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Silverman W, Krinsky-McHale SJ, Lai F, Rosas HD, Hom C, Doran E, Pulsifer M, Lott I, Schupf N. Evaluation of the National Task Group-Early Detection Screen for Dementia: Sensitivity to 'mild cognitive impairment' in adults with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:905-915. [PMID: 33314467 PMCID: PMC8356176 DOI: 10.1111/jar.12849] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/09/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The accuracy of the National Task Group-Early Detection Screen for Dementia (NTG-EDSD) was evaluated in a sample of 185 adults with Down syndrome (DS), emphasizing 'mild cognitive impairment (MCI-DS)'. METHOD Knowledgeable informants were interviewed with the NTG-EDSD, and findings were compared to an independent dementia status rating based on consensus review of detailed assessments of cognition, functional abilities and health status (including physician examination). RESULTS Results indicated that sections of the NTG-EDSD were sensitive to MCI-DS, with one or more concerns within the 'Memory' or 'Language and Communication' domains being most informative. CONCLUSIONS The NTG-EDSD is a useful tool for evaluating dementia status, including MCI-DS. However, estimates of sensitivity and specificity, even for detecting frank dementia, indicated that NTG-EDSD findings need to be supplemented by additional sources of relevant information to achieve an acceptable level of diagnostic/screening accuracy.
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Affiliation(s)
- Wayne Silverman
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Sharon J. Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA,Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
| | - Florence Lai
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - H. Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Christy Hom
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Margaret Pulsifer
- Department of Psychiatry, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Ira Lott
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Nicole Schupf
- Sergievsky Center, Taub Institute, New York, CA, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, CA, USA,Department of Epidemiology, School of Public Health, Columbia University, New York, CA, USA
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Takenoshita S, Terada S, Kuwano R, Inoue T, Kurozumi T, Choju A, Suemitsu S, Yamada N. Validation of the Japanese version of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:970-979. [PMID: 33016572 DOI: 10.1111/jir.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dementia in people with intellectual disabilities (IDs) is difficult to detect because of preexisting cognitive deficits. An effective screening method is required. The Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) was developed as an observer rating tool to screen dementia in people with ID. The aim of this study was to verify the screening accuracy of the DSQIID for Japanese people with ID. METHODS Four-hundred ninety-three subjects with ID participated in this study. Caregivers who had observed the participants for more than 2 years scored the Japanese version of the DSQIID (DSQIID-J) of the participants. Three doctors examined participants directly and diagnosed dementia using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. To identify the key screening items that predict dementia, the specificities of a single and pairs of items with 100% sensitivity were evaluated relative to the dementia diagnosis. RESULTS Of 493 participants, 34 were people with Down syndrome (DS), and 459 were people without DS. Seventeen participants were diagnosed with dementia. The suitable cut-off score of the DSQIID-J was 10/11 (sensitivity 100% and specificity 96.8%) for screening dementia. The inter-rater reliability, test-retest reliability and internal consistency of the DSQIID-J were excellent. Regarding key items, there was no single item with 100% sensitivity, and the best two-item combination was the pair of 'Cannot dress without help' and 'Walks slower' (sensitivity 100% and specificity 93.5%). CONCLUSIONS We identified several important question items of the DSQIID-J related to the diagnosis of dementia in people with ID. The DSQIID-J is a useful screening tool for dementia in adults with ID.
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Affiliation(s)
- S Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - R Kuwano
- Asahigawaso Research Institute, Asahigawaso Medical Welfare Center, Okayama, Japan
| | - T Inoue
- Asahigawaso Research Institute, Asahigawaso Medical Welfare Center, Okayama, Japan
| | - T Kurozumi
- Asahigawaso Research Institute, Asahigawaso Medical Welfare Center, Okayama, Japan
| | - A Choju
- Asahigawaso Research Institute, Asahigawaso Medical Welfare Center, Okayama, Japan
| | - S Suemitsu
- Asahigawaso Research Institute, Asahigawaso Medical Welfare Center, Okayama, Japan
| | - N Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Lifshit HB, Bustan N, Shnitzer-Meirovich S. Intelligence trajectories in adolescents and adults with down syndrome: Cognitively stimulating leisure activities mitigate health and ADL problems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:491-506. [PMID: 33058453 DOI: 10.1111/jar.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
GOALS This study examined: (a) crystallized/fluid intelligence trajectories of adolescents and adults with Down syndrome; and (b) the contribution of endogenous (health, activities of daily living-ADL) and exogenous (cognitively stimulating leisure activities) factors on adults' intelligence with age. METHOD Four cohorts (N = 80) with Down syndrome participated: adolescents (ages 16-21) and adults (ages 30-45, 46-60 and 61+). All completed Vocabulary and Similarities (crystallized) and Block Design and Raven (fluid) intelligence tests (WAIS-IIIHEB , Wechsler, 2001). RESULTS The 30-45 cohort significantly outperformed the 16-21 cohort. Except for Vocabulary, which remained stable, onset of decline was at 40-50. Age-related declining health and ADL correlated with participants' lower fluid intelligence, but cognitive leisure activities mitigated this influence. CONCLUSIONS Intelligence development into adulthood supported the continuous trajectory and compensation age theory, rather than accelerated or stable trajectories. Not only endogenous factors but also exogenous factors determined intelligence levels in adults with Down syndrome, supporting cognitive activity theory.
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Affiliation(s)
- Hefziba Batya Lifshit
- Special Education Department, Machado Chair for Research on Cognitive Modifiability and Human Development, School of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Noa Bustan
- Kibbutzim-Seminar College, Tel-Aviv, Israel
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Takenoshita S, Terada S, Kuwano R, Inoue T, Cyoju A, Suemitsu S, Yamada N. Prevalence of dementia in people with intellectual disabilities: Cross-sectional study. Int J Geriatr Psychiatry 2020; 35:414-422. [PMID: 31894597 DOI: 10.1002/gps.5258] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are only a few studies of the prevalence of dementia in people with intellectual disability (ID) without Down syndrome (DS), and there is a large difference in the prevalences between reported studies. Moreover, the prevalence of mild cognitive impairment (MCI) in ID has not been reported. We aimed to evaluate the prevalence of dementia in adults of all ages and the prevalence of MCI in people with ID. Furthermore, we tried to clarify the differences depending on the various diagnostic criteria. METHODS The survey included 493 adults with ID at 28 facilities in Japan. The caregivers answered a questionnaire, and physicians directly examined the participants who were suspected of cognitive decline. Dementia and MCI were diagnosed according to ICD-10, DC-LD, and DSM-5 criteria. RESULTS The prevalence of dementia was 0.8% for the 45 to 54 years old group, 3.5% for the 55 to 64 years old group, and 13.9% for the 65 to 74 years old group in people with ID without DS. The prevalence of MCI was 3.1% for patients 45 to 54, 3.5% for patients 55 to 64, and 2.8% for patients 65 to 74 with ID without DS. DSM-5 was the most inclusive in diagnosing dementia and MCI in people with ID. CONCLUSIONS People with ID without DS may develop dementia and MCI at an earlier age and higher rate than the general population. Among the diagnostic criteria, DSM-5 was the most useful for diagnosing their cognitive impairment.
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Affiliation(s)
- Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryozo Kuwano
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Tomokazu Inoue
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Atsushi Cyoju
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Shigeru Suemitsu
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Lin JD, Lin LP, Hsu SW. Aging People with Intellectual Disabilities: Current Challenges and Effective Interventions. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0082-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rafii MS. Pro: Are we ready to translate Alzheimer's disease modifying therapies to people with Down syndrome? ALZHEIMERS RESEARCH & THERAPY 2014; 6:60. [PMID: 25478025 PMCID: PMC4255529 DOI: 10.1186/s13195-014-0060-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Down Syndrome (DS) is caused by trisomy of chromosome 21, which includes the gene for the amyloid precursor protein (APP) and leads to overproduction of beta-amyloid. Clinical-pathological studies indicate that individuals with DS begin demonstrating Alzheimer's disease (AD) pathology during adolescence and that 100% exhibit such changes by age 40. Individuals with DS therefore represent a highly enriched population for AD. Additionally, owing to their baseline intellectual disability, people with DS represent a more vulnerable group of individuals as compared with other populations. Given the recent developments in AD biomarkers, combined with the prospect of achieving greater efficacy with earlier therapeutic intervention, it is logical to include adults with DS in prevention trials for AD. DISCUSSION The US Food and Drug Administration has released draft guidance on drug development for early-stage AD, based on the understanding that AD is a progressive disease with symptoms developing decades after the disease process has begun. New biomarkers now permit detection of AD pathology in asymptomatic individuals such that there now exists an opportunity to conduct clinical trials of potentially disease-modifying drugs in the earliest stages of the disease and perhaps have the greatest chance of demonstrating efficacy. As such, clinical trials are being actively planned or conducted in individuals with causative mutations in the APP, presenilin-1 (PSEN1), and presenilin-2 (PSEN2) genes. SUMMARY Individuals with DS comprise perhaps the largest group of people with genetically determined AD, with a worldwide population of about 6 million people. Only by inclusion can we provide access to rational therapies that offer the greatest chance of benefiting this highly at-risk population.
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Affiliation(s)
- Michael S Rafii
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, MC 0949, La Jolla 92093, CA, USA
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Carr J, Collins S. Ageing and dementia in a longitudinal study of a cohort with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 27:555-63. [PMID: 24687962 DOI: 10.1111/jar.12093] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND A population sample of people with Down syndrome has been studied from infancy and has now been followed up again at age 47 years. METHODS Intelligence and language skills were tested and daily living skills assessed. Memory/cognitive deterioration was examined using two test instruments. RESULTS Scores on verbal tests of intelligence changed little. Those on a non-verbal test, on self-help skills and on both memory tests showed some decline, even when the scores of those already suffering from dementia were discounted. CONCLUSIONS At age 47, scores on most tests of even the majority of the cohort (i.e. those not definitely diagnosed with dementia) showed some decline. While this includes the scores of people who may subsequently develop dementia, it may also reflect the normal ageing process in this population.
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Affiliation(s)
- Janet Carr
- Gaston Cottages formerly at St George's Hospital, Cranmer Terrace, London, SW170RE, UK
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Krinsky-McHale SJ, Silverman W. Dementia and mild cognitive impairment in adults with intellectual disability: issues of diagnosis. ACTA ACUST UNITED AC 2014; 18:31-42. [PMID: 23949827 DOI: 10.1002/ddrr.1126] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/09/2012] [Accepted: 10/15/2012] [Indexed: 01/21/2023]
Abstract
Individuals with intellectual disability (ID) are now living longer with the majority of individuals reaching middle and even "old age." As a consequence of this extended longevity they are vulnerable to the same age-associated health problems as elderly adults in the general population without ID. This includes dementia, a general term referring to a variety of diseases and conditions causing substantial loss of cognitive ability and functional declines; adults with Down syndrome are at especially high risk. A great deal of recent effort has focused on the very earliest detectable indicators of decline (and even prodromal stages of dementia-causing diseases). A condition called mild cognitive impairment (MCI) has been conceptually defined as a decline in functioning that is more severe than expected with typical brain aging but not severe enough to meet criteria for a diagnosis of dementia. Consensus criteria for both dementia and MCI have been developed for typically developing adults but are of limited applicability for adults with ID, given their pre-existing cognitive impairments. Early diagnosis will continue to be of growing importance, both to support symptomatic treatment and to prevent irreversible neuropathology when interventions are developed to slow or halt the progression of underlying disease. While the intellectual and developmental disabilities field has for some time recognized the need to develop best-practices for the diagnosis of MCI and dementia, there remains a pressing need for empirically based assessment methods and classification criteria.
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Affiliation(s)
- Sharon J Krinsky-McHale
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York 10314-6399, USA.
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Silverman WP, Zigman WB, Krinsky-McHale SJ, Ryan R, Schupf N. Intellectual Disability, Mild Cognitive Impairment, and Risk for Dementia. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2013; 10. [PMID: 24273589 DOI: 10.1111/jppi.12042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
People with intellectual disability (ID) are living longer than ever before, raising concerns about old-age associated disorders. Dementia is among the most serious of these disorders, and theories relating cognitive reserve to risk predict that older adults with ID should be particularly vulnerable. Previous estimates of relative risk for dementia associated with ID have been inconsistent, and the present analyses examined the possible influence of variation in diagnostic criteria on findings. As expected, relaxation in the stringency of case definition for adults with ID increased relative risk, underscoring the importance of developing valid criteria for defining mild cognitive impairment, early dementia, and distinguishing between the two in adults with ID. Once available, these standards will contribute to more effective evidence-based planning.
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Affiliation(s)
- Wayne P Silverman
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland USA
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Zigman WB. Atypical aging in down syndrome. ACTA ACUST UNITED AC 2013; 18:51-67. [DOI: 10.1002/ddrr.1128] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 11/14/2012] [Accepted: 11/29/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Warren B. Zigman
- Department of Psychology, Laboratory of Community Psychology, NYS Institute for Basic Research in Developmental Disabilities; Staten Island; New York
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Krinsky-McHale SJ, Silverman W, Gordon J, Devenny DA, Oley N, Abramov I. Vision deficits in adults with Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 27:247-63. [PMID: 23784802 DOI: 10.1111/jar.12062] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND In individuals with Down syndrome, virtually all structures of the eye have some abnormality, which likely diminishes vision. We examined basic vision functions in adults with Down syndrome. MATERIALS AND METHODS Participants completed a battery of psychophysical tests that probed a comprehensive array of visual functions. The performance of adults with Down syndrome was compared with younger and older adults without intellectual disability. RESULTS Adults with Down syndrome had significant vision deficits, reduced sensitivity across spatial frequencies and temporal modulation rates, reduced stereopsis, impaired vernier acuity and anomalies in colour discrimination. The pattern of deficits observed was similar to those seen by researchers examining adults with Alzheimer's disease. CONCLUSIONS Our findings suggest that a common mechanism may be responsible for the pattern of deficits observed, possibly the presence of Alzheimer's disease neuropathology in the visual association cortex. We also showed that individuals with mild to moderate intellectual disability are capable of participating in studies employing state-of-the-art psychophysical procedures. This has wider implications in terms of their ability to participate in research that use similar techniques.
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Affiliation(s)
- Sharon J Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
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Friedman SL, Helm DT, Woodman AC. Unique and universal barriers: hospice care for aging adults with intellectual disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:509-532. [PMID: 23167489 DOI: 10.1352/1944-7558-117.6.509] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As life expectancy of people with intellectual disability (ID) has increased, there has been a concurrent increase in age-related illnesses and conditions similar to that of the general population. These circumstances result in people with ID dying from typical life-ending conditions, and thus, they require similar end-of-life services such as palliative and hospice care. Although there are notable barriers to hospice for all, people with ID face additional challenges in accessing the benefits of these services. This article presents a review of the literature on these issues, underscoring the multiple challenges and the importance of a more collaborative approach between hospice and palliative care workers with people with ID, their families, and other important stakeholders.
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Ophthalmic disorders in adults with down syndrome. Curr Gerontol Geriatr Res 2012; 2012:974253. [PMID: 22570648 PMCID: PMC3337581 DOI: 10.1155/2012/974253] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/11/2012] [Accepted: 01/22/2012] [Indexed: 11/18/2022] Open
Abstract
A myriad of ophthalmic disorders is associated with the phenotype of Down syndrome including strabismus, cataracts, and refractive errors potentially resulting in significant visual impairment. Ophthalmic sequelae have been extensively studied in children and adolescents with Down syndrome but less often in older adults. In-depth review of medical records of older adults with Down syndrome indicated that ophthalmic disorders were common. Cataracts were the most frequent ophthalmic disorder reported, followed by refractive errors, strabismus, and presbyopia. Severity of intellectual disability was unrelated to the presence of ophthalmic disorders. Also, ophthalmic disorders were associated with lower vision-dependent functional and cognitive abilities, although not to the extent that was expected. The high prevalence of ophthalmic disorders highlights the need for periodic evaluations and individualized treatment plans for adults with Down syndrome, in general, but especially when concerns are identified.
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Carr J. Six Weeks to 45 Years: A Longitudinal Study of a Population with Down Syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2012; 25:414-22. [DOI: 10.1111/j.1468-3148.2011.00676.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kim NH, Hoyek GE, Chau D. Long-term care of the aging population with intellectual and developmental disabilities. Clin Geriatr Med 2011; 27:291-300. [PMID: 21641512 DOI: 10.1016/j.cger.2011.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aging population with intellectual and developmental disabilities (I/DD) deserves appropriate health care and social support. This population poses unique medical and social challenges to the multidisciplinary team that provides care. In the past, long-term care (LTC) facilities played an essential role in the livelihood of this population. The likelihood that the geriatric LTC system must prepare for adequately caring for this population is high. This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future.
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Affiliation(s)
- Nae-Hwa Kim
- Department of Internal Medicine, Resident PGY 2, University of Nevada School of Medicine, Reno, NV 89502, USA
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Urv TK, Zigman WB, Silverman W. Psychiatric symptoms in adults with Down syndrome and Alzheimer's disease. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 115:265-276. [PMID: 20597723 DOI: 10.1352/1944-7558-115.4.265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Changes in psychiatric symptoms related to specific stages of dementia were investigated in 224 adults 45 years of age or older with Down syndrome. Findings indicate that psychiatric symptoms are a prevalent feature of dementia in the population with Down syndrome and that clinical presentation is qualitatively similar to that seen in Alzheimer's disease within the general population. Psychiatric symptoms related to Alzheimer's disease vary by the type of behavior and stage of dementia, but do not seem to be influenced by sex or level of premorbid intellectual impairment. Some psychiatric symptoms may be early indicators of Alzheimer's disease and may appear prior to substantial changes in daily functioning. Improvements in understanding the progression of dementia in individuals with Down syndrome may lead to improved diagnosis and treatment.
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Affiliation(s)
- Tiina K Urv
- National Institute of Child Health and Human Development, Bethesda, MD 20892, USA.
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Agiovlasitis S, McCubbin JA, Yun J, Mpitsos G, Pavol MJ. Effects of Down syndrome on three-dimensional motion during walking at different speeds. Gait Posture 2009; 30:345-50. [PMID: 19595593 DOI: 10.1016/j.gaitpost.2009.06.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 03/29/2009] [Accepted: 06/10/2009] [Indexed: 02/02/2023]
Abstract
The inherent joint laxity and muscle hypotonia of adults with Down syndrome (DS) may result in reduced gait stability and increased energetic cost. These factors vary as a function of walking speed and may be reflected in gait patterns. The present study therefore examined whether the three-dimensional motion of the body center of mass (COM) and stepping characteristics differ between adults with and without DS as a function of speed. Fifteen adults with DS and 15 adults without DS underwent a series of treadmill walking trials. Walking speeds were determined as Froude numbers, based on leg length. Participants walked at Froude numbers of 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, and, for adults without DS, 0.7. Whole-body kinematic data were collected for 30-35 steps at each speed. Across speeds, adults with DS showed greater and more variable mediolateral COM motion than adults without DS. COM anteroposterior velocity and vertical motion did not differ in range between groups, but were more variable in adults with DS. Adults with DS also showed smaller-duration steps and varied their step widths and step lengths more than adults without DS. The results suggest a gait pattern with lesser stability and greater energetic cost among adults with DS.
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Affiliation(s)
- Stamatis Agiovlasitis
- Mississippi State University, Department of Kinesiology, McCarthy Gym, Mississippi State, MS 39762, USA.
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Nochajski SM. The Impact of Age-Related Changes on the Functioning of Older Adults with Developmental Disabilities. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v18n01_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Krinsky-McHale SJ, Devenny DA, Kittler P, Silverman W. Selective Attention Deficits Associated With Mild Cognitive Impairment and Early Stage Alzheimer's Disease in Adults With Down Syndrome. ACTA ACUST UNITED AC 2008; 113:369-86. [DOI: 10.1352/2008.113:369-386] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AbstractAdults with Down syndrome and early stage Alzheimer's disease showed decline in their ability to selectively attend to stimuli in a multitrial cancellation task. They also showed variability in their performance over the test trials, whereas healthy participants showed stability. These changes in performance were observed approximately 2 years prior to a physician's diagnosis of possible Alzheimer's disease, which was made when they were exhibiting declines in episodic memory suggestive of mild cognitive impairment. Performance on this task varied with the evolution of dementia, showed modestly good sensitivity and specificity, and was relatively easy to administer. Given these qualities this task could be a valuable addition to a neuropsychological battery intended for the assessment of mild cognitive impairment and Alzheimer's disease in adults with Down syndrome.
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Affiliation(s)
| | | | - Phyllis Kittler
- New York State Institute for Basic Research in Developmental Disabilities
| | - Wayne Silverman
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine
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Krinsky-McHale SJ, Devenny DA, Gu H, Jenkins EC, Kittler P, Murty VV, Schupf N, Scotto L, Tycko B, Urv TK, Ye L, Zigman WB, Silverman W. Successful aging in a 70-year-old man with down syndrome: a case study. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2008; 46:215-228. [PMID: 18578579 DOI: 10.1352/2008.46:215-228] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors present a case study of a 70-year-old man with Down syndrome ("Mr. C.") who they followed for 16 years and who does not exhibit declines in cognitive or functional capacities indicative of dementia, despite having well-documented, complete trisomy 21. The authors describe the age-associated changes that occurred over 16 years as well as provide detailed information regarding Mr. C.'s health and genetic status. To further emphasize Mr. C.'s successful aging, the authors compared his longitudinal performance profile with that of 2 peers of comparable level of intellectual functioning: 1 similar-aged man with clinical Alzheimer's disease and a younger man who was healthy. The authors present potential explanations for the phenotypic variability observed in individuals with Down syndrome.
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Affiliation(s)
- Sharon J Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314, USA.
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21
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Lazenby T. The impact of aging on eating, drinking, and swallowing function in people with Down's syndrome. Dysphagia 2008; 23:88-97. [PMID: 17694411 DOI: 10.1007/s00455-007-9096-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Many people with Down's syndrome (DS) experience eating, drinking, and swallowing (EDS) difficulties, which can potentially lead to life-threatening conditions such as malnutrition, dehydration, and aspiration pneumonia. As the life expectancy of people with DS continues to improve, there is an increasing need to examine how the aging process may further affect these conditions. Published research studies have yet to address this issue; therefore, this article draws on the literature in three associated areas in order to consider the dysphagic problems that might develop in aging people with DS. The areas examined are EDS development in children and adolescents with DS, EDS changes associated with aging, and EDS changes associated with dementia of the Alzheimer's type (DAT) because this condition is prevalent in older adults with DS. This article concludes that unlike in the general population, the aging process is likely to cause dysphagic difficulties in people with DS as they get older. Therefore, it is suggested that longitudinal studies are needed to examine the specific aspects of EDS function that may be affected by aging and concomitant conditions in DS.
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Affiliation(s)
- Tracy Lazenby
- NHS Lothian Primary and Community Division, Southwest Edinburgh Community Learning Disabilities Service, 86 Longstone Road, Edinburgh, EH14 2AS, UK.
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22
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Abstract
Down syndrome (DS) is characterized by increased mortality rates, both during early and later stages of life, and age-specific mortality risk remains higher in adults with DS compared with the overall population of people with mental retardation and with typically developing populations. Causes of increased mortality rates early in life are primarily due to the increased incidence of congenital heart disease and leukemia, while causes of higher mortality rates later in life may be due to a number of factors, two of which are an increased risk for Alzheimer's disease (AD) and an apparent tendency toward premature aging. In this article, we describe the increase in lifespan for people with DS that has occurred over the past 100 years, as well as advances in the understanding of the occurrence of AD in adults with DS. Aspects of the neurobiology of AD, including the role of amyloid, oxidative stress, Cu/ZN dismutase (SOD-1), as well as advances in neuroimaging are presented. The function of risk factors in the observed heterogeneity in the expression of AD dementia in adults with DS, as well as the need for sensitive and specific biomarkers of the clinical and pathological progressing of AD in adults with DS is considered.
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Affiliation(s)
- Warren B Zigman
- Department of Psychology, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, New York 10314, USA.
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23
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Zigman WB, Devenny DA, Krinsky-McHale SJ, Jenkins EC, Urv TK, Wegiel J, Schupf N, Silverman W. Alzheimer's Disease in Adults with Down Syndrome. INTERNATIONAL REVIEW OF RESEARCH IN MENTAL RETARDATION 2008; 36:103-145. [PMID: 19633729 PMCID: PMC2714652 DOI: 10.1016/s0074-7750(08)00004-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Warren B. Zigman
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
| | - Darlynne A. Devenny
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
| | - Sharon J. Krinsky-McHale
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
| | - Edmund C. Jenkins
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
| | - Tiina K. Urv
- Mental Retardation & Developmental Disabilities Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892
| | - Jerzy Wegiel
- Department of Developmental Neurobiology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
| | - Nicole Schupf
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, N.Y. 10032
- Departments of Epidemiology and Psychiatry, Columbia University Medical Center, New York, NY 10032
| | - Wayne Silverman
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD 21205
- Department of Psychiatry and Behavioral Medicine, Johns Hopkins University Medical School, Baltimore, MD 21205
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24
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25
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Abstract
The number of people over the age of 60 years with lifelong developmental delays is predicted to double by 2030. Down syndrome (DS) is the most frequent chromosomal cause of developmental delays. As the life expectancy of people with DS increases, changes in body function and structure secondary to aging have the potential to lead to activity limitations and participation restrictions for this population. The purpose of this update is to: (1) provide an overview of the common body function and structure changes that occur in adults with DS as they age (thyroid dysfunction, cardiovascular disorders, obesity, musculoskeletal disorders, Alzheimer disease, depression) and (2) apply current research on exercise to the prevention of activity limitations and participation restrictions. As individuals with DS age, a shift in emphasis from disability prevention to the prevention of conditions that lead to activity and participation limitations must occur. Exercise programs appear to have potential to positively affect the overall health of adults with DS, thereby increasing the quality of life and years of healthy life for these individuals.
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Affiliation(s)
- Robert C Barnhart
- Department of Physical Therapy, East Tennessee State University, Box 70624, Johnson City, TN 37614, USA.
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26
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Devenny DA, Wegiel J, Schupf N, Jenkins E, Zigman W, Krinsky-McHale SJ, Silverman WP. Dementia of the Alzheimer's type and accelerated aging in Down syndrome. ACTA ACUST UNITED AC 2005; 2005:dn1. [PMID: 15814818 DOI: 10.1126/sageke.2005.14.dn1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This case study, of a woman with Down syndrome and dementia of the Alzheimer's type (DAT), follows the course of her decline over an 11-year period until death at age 57. Detailed neuropathological findings are also presented. This case illustrates features of premature aging that are typically associated with Down syndrome, and the progressive changes in memory and cognition that are usually associated with DAT. Although the subject's cardiovascular condition and thyroid disorder were treated, they may have contributed to the decline of her memory. This case shows the difficulty in diagnosing dementia in an individual with mental retardation who suffered comorbid episodes of depression and psychosis.
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Affiliation(s)
- D A Devenny
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA.
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27
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Lifshitz H, Merrick J. Aging among persons with intellectual disability in Israel in relation to type of residence, age, and etiology. RESEARCH IN DEVELOPMENTAL DISABILITIES 2004; 25:193-205. [PMID: 15026094 DOI: 10.1016/j.ridd.2003.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2003] [Revised: 03/14/2003] [Accepted: 05/18/2003] [Indexed: 05/24/2023]
Abstract
This study was conducted to compare aging phenomena of persons with intellectual and developmental disability (ID) aged 40 years and older living in community residence (N = 65) with those living with their families (N = 43) in Jerusalem, Israel. All 108 persons and care givers were interviewed to ascertain health problems, sensory impairment, activity of daily living (ADL), cognitive skills, and leisure activities. Health problem had already developed by age 40 years. The most frequent were visual (33%), hearing impairments (20%) and dental problems (30%). The community residence group displayed more medical problems, whereas individuals living at home had more dental problems. Health problems in persons with Down syndrome were significantly higher. ADL functioning for all participants was high, but persons with Down syndrome and cerebral palsy had more dependence. A decline in functioning in both residential groups was observed concerning leisure time, but scores for social life leisure activities were better for the community residential group. The data provided in this study can serve as information to develop geriatric services for persons with ID and provide a basis for comparison with peers in the general population in Israel. Dental service to persons with ID living at home should be improved.
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Affiliation(s)
- Hefziba Lifshitz
- School of Education, Bar Ilan University, Ramat Gan, IL-52900, Israel
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28
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Krinsky-McHale SJ, Devenny DA, Silverman WP. Changes in explicit memory associated with early dementia in adults with Down's syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2002; 46:198-208. [PMID: 11896805 DOI: 10.1046/j.1365-2788.2002.00365.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND A modified version of the Selective Reminding Test (SRT) (Buschke 1973) was used to examine the changes in memory that occur with early-stage dementia of the Alzheimer's type (DAT) in adults with intellectual disability (ID) and Down's syndrome (DS), and to compare these changes to those occurring with 'normal' ageing. METHOD Hierarchical linear modelling analyses showed steep declines in the performance of participants who had met the criteria for the onset of DAT. Non-demented participants also showed declines in performance which were related to their age. However, the absolute magnitude of these declines was consistent with a 'normal' ageing pattern and not with undetected dementia. RESULTS In analysing the specific memory components that are compromised, the present authors found that participants with early-stage DAT showed severely diminished long-term storage and retrieval processing abilities compared to their non-demented peers. Notably, these declines preceded other symptoms of dementia, in most cases by more than a full year and sometimes by as much as 3 years. CONCLUSIONS Thus, the present results clearly confirm that memory processes are affected during early dementia in adults with DS, and that the SRT has promise as a clinical tool.
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Affiliation(s)
- S J Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York 10314-6399, USA.
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29
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Devenny DA, Krinsky-McHale SJ, Sersen G, Silverman WP. Sequence of cognitive decline in dementia in adults with Down's syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2000; 44 ( Pt 6):654-665. [PMID: 11115020 DOI: 10.1046/j.1365-2788.2000.00305.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Adults with Down's syndrome (DS) are known to be at risk of dementia of the Alzheimer type (DAT), but because of their lifelong intellectual deficits, it is difficult to determine the earliest signs and characteristics of age-associated decline and dementia. In a longitudinal study in which all participants were healthy at the time of their entry into the study, the present authors compared the amount of decline on the subtests of the WISC-R to determine the sequence of cognitive decline associated with varying stages of dementia. Twenty-two individuals with varying degrees of cognitive decline were compared to 44 adults with DS who have remained healthy. All participants functioned in the mild or moderate range of intellectual disability at initial testing. On each subtest of the WISC-R, the amount of change experienced by the healthy participants over the study period was compared to the amount of change found for each of the groups with decline. Out of the individuals who showed declines, 10 adults with DS were classified as having 'questionable' decline based on the presence of memory impairment, and five and seven adults with DS were classified as in the 'early stage' and 'middle stage' of DAT, respectively, based on the presence of memory impairment, score on the Dementia Scale for Down Syndrome and a physician's diagnosis. It was found that participants who were identified as 'questionable', in addition to the memory loss that determined their classification, also showed significant declines on the Block Design and Coding subtests. The five adults in the early stage of dementia showed declines on these subtests, and in addition, on the Object Assembly, Picture Completion, Arithmetic and Comprehension subtests. The seven adults in the middle stage of dementia showed declines on these subtests, plus declines on Information, Vocabulary and Digit Span subtests. The Picture Arrangement and Similarities subtests were not useful in distinguishing between the groups because of baseline floor effects for a substantial proportion of participants. The present longitudinal study showed a sequence of cognitive decline associated with DAT, beginning with a possible 'pre-clinical' stage, and progressing through the early and middle stages. This approach begins to define the sequence of declining cognitive capacities that contributes to the observed functional deterioration caused by Alzheimer's disease and that is likely to reflect the involvement of cortical areas as the disease progresses.
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Affiliation(s)
- D A Devenny
- New York State Institute for Basic Research, Staten Island, New York 10314, USA
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