Alzheimer’s Disease

Alzheimer’s disease is three to five times more frequent in adults with Down syndrome than it is in the general population. Twenty-five percent or more of adults with Down syndrome over the age of 35 have clinical signs and symptoms of Alzheimer’s-type dementia. In contrast, only 5-10 percent of the general population over the age of 65 have Alzheimer’s disease. Alzheimer’s disease is rare in non-disabled adults under the age of 50. There is some speculation that particular genes on chromosome 21 may predispose people with Down syndrome to Alzheimer’s disease.

Early symptoms of Alzheimer’s disease include:

Individuals with Down syndrome and Alzheimer’s disease often manifest prominent non-cognitive symptoms as well, including aggression, social withdrawal, and compulsive behaviors.

INSTANT FEEDBACK:
Alzheimer’s disease is more common in adults with Down syndrome than in the general population, and occurs at an earlier age.
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Alzheimer’s disease is difficult to diagnose, particularly in individuals with Down syndrome who already have impairments in the cognitive, communicative, adaptive, social, and physical domains. It is important that healthcare providers rule out the following conditions before attributing age-related decline to Alzheimer’s disease in adults with Down syndrome:

There are a number of questionnaires that can be answered by family members, companions, or caretakers to identify early signs of dementia. The National Down Syndrome Society (NDSS) recommends that individuals with Down syndrome take a baseline test of cognitive function at age 30, and then annually thereafter. If early signs of dementia are detected, further diagnostic testing can be done.

INSTANT FEEDBACK:
The National Down Syndrome Society recommends a baseline test of cognitive function at age 30, and then once a year after that, for adults with Down syndrome.
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Virtually all adults with Down syndrome over the age of 40 years have some of the neuropathological changes associated with Alzheimer’s disease. Only some of the adults develop dementia. A major study is currently underway to identify methods for diagnosing dementia in people with Down syndrome, and to determine the dementia-associated changes in their brains (Zigman, 2003). In addition, several centers are testing various therapeutic approaches designed to delay the onset of Alzheimer’s disease, or slow its progression, in people with Down syndrome.

In working with adults with Down syndrome, nurses need to be aware of the high risk for Alzheimer’s disease. It’s important to report early warning signs to the patient’s primary healthcare provider. Remember that adults with Down syndrome and Alzheimer’s disease may show some of the classic early signs of dementia (memory loss, personality changes, functional impairments) as well as behavioral changes such as aggression, social withdrawal, and compulsive behaviors. With early diagnosis and treatment, it may be possible to delay the onset and/or slow the progression of Alzheimer’s disease. Early reporting of symptoms will also provide the healthcare provider with information to rule out other disorders (such as hypothyroidism) that may mimic Alzheimer’s disease.

INSTANT FEEDBACK:
Adults with Down syndrome and Alzheimer’s disease may show classic signs of dementia, along with behavioral changes such as social withdrawal and compulsive behaviors.
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Once Alzheimer’s disease has been diagnosed in an adult with Down syndrome, nurses working with the patient are advised to focus on the four S’s:

Safety: Early on, home modifications and monitoring may be sufficient to ensure the adult’s safety. As the dementia progresses, a change in living arrangements may be warranted.
Stability of the environment: Experts recommend keeping the adult in the present environment as long as it is safely possible, making only minor changes when necessary.
Social (emotional) issues: Family members and caregivers often need counseling, emotional support, and respite care for time away from the adult with Alzheimer’s disease. It’s also important to keep the patient socially active as long as possible to maximize function.
Symptoms: Seizures, incontinence, and psychological symptoms including depression, psychotic features, and anxiety are common in adults with Down syndrome and Alzheimer’s disease. The adult may also have changes in sleeping and eating patterns. Nurses working with the adult are in an ideal position to make appropriate nursing diagnoses around these concerns, and to develop a plan for minimizing their impact for the adult and the caregivers.

INSTANT FEEDBACK:
Once an adult with Down syndrome shows early signs of Alzheimer’s disease, it’s important to seek appropriate alternate living arrangements so the person can be accustomed to the new situation as quickly as possible.
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