred from their usual living conditions. The ideal situation is to obtain support from the family or to arrange for caretakers at home so that the patient is maintained in a familiar and friendly environment as long as possible.

Complications

  • Good nursing care is needed to avoid complications (eg, decubitus ulcers, aspiration pneumonia, deterioration of gastroesophageal reflux, fractures, dysphagia, urinary tract infections, accidents).

Prognosis

  • As no treatment is available for the primary disease, prognosis is poor.

Patient Education

  • Discuss issues related to diagnosis and prognosis with the family and caregivers early in the course of the disease.
  • Establishing rapport with a team that specializes in the management of AD is useful.
  • Caregivers are an important component in the care of persons with AD. In most instances, caregivers are family members. Several recent studies showed that caregivers endure a significant burden that might result in physical and emotional disorders. A good program for the treatment of persons with AD, with or without DS, should include education for and protection of the caregivers. A program consisting of 2 sessions of individual therapy for the caregiver of a person with AD (usually the spouse), 4 sessions of family counseling, support group participation, and continuous availability of phone counseling for the caregiver resulted in a 28.3% reduction in nursing home placement and a delay of almost a year and a half in the admission to a nursing home when that was needed. These positive results were achieved without a negative impact on caregiver well being.
  • For excellent patient education resources, visit eMedicine's Dementia Center. Also, see eMedicine's patient education articles Alzheimer Disease and Alzheimer Disease in Individuals With Down Syndrome.

Miscellaneous

Alzheimer Functional Assessment Tool

This tool was developed by the Alzheimer team at Wrentham Developmental Center, Massachusetts and was designed to record key information on the status of patients with Alzheimer disease and to assist in making decisions concerning the patient's program and residential placement.

Interview the staff on all shifts who work directly with the patient. Find out the patient's behavior and overall ADL. The patient's abilities (skills, problems, other considerations) are described in the "description of skills" section of the summary sheet. Perform this assessment at the time of diagnosis of AD and every 6 months or when a significant change in status is observed.

  • Alzheimer Functional Assessment Tool 
    • Date:
    • Name:
    • Activities of daily living:
    • Description of skills:
    • Toileting:
    • Dining:
    • Walking/motor:
    • Bathing:
    • Dressing:
    • Personal/oral hygiene:
    • Environmental awareness:
  • Scoring for Alzheimer Functional Assessment Tool
    • Toileting
      1. Can use bathroom in familiar and unfamiliar environments independently
      2. Goes to the toilet independently or asks staff to assist; may need reminders to use toilet paper and wash hands
      3. Has occasional toileting accidents; needs verbal reminders
      4. Needs staff to take to the bathroom on a schedule; remains continent 90% of the time
      5. Needs staff to take to the bathroom on a schedule; remains continent 50% of the time or less
      6. No bowel or bladder control; may require frequent changing or special clothing (eg, pads, diapers)
    • Dining
      1. Can prepare simple food (eg, sandwich, toast); can set table and clean up after meal; uses knife and fork to cut food; may or may not use adaptive equipment to eat independently
      2. Can use fork and spoon to eat independently but needs food to be cut
      3. Eats independently with the help of adaptive equipment
      4. Can use fork and spoon to eat independently but may need occasional prompts to start or continue eating; may finger feed; needs food to be cut
      5. Needs physical assistance to complete the meal
      6. Develops swallowing problems; needs change in consistency of food or thick drinks
      7. Completely dependent; may need specialized feeding program
    • Walking/motor
      1. Independent ambulation; able to walk steadily; able to start, stop, and change direction without falling; able to walk fast or run; ascends and descends stairs; capable of leaving premises without assistance
      2. Independent ambulation for short distances; walks up and down the stairs one step at a time by holding rails; able to leave premises without assistance
      3. Independent but cannot negotiate stairs; unable to leave premises without assistance
      4. Can walk without support but requires supervision; may be unsteady; requires supportive measures at times
      5. Needs assistance (another person to hold, walker) to walk; "cruises" around using structures such as furniture and walls as support; unable to leave premises independently
      6. Needs wheelchair but can move independently
      7. Needs an adapted wheelchair and cannot move independently; needs to be pushed
    • Bathing
      1. Can independently carry out an appropriate bathing routine (disrobing, washing, drying, and dressing)
      2. Can carry out an appropriate bathing routine with occasional reminders to do a step or wash more thoroughly
      3. Needs verbal prompts to initiate and/or complete some steps in the bathing process (due to subtle confusion and/or fear); continuous staff supervision at shower time not necessary; may use toiletries inappropriately
      4. Requires continuous staff supervision at shower time to ensure complete bathing and safety (eg, problems due to confusion and/or fear); hand-over-hand assistance may be necessary at times; alternatives to showering or a specialized program may be recommended due to fear of showering; safe use of hot and cold water needs to be monitored
      5. Primarily passive during bathing; requires some form of assistance for all steps; may be able to stand and move a body part when given a verbal or touch cue; fear of water may be present
      6. Physically and cognitively unable to participate actively in bathing process; may respond to stimulation during bathing with vocalizations or changes in facial expressions
    • Dressing (skills and appropriate dress)
      1. Dresses independently or with physical assistance due to handicap; can choose appropriate clothing (for weather or activity of the day) and cares for own clothing (eg, places dirty clothes in hamper, hangs clothing, stores properly)
      2. Occasionally needs reminders to dress appropriately ("It's cold out today") and to care for clothes ("Remember where your dirty socks go?")
      3. Dresses with minimal assistance or verbal prompts
      4. Dresses inappropriately for weather (layers clothing and/or puts clothing on inappropriately); may undress at an inappropriate time and/or place; may benefit from adaptive clothing to retain dressing skills; makes no attempt to care for own clothing
      5. Needs assistance in dressing (50% or more of task) and may be resistive; may assist when compliant (eg, puts arm through sleeve)
      6. Lies passively during dressing; does not respond to dressing or undressing
    • Personal/oral hygiene (hair brushing, teeth brushing, sanitary pad, shaving)
      1. Able to perform all personal hygiene tasks
      2. Able to perform all personal hygiene tasks within regular routines; may show difficulty in performing tasks if routine is changed (eg, hospitalized, moved)
      3. Able to perform all personal hygiene tasks but requires occasional reminders from staff to complete the task
      4. Able to perform personal hygiene tasks but requires frequent reminders from staff to complete the task; may need staff guidance (verbal and point cues) in some parts of some tasks (ie, may forget steps); may still be proficient in one area and lose ability in another area
      5. Requires staff supervision (verbal and point cues) to complete some personal hygiene tasks and staff assistance (light, moderate physical cues) to complete others
      6. May still be able to perform some steps of some personal hygiene tasks with staff assistance but depends on staff to meet other personal hygiene needs
      7. Depends on staff to meet all personal hygiene needs
    • Environmental awareness
      1. Cognizant and responsive, in a relevant way, to familiar and unfamiliar people and other environmental stimuli
      2. Generally responsive to familiar and unfamiliar people and situations but seems self-absorbed and/or confused most of the time
      3. Cognizant and responsive in a relevant way to familiar people and situations but shows a delayed or inappropriate response to unfamiliar people and situations
      4. Cognizant and responsive to stimuli, but response is often inappropriate, even in familiar situations
      5. Mostly awake but seems self-involved, showing little or inconsistent response to the environment
      6. Sometimes awake but shows little interest in surroundings; sleeps at other times
      7. Sleeps most of the day; needs to be aroused repeatedly to maintain interaction

Medicolegal Pitfalls

  • Individuals with Down syndrome (DS) are considered independent adults when older than 18 years.
  • Instruct parents to obtain legal guardianship through the courts; otherwise, any authorization provided by the parents has no legal value. Discuss issues such as surgical procedures, placement of feeding tubes, and hospice care with the legal guardians.  

Special Concerns

  • The term mild cognitive impairment (MCI) has been used to characterize a state of cognitive decline transitional between normal and dementia and is characterized by impairment in memory and other cognitive functions as demonstrated by standardized neuropsychological tests. A substantial percentage of patients with the amnestic form of MCI progress to AD within 4 years of diagnosis. The lack of adequate normative data for memory in DS in different age groups makes the concept of MCI impossible to operationalize in individuals with DS.
  • The term pseudodementia is used to describe reversible cognitive impairment associated with psychiatric disease — usually depression. With treatment and amelioration of the psychiatric disease, the cognition returns to baseline. In patients without DS, many patients who develop AD have symptoms of depression in the early stages of disease, and the depression itself can impair cognitive function. Treatment of the depression (usually with SSRIs) often improves mood and sometimes cognition.  However, over the next 24-36 months, progressive cognitive impairment, not necessarily accompanied by mood disturbances, becomes clear. Data are not available on depression in patients with DS and AD.
  • Hypothyroidism, observed in almost 30% of individuals with DS, may simulate dementia. Hypothyroidism is frequently present in people with DS and AD; however, treatment with hormone replacement does not change the course of the underlying disease.
  • Vitamin B-12 deficiency has been reported in several individuals with DS and AD; however, replacement therapy does not change the evolution of the underlying disease.
  • Persons with AD and DS present with a higher number of health comorbidities when compared with individuals with DS and no AD. The frequency of the comorbidities increase as the AD is more severe. Among the health comorbidities expected are epileptic seizures, lung diseases (mostly aspiration pneumonias), depression, visual and hearing impairment, lack of mobility, and tube feedings.
 


More on Alzheimer Disease in Individuals With Down Syndrome

Overview: Alzheimer Disease in Individuals With Down Syndrome
Differential Diagnoses & Workup: Alzheimer Disease in Individuals With Down Syndrome
Treatment & Medication: Alzheimer Disease in Individuals With Down Syndrome
Follow-up: Alzheimer Disease in Individuals With Down Syndrome
Multimedia: Alzheimer Disease in Individuals With Down Syndrome
References
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References

  1. Schapiro MB, Ball MJ, Grady CL, et al. Dementia in Down's syndrome: cerebral glucose utilization, neuropsychological assessment, and neuropathology. Neurology. Jun 1988;38(6):938-42. [Medline].

  2. Aisen PS, Dalton AJ, Sano M. Design and implementation of a multicenter trial of vitamin E in aging individuals with down syndrome. J of Policy and Pract in Intellect Disabil 2. 86-93.

  3. Aisen PS, Saumier D, Briand R, et al. A Phase II study targeting amyloid-beta with 3APS in mild-to-moderate Alzheimer disease. Neurology. Nov 28 2006;67(10):1757-63. [Medline].

  4. Alzheimer's Association. Alzheimer's disease. Available at www.alz.org. Accessed 2006.

  5. Alzheimer's Association. ApoE genotyping. Available at www.alz.org. Accessed 2006.

  6. Alzheimer's Association. Genes and alzheimer's disease. Available at www.alz.org. Accessed 2006.

  7. Alzheimer's Association. Screening tests for dementia. Available at www.alz.org. Accessed 2006.

  8. Alzheimer's Association. Tau/Abeta42 test. Available at www.alz.org. Accessed 2006.

  9. Aylward EH, Burt DB, Thorpe LU, et al. Diagnosis of dementia in individuals with intellectual disability. J Intellect Disabil Res. 41 (Pt 2):152-64. [Medline].

  10. Beacher F, Simmons A, Daly E, et al. Hippocampal myo-inositol and cognitive ability in adults with Down syndrome: an in vivo proton magnetic resonance spectroscopy study. Arch Gen Psychiatry. Dec 2005;62(12):1360-5. [Medline].

  11. Berg JM, Karlinsky H, Holland AJ. Alzheimer Disease, Down's Syndrome, and Their Relationship. New York: Oxford University Press;1993. [Medline].

  12. Blacker D, Tanzi RE. The genetics of Alzheimer disease: current status and future prospects. Arch Neurol. Mar 1998;55(3):294-6. [Medline].

  13. Boada-Rovira M, Hernandez-Ruiz I, Badenas-Homiar S, Buendía-Torras M, Tárraga-Mestre L. [Clinical-therapeutic study of dementia in people with Down syndrome and the effectiveness of donepezil in this population]. Rev Neurol. Aug 1-15 2005;41(3):129-36. [Medline].

  14. Burt DB, Loveland KA, Primeaux-Hart S, et al. Dementia in adults with Down syndrome: diagnostic challenges. Am J Ment Retard. Sep 1998;103(2):130-45. [Medline].

  15. Bush A, Beail N. Risk factors for dementia in people with down syndrome: issues in assessment and diagnosis. Am J Ment Retard. Mar 2004;109(2):83-97. [Medline].

  16. Cooper SA, Prasher VP. Maladaptive behaviours and symptoms of dementia in adults with Down''s syndrome compared with adults with intellectual disability of other aetiologies. J Intellect Disabil Res. Aug 1998;42 ( Pt 4):293-300. [Medline].

  17. Cournot M, Marquie JC, Ansiau D, et al. Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology. Oct 10 2006;67(7):1208-14. [Medline].

  18. Cutler NR, Heston LL, Davies P, Haxby JV, Schapiro MB. NIH Conference. Alzheimer's disease and Down's syndrome: new insights. Ann Intern Med. Oct 1985;103(4):566-78. [Medline].

  19. Deary IJ, Whalley LJ, Batty GD, et al. Physical fitness and lifetime cognitive change. Neurology. Oct 10 2006;67(7):1195-200. [Medline].

  20. Devenny DA, Zimmerli EJ, Kittler P, Krinsky-McHale SJ. Cued recall in early-stage dementia in adults with Down's syndrome. J Intellect Disabil Res. Sep 2002;46(Pt 6):472-83. [Medline].

  21. Evenhuis HM. The natural history of dementia in Down's syndrome. Arch Neurol. Mar 1990;47(3):263-7. [Medline].

  22. Farlow MR. Alzheimer' Disease. Treatment update. CNS News. Special Edition. 2003;5:35-38.

  23. Feldman HH, Schmitt FA, Olin JT. Activities of Daily Living in Moderate-to-Severe Alzheimer Disease: An Analysis of the Treatment Effects of Memantine in Patients Receiving Stable Donepezil Treatment. Alzheimer Dis Assoc Disord. October/December 2006;20(4):263-268. [Medline].

  24. Friedman DL, Kastner T, Pond WS, O'Brien DR. Thyroid dysfunction in individuals with Down syndrome. Arch Intern Med. Sep 1989;149(9):1990-3. [Medline].

  25. Frisoni GB, Padovani A, Wahlund LO. The diagnosis of Alzheimer disease before it is Alzheimer dementia. Arch Neurol. Jul 2003;60(7):1023; author reply 1023-4. [Medline].

  26. [Best Evidence] Gamaldo A, Moghekar A, Kilada S, et al. Effect of a clinical stroke on the risk of dementia in a prospective cohort. Neurology. Oct 24 2006;67(8):1363-9. [Medline].

  27. Gedye A. DSDS Dementia Scale for Down's Syndrome. Vancouver, British Columbia: 1995:1-67.

  28. Green RC, Dekosky ST. Primary prevention trials in Alzheimer disease. Neurology. Nov 14 2006;67(9 Suppl 3):S2-5. [Medline].

  29. Hawkins BA, Eklund SJ. Planning processes and outcomes for an aging population with developmental disabilities. Ment Retard. Feb 1990;28(1):35-40. [Medline].

  30. Hawkins BA, Eklund SJ, Martz BL. Detecting aging related declines in adults with developmental disabilities: a research monograph. National Institute of Disability and Rehabilitation. Agreement #H 133B 80050: United States Department of Edcation, Office of Special Education and Rehabilitation Services; 1992.

  31. Hemingway-Eltomey JM, Lerner AJ. Adverse effects of donepezil in treating Alzheimer's disease associated with Down's syndrome. Am J Psychiatry. Sep 1999;156(9):1470. [Medline].

  32. Heyman A, Wilkinson WE, Stafford JA, Helms MJ, Sigmon AH, Weinberg T. Alzheimer's disease: a study of epidemiological aspects. Ann Neurol. Apr 1984;15(4):335-41. [Medline].

  33. Huxley A, Prasher VP, Haque MS. The dementia scale for Down's syndrome. J Intellect Disabil Res. Dec 2000;44 ( Pt 6):697-8. [Medline].

  34. Kishnani PS, Spiridigliozzi GA, Heller JH, Sullivan JA, Doraiswamy PM, Krishnan KR. Donepezil for Down's syndrome. Am J Psychiatry. Jan 2001;158(1):143. [Medline].

  35. Kishnani PS, Sullivan JA, Walter BK, Spiridigliozzi GA, Doraiswamy PM, Krishnan KR. Cholinergic therapy for Down's syndrome. Lancet. Mar 27 1999;353(9158):1064-5. [Medline].

  36. Lai F. Clinicopathological features of Alzheimer's disease in Down's syndrome. In: Down's Syndrome and Alzheimer's Disease. Wiley-Liss Inc; 1992:15-34.

  37. Lai F, Kammann E, Rebeck GW, Anderson A, Chen Y, Nixon RA. APOE genotype and gender effects on Alzheimer disease in 100 adults with Down syndrome. Neurology. Jul 22 1999;53(2):331-6. [Medline].

  38. Lai F, Williams RS. A prospective study of Alzheimer disease in Down syndrome. Arch Neurol. Aug 1989;46(8):849-53. [Medline].

  39. Lee HG, Zhu X et al. Amyloid beta: the alternate theory. Current Alzheimer Research. 2006;3:75-80.

  40. Lott IT, Osann K, Doran E, Nelson L. Down syndrome and Alzheimer disease: response to donepezil. Arch Neurol. Jul 2002;59(7):1133-6. [Medline].

  41. Mani C. Hypothyroidism in Down's syndrome. Br J Psychiatry. Jul 1988;153:102-4. [Medline].

  42. McCarron M, Gill M, McCallion P, Begley C. Health co-morbidities in ageing persons with Down syndrome and Alzheimer's dementia. J Intellect Disabil Res. July 2005;49:560-6. [Medline].

  43. McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer''s disease: a review of 17 epidemiological studies. ALYSIS. Aug 1996;47(2):425-32. [Medline].

  44. Mehta PD, Dalton AJ, Mehta SP, et al. Increased plasma amyloid beta protein 1-42 levels in Down''s syndrome. Neurosci Lett. Jan 23 1998;241(1):13-6. [Medline].

  45. Mendez MF, Mendez MA, Martin R, Smyth KA, Whitehouse PJ. Complex visual disturbances in Alzheimer's disease. Neurology. Mar 1990;40(3 Pt 1):439-43. [Medline].

  46. Menendez M. Down syndrome Alzheimer's disease and seizures. Brain Dev. Jun 2005;27 (4):246-252. [Medline].

  47. [Best Evidence] Mittelman MS, Haley WE, Clay OJ, et al. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. Nov 14 2006;67(9):1592-9. [Medline].

  48. Morris MC, Evans DA, Tangney CC, et al. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. Oct 24 2006;67(8):1370-6. [Medline].

  49. Prasher V, Cumella S, Natarajan K, Rolfe E, Shah S, Haque MS. Magnetic resonance imaging, Down's syndrome and Alzheimer's disease: research and clinical implications. J Intellect Disabil Res. Feb 2003;47(Pt 2):90-100. [Medline].

  50. Prasher V, Cumella S, Natarajan K, Rolfe E, Shah S, Haque MS. Magnetic resonance imaging, Down's syndrome and Alzheimer's disease: research and clinical implications. J of Intellect Disabil Res. Feb 2003;47(Pt 2):90-100. [Medline].

  51. Prasher VP. Review of donepezil, rivastigmine, galantamine and memantine for the treatment of dementia in Alzheimer's disease in adults with Down syndrome: implications for the intellectual disability population. Int J Geriatr Psychiatry. Jun 2004;19(6):509-15. [Medline].

  52. Prasher VP, Adams C, Holder R,. Long term safety and efficacy of donepezil in the treatment of dementia in Alzheimer's disease in adults with Down syndrome: open label study. Int J Geriatr Psychiatry. Jun 2003;18(6):549-51. [Medline].

  53. Prasher VP, Chung MC. Causes of age-related decline in adaptive behavior of adults with Down syndrome: differential diagnoses of dementia. Am J Ment Retard. Sep 1996;101(2):175-83. [Medline].

  54. Prasher VP, Fung N, Adams C. Rivastigmine in the treatment of dementia in Alzheimer's disease in adults with Down syndrome. Int J Geriatr Psychiatry. May 2005;20(5):496-7. [Medline].

  55. Pueschel SM. The effect of acetyl-L-carnitine administration on persons with Down syndrome. Res Dev Disabil. Nov-Dec 2006;27(6):599-604. [Medline].

  56. Regan C, Katona C, Walker Z, et al. Relationship of vascular risk to the progression of Alzheimer disease. Neurology. Oct 24 2006;67(8):1357-62. [Medline].

  57. Rödel C, Liersch T, Hermann RM, et al. Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J Clin Oncol. Jan 2007;25(1):110-7. [Medline].

  58. Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study. N Engl J Med. Apr 24 1997;336(17):1216-22. [Medline].

  59. Sato M, Aisen PS. Assessment of aging individuals with Down Syndrome in clinical trials. J Policy and Pract Intellect Disabil. June 2005;126-138.

  60. [Best Evidence] Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med. Oct 12 2006;355(15):1525-38. [Medline].

  61. Schupf N, Pang D, Patel BN, et al. Onset of dementia is associated with age at menopause in women with Down's syndrome. Ann Neurol. Oct 2003;54(4):433-8. [Medline].

  62. Schupf N, Sergievsky GH. Genetic and host factors for dementia in Down's syndrome. Br J Psychiatry. May 2002;180:405-10. [Medline].

  63. Schupf N, Winsten S, Patel B, et al. Bioavailable estradiol and age at onset of Alzheimer's disease in postmenopausal women with Down syndrome. Neurosci Lett. Oct 9 2006;406(3):298-302. [Medline].

  64. Shultz J, Aman M, Kelbley T, et al. Evaluation of screening tools for dementia in older adults with mental retardation. Am J Ment Retard. Mar 2004;109(2):98-110. [Medline].

  65. Stewart WF, Kawas C, Corrada M, Metter EJ. Risk of Alzheimer''s disease and duration of NSAID use. Neurology. Mar 1997;48(3):626-32. [Medline].

  66. Teipel SJ, Hampel H. Neuroanatomy of Down syndrome in vivo: a model of preclinical Alzheimer's disease. Behav Genet. May 2006;36(3):405-15. [Medline].

  67. Temple V, Konstantareas MM. A comparison of the behavioural and emotional characteristics of Alzheimer's diseases in individuals with and without Down Syndrome. Canadian J Aging. Summer 2005;24(2):179-189. [Medline].

  68. Teri L, McCurry SM, Buchner DM, Logsdon RG, LaCroix AZ, Kukull WA. Exercise and activity level in Alzheimer's disease: a potential treatment focus. J Rehabil Res Dev. Oct 1998;35(4):411-9. [Medline].

  69. Thase ME. Reversible dementia in Down's syndrome. J Ment Defic Res. Jun 1982;26 (Pt 2):111-3. [Medline].

  70. Vellas B, Thal L. Prevention trials in the field of Alzheimer disease. Neurol. Nov 14 2006;67(9)(suppl 3).

  71. Visser FE, Aldenkamp AP, van Huffelen AC, Kuilman M, Overweg J, van Wijk J. Prospective study of the prevalence of Alzheimer-type dementia in institutionalized individuals with Down syndrome. Am J Ment Retard. Jan 1997;101(4):400-12. [Medline].

  72. Visser PJ, Kester A, Jolles J, Vrehey F. Ten-year risk of dementia in subjects with mild cognitive impairment. Neurology. Oct 10 2006;67(7):1201-7. [Medline].

  73. Volicer L, Rheaume Y, Brown J, et al. Hospice approach to the treatment of patients with advanced dementia of the Alzheimer type. JAMA. Oct 24-31 1986;256(16):2210-3. [Medline].

  74. Warren AC, Holroyd S, Folstein MF. Major depression in Down's syndrome. Br J Psychiatry. Aug 1989;155:202-5. [Medline].

  75. Wolfensberger W. A Guideline on Protecting the Health and Lives of Patients in Hospitals, Especially if the Patient is a Member of a Societally Devalued Class. Syracuse University, NY: Training Institute for Human Service Planning, Leadership and Change Agentry; 1992.

  76. Zigman WB, Schupf N, Sersen E, Silverman W. Prevalence of dementia in adults with and without Down's syndrome. Am J Ment Retard. Jan 1996;100(4):403-12. [Medline].

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Further Reading

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Keywords

Alzheimer's disease, Alzheimer's, AD, dementia, Alzheimer dementia, presenile dementia, dementia presenilis, primary neuronal degeneration, primary senile dementia, trisomy 21, trisomy 21 syndrome, Down's syndrome, DS, mental retardation

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Contributor Information and Disclosures

Author

Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Robert A Hauser, MD, Professor, Departments of Neurology, Pharmacology, and Experimental Therapeutics, Director, Parkinson's Disease and Movement Disorders Center, University of South Florida and Tampa General Healthcare
Robert A Hauser, MD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society
Disclosure: Nothing to disclose.

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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Pfizer Honoraria Speaking and teaching; Myriad Honoraria Consulting

 
 
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