Individuals with Down syndrome are living longer than ever before. In the 1940s, the average life expectancy was only 12 and now it is 60 and beyond. With this increase in life expectancy comes an increased risk of developing early onset Alzheimer’s disease due to trisomy (extra copy) of chromosome 21. Among individuals with Down syndrome, the more “classic” features of the disease may not be present, leading to preclinical signs being overlooked or misdiagnosed. Lack of early detection may poorly impact the individual’s health outcomes and quality of life.
It is therefore important to identify various cognitive and behavioral changes occurring during the early stages of Alzheimer’s disease among individuals with Down syndrome. There are some important differences to be aware of between the general population and those with Down syndrome. Among the general population, memory loss is almost always the key indicator associated with the onset of Alzheimer’s disease.
On the other hand, memory decline is preceded by deterioration in executive function (goal-directed behavior, planning, attention) and behavioral and psychological symptoms. Some experts believe that the progression of Alzheimer’s disease in people with Down syndrome may be closer to dementia of the frontal type as experienced by the general population.
Caring for individuals with Down syndrome who are exhibiting early signs of Alzheimer’s disease begins with understanding signs and symptoms associated with it. Research indicates that many caregivers are not aware of the typical psychological, cognitive or behavioral changes that occur as Alzheimer’s begins to develop. Identifying changes is necessary for appropriate clinical interventions, pharmaceutical therapies, and overall well-being.
Differentiating clinical characteristics associated with Down syndrome and early onset Alzheimer’s disease is no easy task. Down syndrome, for instance, is known to be associated with impairments in working memory (remembering information for short periods of time), making measuring declines in memory difficult. It has been shown in research that declines in executive functioning precede memory problems associated with Alzheimer’s disease. Loss of everyday skills, or ADLs, are also impaired prior to the onset of Alzheimer’s disease. Loss of independence in personal hygiene and lack of spatial disorientation are early signs, as are incontinence and motor difficulties.
It is a well-known fact that individuals with Down syndrome will begin showing signs of early Alzheimer’s disease in their late 40s and early 50s. Many will require skilled care due to multiple comorbidities. Knowing the signs and symptoms of early onset Alzheimer’s can make a significant difference in their care and quality of life.