Neurologic findings in adults with Down syndrome

Patients with Down syndrome (DS) over the age of 40 develop plaques and tangles in their brains similar to those seen in persons with Alzheimer’s disease (AD). New investigations indicate that immunological findings in patients with DS over the age of 30 have some specific characteristics. Cytokine production, phytohemagglutinin (PHA)-stimulated proliferation of non-adherent monocytes and superoxide anion production from polymorphonuclear leukocytes was significantly lower in older individuals (> 30 years old) with DS than that of age and sex matched controls. The decrease of proliferation in older males with DS is significantly greater than in older women with DS. Declines in function in persons with DS need careful clinical evaluation to avoid missing potentially reversible causes of the decline. It is necessary to look for thyroid dysfunction, deficit B12 and folic acid, atlanto-axial instability, depression; infections such as hepatitis B etc. AD is the most common form of dementia. It usually occurs after 65 years. There are only two definite factors that increase the risk for AD: a family history of dementia and DS. About 3 percent of men and women ages 65 to 74 have AD and nearly half of those age 85 and older may have the disease. When an adult with DS is diagnosed with AD we have to focus on “the four S”. Safety means to prevent wounding by touching or using objects in the home. Stability of the environment helps reduce confusion. Negotiating a new environment is more difficult and increases confusion and limits the remaining skills. Social (emotional) supports are also important. It is very important keeping the individual with DS as much involved in activities as possible. Symptoms as incontinence, seizures, depression, sleep disturbance and others need care management.