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 Alzheimers-type
dementia. In contrast, only 5-10 percent of the general population over the
age of 65 have Alzheimers disease. Alzheimers 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 Alzheimers
Early symptoms of Alzheimers
Individuals with Down syndrome and Alzheimers disease often manifest prominent non-cognitive symptoms as well, including aggression, social withdrawal, and compulsive behaviors.
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.
In working with adults with Down syndrome, nurses need to be aware of the high risk for Alzheimers disease. Its important to report early warning signs to the patients primary healthcare provider. Remember that adults with Down syndrome and Alzheimers 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 Alzheimers disease. Early reporting of symptoms will also provide the healthcare provider with information to rule out other disorders (such as hypothyroidism) that may mimic Alzheimers disease.
Safety: Early on,
home modifications and monitoring may be sufficient to ensure the adults
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 Alzheimers disease. Its 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 Alzheimers 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.