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Rutherford G, Hussain R, Tait K. Pattern of multimorbidity in middle-aged and older-aged people with mild intellectual disability in Australia. J Appl Res Intellect Disabil 2024; 37:e13215. [PMID: 38413378 DOI: 10.1111/jar.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Non-communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill-health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid-aged and older-aged people with mild intellectual disability. METHOD Comparative data comes from two cross-sectional surveys using similar methodology and timeframes. The analysis sample comprises mid-aged group (30-50 years, N = 291) and older-aged group (≥60 years, N = 391). RESULTS People with mild intellectual disability start developing NCDs in early to mid-adulthood and increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). CONCLUSION There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement.
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Affiliation(s)
- Grace Rutherford
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Rafat Hussain
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Kathleen Tait
- Macquarie School of Education, Macquarie University, Sydney, Australia
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Molinari S, Fossati C, Nicolosi ML, Di Marco S, Faraguna MC, Limido F, Ocello L, Pellegrinelli C, Lattuada M, Gazzarri A, Lazzerotti A, Sala D, Vimercati C, Capitoli G, Daolio C, Biondi A, Balduzzi A, Cattoni A. Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life. Front Endocrinol (Lausanne) 2024; 15:1348397. [PMID: 38654931 PMCID: PMC11036865 DOI: 10.3389/fendo.2024.1348397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chiara Fossati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Santo Di Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Francesca Limido
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Laura Ocello
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Martina Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandra Gazzarri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Debora Sala
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Vimercati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cecilia Daolio
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Llambrich S, Tielemans B, Saliën E, Atzori M, Wouters K, Van Bulck V, Platt M, Vanherp L, Gallego Fernandez N, Grau de la Fuente L, Poptani H, Verlinden L, Himmelreich U, Croitor A, Attanasio C, Callaerts-Vegh Z, Gsell W, Martínez-Abadías N, Vande Velde G. Pleiotropic effects of trisomy and pharmacologic modulation on structural, functional, molecular, and genetic systems in a Down syndrome mouse model. eLife 2024; 12:RP89763. [PMID: 38497812 PMCID: PMC10948151 DOI: 10.7554/elife.89763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Down syndrome (DS) is characterized by skeletal and brain structural malformations, cognitive impairment, altered hippocampal metabolite concentration and gene expression imbalance. These alterations were usually investigated separately, and the potential rescuing effects of green tea extracts enriched in epigallocatechin-3-gallate (GTE-EGCG) provided disparate results due to different experimental conditions. We overcame these limitations by conducting the first longitudinal controlled experiment evaluating genotype and GTE-EGCG prenatal chronic treatment effects before and after treatment discontinuation. Our findings revealed that the Ts65Dn mouse model reflected the pleiotropic nature of DS, exhibiting brachycephalic skull, ventriculomegaly, neurodevelopmental delay, hyperactivity, and impaired memory robustness with altered hippocampal metabolite concentration and gene expression. GTE-EGCG treatment modulated most systems simultaneously but did not rescue DS phenotypes. On the contrary, the treatment exacerbated trisomic phenotypes including body weight, tibia microarchitecture, neurodevelopment, adult cognition, and metabolite concentration, not supporting the therapeutic use of GTE-EGCG as a prenatal chronic treatment. Our results highlight the importance of longitudinal experiments assessing the co-modulation of multiple systems throughout development when characterizing preclinical models in complex disorders and evaluating the pleiotropic effects and general safety of pharmacological treatments.
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Affiliation(s)
- Sergi Llambrich
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Birger Tielemans
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Ellen Saliën
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Marta Atzori
- Department of Human Genetics, KU LeuvenLeuvenBelgium
| | - Kaat Wouters
- Laboratory of Biological Psychology, KU LeuvenLeuvenBelgium
| | | | - Mark Platt
- Centre for Preclinical Imaging, Department of Molecular and Clinical Cancer Medicine, University of LiverpoolLiverpoolUnited Kingdom
| | - Laure Vanherp
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Nuria Gallego Fernandez
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Facultat de Biologia, Universitat de BarcelonaBarcelonaSpain
| | - Laura Grau de la Fuente
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Facultat de Biologia, Universitat de BarcelonaBarcelonaSpain
| | - Harish Poptani
- Centre for Preclinical Imaging, Department of Molecular and Clinical Cancer Medicine, University of LiverpoolLiverpoolUnited Kingdom
| | - Lieve Verlinden
- Clinical and Experimental Endocrinology, KU LeuvenLeuvenBelgium
| | - Uwe Himmelreich
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Anca Croitor
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | | | | | - Willy Gsell
- Biomedical MRI, Department of Imaging and Pathology, KU LeuvenLeuvenBelgium
| | - Neus Martínez-Abadías
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals (BEECA), Facultat de Biologia, Universitat de BarcelonaBarcelonaSpain
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Sánchez‐Moreno B, Zhang L, Mateo G, Moldenhauer F, Brudfors M, Ashburner J, Nachev P, de Asúa DR, Strange BA. Voxel-based dysconnectomic brain morphometry with computed tomography in Down syndrome. Ann Clin Transl Neurol 2024; 11:143-155. [PMID: 38158639 PMCID: PMC10791030 DOI: 10.1002/acn3.51940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/23/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Alzheimer's disease (AD) is a major health concern for aging adults with Down syndrome (DS), but conventional diagnostic techniques are less reliable in those with severe baseline disability. Likewise, acquisition of magnetic resonance imaging to evaluate cerebral atrophy is not straightforward, as prolonged scanning times are less tolerated in this population. Computed tomography (CT) scans can be obtained faster, but poor contrast resolution limits its function for morphometric analysis. We implemented an automated analysis of CT scans to characterize differences across dementia stages in a cross-sectional study of an adult DS cohort. METHODS CT scans of 98 individuals were analyzed using an automatic algorithm. Voxel-based correlations with clinical dementia stages and AD plasma biomarkers (phosphorylated tau-181 and neurofilament light chain) were identified, and their dysconnectomic patterns delineated. RESULTS Dementia severity was negatively correlated with gray (GM) and white matter (WM) volumes in temporal lobe regions, including parahippocampal gyri. Dysconnectome analysis revealed an association between WM loss and temporal lobe GM volume reduction. AD biomarkers were negatively associated with GM volume in hippocampal and cingulate gyri. INTERPRETATION Our automated algorithm and novel dysconnectomic analysis of CT scans successfully described brain morphometric differences related to AD in adults with DS, providing a new avenue for neuroimaging analysis in populations for whom magnetic resonance imaging is difficult to obtain.
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Affiliation(s)
- Beatriz Sánchez‐Moreno
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Linda Zhang
- Alzheimer Disease Research UnitCIEN Foundation, Queen Sofia Foundation Alzheimer CentreMadridSpain
| | - Gloria Mateo
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Mikael Brudfors
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - John Ashburner
- Wellcome Centre for Human NeuroimagingUniversity College LondonLondonUK
| | - Parashkev Nachev
- High‐Dimensional Neurology GroupUniversity College London Queen Square Institute of NeurologyLondonUK
| | - Diego Real de Asúa
- Adult Down Syndrome Unit, Department of Internal MedicineHospital Universitario de La PrincesaMadridSpain
| | - Bryan A. Strange
- Alzheimer Disease Research UnitCIEN Foundation, Queen Sofia Foundation Alzheimer CentreMadridSpain
- Laboratory for Clinical NeuroscienceCTB, Universidad Politécnica de MadridMadridSpain
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Boyd NK, Nguyen J, Khoshnood MM, Jiang T, Nguyen L, Mendez L, Spinazzi NA, Manning MA, Rafii MS, Santoro JD. Hypovitaminosis D in persons with Down syndrome and autism spectrum disorder. J Neurodev Disord 2023; 15:35. [PMID: 37880588 PMCID: PMC10599027 DOI: 10.1186/s11689-023-09503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Plasma levels of vitamin D have been reported to be low in persons with Down syndrome (DS) and existing data is limited to small and homogenous cohorts. This is of particular importance in persons with DS given the high rates of autoimmune disease in this population and the known relationship between vitamin D and immune function. This study sought to investigate vitamin D status in a multi-center cohort of individuals with DS and compare them to individuals with autism spectrum disorder (ASD) and neurotypical (NT) controls. METHODS A retrospective, multi-center review was performed. The three sites were located at latitudes of 42.361145, 37.44466, and 34.05349. Patients were identified by the International Classification of Diseases (ICD)-9 or ICD-10 codes for DS, ASD, or well-child check visits for NT individuals. The first vitamin D 25-OH level recorded in the electronic medical record (EMR) was used in this study as it was felt to be the most reflective of a natural and non-supplemented state. Vitamin D 25-OH levels below 30 ng/mL were considered deficient. RESULTS In total, 1624 individuals with DS, 5208 with ASD, and 30,775 NT controls were identified. Individuals with DS had the lowest mean level of vitamin D 25-OH at 20.67 ng/mL, compared to those with ASD (23.48 ng/mL) and NT controls (29.20 ng/mL) (p < 0.001, 95% CI: -8.97 to -6.44). A total of 399 (24.6%) individuals with DS were considered vitamin D deficient compared to 1472 (28.3%) with ASD and 12,397 (40.3%) NT controls (p < 0.001, 95% CI: -5.43 to -2.36). Individuals with DS with higher body mass index (BMI) were found to be more likely to have lower levels of vitamin D (p < 0.001, 95% CI: -0.3849 to -0.1509). Additionally, having both DS and a neurologic diagnosis increased the likelihood of having lower vitamin D levels (p < 0.001, 95% CI: -5.02 to -1.28). Individuals with DS and autoimmune disease were much more likely to have lower vitamin D levels (p < 0.001, 95% CI: -6.22 to -1.55). Similarly, a history of autoimmunity in a first-degree relative also increased the likelihood of having lower levels of vitamin D in persons with DS (p = 0.01, 95% CI: -2.45 to -0.63). CONCLUSIONS Individuals with DS were noted to have hypovitaminosis D in comparison to individuals with ASD and NT controls. Associations between vitamin D deficiency and high BMI, personal autoimmunity, and familial autoimmunity were present in individuals with DS.
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Affiliation(s)
- Natalie K Boyd
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA
| | | | - Mellad M Khoshnood
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA
| | - Timothy Jiang
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA
| | - Lina Nguyen
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA
| | - Lorena Mendez
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA
| | - Noemi A Spinazzi
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, Oakland, CA, USA
| | - Melanie A Manning
- Department of Genetics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael S Rafii
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Jonathan D Santoro
- Division of Neurology, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA, 90027, USA.
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Svensson M, Ekström M, Sundh J, Ljunggren M, Grote L, Palm A. Adherence to CPAP therapy in Down syndrome: the population-based DISCOVERY study. J Clin Sleep Med 2023; 19:453-458. [PMID: 36458740 PMCID: PMC9978440 DOI: 10.5664/jcsm.10364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 12/04/2022]
Abstract
STUDY OBJECTIVES Persons with Down syndrome (DS) have an increased risk of obstructive sleep apnea (OSA) needing continuous positive airway pressure (CPAP), but data on the therapy and outcomes in this population are scarce. We aimed to compare patient characteristics and outcomes of CPAP treatment for patients with OSA with and without DS. METHODS This was a population-based, longitudinal study on patients initiating CPAP therapy between July 2010 and March 2018 in Sweden and a population-based sex- and age-matched control group (control:case ratio 5:1), with linked data from the Swedish National Patient Registry and the Prescribed Drug Registry (DISCOVERY study cohort). RESULTS Patients with DS (n = 64) had a higher apnea-hypopnea index (51.7 ± 30.3 vs 36.8 ± 29.1 events/h, P < .001), Epworth Sleepiness Scale score (13.7 ± 5.9 vs 11.0 ± 4.9, P = .001), rate of previous surgery of tonsils and/or adenoids (21.9% vs 8.2%, P = .001), and more thyroid replacement hormone therapy (45.3% vs 7.8%, P < .001), but lower use of cardiovascular drugs (7.8% vs 22.3%, P = .003) compared with controls. At follow-up after 1.3 ± 0.9 years, there were no differences in nocturnal CPAP usage time (5.6 ± 2.4 vs 5.5 ± 2.0 hours, P = .77), CPAP adherence ≥ 4 hours/night (62% vs 65%, P = .93), or improvement in Epworth Sleepiness Scale score (-5.4 ± 6.8 vs -5.0 ± 2.0, P = .84) between DS and non-DS patients. CONCLUSIONS OSA severity was substantially higher in patients with DS despite an increased rate of tonsil surgery. Treatment outcomes in terms of adherence and improved daytime sleepiness were comparable between groups, underlining the importance of both OSA diagnosis and treatment in patients with DS. CITATION Svensson M, Ekström M, Sundh J, Ljunggren M, Grote L, Palm A. Adherence to CPAP therapy in Down syndrome: the population-based DISCOVERY study. J Clin Sleep Med. 2023;19(3):453-458.
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Affiliation(s)
- Malin Svensson
- Centre for Research and Development, Uppsala University, Region of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Otorhinolaryngology, Head and Neck Cancer, Uppsala University, Uppsala, Sweden
| | - Magnus Ekström
- Department of Clinical Sciences, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ludger Grote
- Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Sleep and Wake Disorders, Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Andreas Palm
- Centre for Research and Development, Uppsala University, Region of Gävleborg, Gävle Hospital, Gävle, Sweden
- Department of Otorhinolaryngology, Head and Neck Cancer, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Cai W, Baek S. Effects of 24-week basketball programme on body composition and functional fitness on adults with Down syndrome. J Intellect Disabil Res 2022; 66:939-951. [PMID: 35642288 PMCID: PMC9796735 DOI: 10.1111/jir.12951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The body index [body mass, body mass index (BMI), waist circumference and waist-height ratio] and functional fitness (aerobic capacity, muscular strength, balance, flexibility and functional ability) of people with Down syndrome (DS) are substantially lower than those in the general population, as DS has an overall negative impact on health. AIMS This study explored the effect of a 24-week basketball training programme on the body composition and functional fitness of adults with DS. METHODS AND PROCEDURE OUTCOMES Twenty-two adults with DS (24 ± 6 years; 25 ± 4 kg/m2 ) were randomly allocated to the experimental (n = 11, 67.04 kg) and control groups (n = 11, 69.36 kg). The experimental group performed 24 weeks of basketball programme training (3 times per week, 60 min per session), while the control group maintained their daily activities without any special physical training. Body composition and functional fitness parameters were measured before and after the intervention. To evaluate the differences between groups, an analysis of covariance (ANCOVA) was used while controlling for differences at baseline. RESULTS Hip circumference and waist-height ratio were statistically different at baseline between the intervention and control groups. After the 24-week basketball training programme, the results showed significant differences between the exercise and control groups for hip circumference, body mass, BMI, waist circumference, hip circumference, waist-height ratio, flexibility, aerobic capacity, static and dynamic balance, balance and basketball functional ability (P < 0.05). The exercise group showed significant improvements in all variables of body composition and functional fitness (P < 0.05) except for the waist-hip ratio. There was no statistical significance between all physical composition and functional health variables in the control group except for the standing long jump (P > 0.05), with effect sizes ranging from small to large. CONCLUSIONS AND IMPLICATIONS The basketball training programme improved body composition and functional fitness of adults with DS.
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Affiliation(s)
- W. Cai
- School of Physical EducationAnhui Normal UniversityWuhuChina
- Exercise Rehabilitation Research InstituteSangmyung UniversitySeoulKorea
| | - S.‐S. Baek
- Exercise Rehabilitation Research InstituteSangmyung UniversitySeoulKorea
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Fleming V, Piro-Gambetti B, Handen B, Christian BT, Cohen A, Tudorascu D, Plante DT, Okonkwo O, Hartley SL. Physical Activity and Physical and Mental Health in Middle-Aged Adults with Down Syndrome. J Policy Pract Intellect Disabil 2022; 19:408-418. [PMID: 36570324 PMCID: PMC9788305 DOI: 10.1111/jppi.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/27/2022] [Indexed: 12/30/2022]
Abstract
Background Adults with Down syndrome have an increased risk of aging-related physical and mental health conditions and experience them at an earlier age than the general population. There is a need to investigate modifiable lifestyle factors that may reduce risk for these conditions. Method The present study investigated the associations between physical activity (i.e., sedentary behavior and moderate-to-vigorous activity) assessed via accelerometer across 7 days and caregiver-reported physical and mental health of 66 non-demented middle-aged adults with Down Syndrome aged 25-55 years (52% female). Results Regression analyses indicated that more time spent in moderate intensity physical activity was associated with less risk of sleep apnea (b = -.031 p = .004) and endocrine/metabolic conditions (b = -.046 p = .009), and lower total number of physical health conditions (b = -.110 p =.016) and anxiety disorders (b = -.021 p =.049) after controlling for relevant sociodemographics. After also adjusting for BMI, the association between time spent in moderate intensity physical activity and sleep apnea (b=-.035, p = .002), endocrine/metabolic conditions (b=-.033, p = .045) and total physical health (b=-.091, p =.026) remained significant Unexpectedly, time spent in sedentary behavior was negatively associated with musculoskeletal conditions (b=-.017, p = .044). Conclusion Findings indicate important associations between physical activity in everyday life and the physical and mental health of adults with Down syndrome. Social policies and interventions aimed at reducing time spent sitting around (i.e., sedentary behavior) and encouraging moderate-to-vigorous activity may be a low-burden and low-cost mechanism for fostering healthy physical and mental aging in the Down syndrome population.
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Affiliation(s)
- Victoria Fleming
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53706, USA
- School of Human Ecology, University of Wisconsin-Madison, 1300 Linden Dr, Madison, WI 53792, USA
| | - Brianna Piro-Gambetti
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53706, USA
- School of Human Ecology, University of Wisconsin-Madison, 1300 Linden Dr, Madison, WI 53792, USA
| | - Benjamin Handen
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Bradley T Christian
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53706, USA
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Annie Cohen
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Dana Tudorascu
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - David T Plante
- University of Wisconsin-Madison, Department of Psychiatry, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Ozioma Okonkwo
- University of Wisconsin-Madison, Department of Medicine, 1685 Highland Ave, Madison, WI 53705, USA
| | - Sigan L Hartley
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53706, USA
- School of Human Ecology, University of Wisconsin-Madison, 1300 Linden Dr, Madison, WI 53792, USA
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Aparicio P, Barba R, Moldenhauer F, Suárez C, Real de Asúa D. What brings adults with Down syndrome to the hospital? A retrospective review of a Spanish cohort between 1997 and 2014. Research Intellect Disabil 2022; 36:143-152. [DOI: 10.1111/jar.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Raquel Barba
- Department of Internal Medicine Hospital Universitario Rey Juan Carlos Madrid Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine Hospital Universitario de la Princesa Madrid Spain
| | - Carmen Suárez
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine Hospital Universitario de la Princesa Madrid Spain
| | - Diego Real de Asúa
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine Hospital Universitario de la Princesa Madrid Spain
- Down Syndrome Medical Interest Group‐USA (DSMIG‐USA)
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Akoto T, Li JJ, Estes AJ, Karamichos D, Liu Y. The Underlying Relationship between Keratoconus and Down Syndrome. Int J Mol Sci 2022; 23:ijms231810796. [PMID: 36142709 PMCID: PMC9503764 DOI: 10.3390/ijms231810796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.
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Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Jiemin J. Li
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2015
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11
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Ortega Junco E, Quiroga B. Kidney-vascular-bone axis in down syndrome. Nefrologia 2022; 42:363-366. [PMID: 36396571 DOI: 10.1016/j.nefroe.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 06/16/2023] Open
Affiliation(s)
- Esther Ortega Junco
- Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain.
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12
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Ortega Junco E, Quiroga B. El eje riñón-vaso-hueso en el síndrome de Down. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Wagemann O, Loosli SV, Vöglein J, Prix C, Wlasich E, Nübling G, Danek A, Levin J. [Regression in Young Adults with Down-Syndrome: A Case Series]. Fortschr Neurol Psychiatr 2022; 90:465-470. [PMID: 35405744 DOI: 10.1055/a-1743-2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Regression in young adults with Down syndrome can present itself with an acute loss of acquired skills and change in behavior. The aim of our case series was to describe the heterogeneous clinical presentation of this syndrome as well as accompanying diagnostic and therapeutic challenges and consequences. METHODS All three patients were assessed with the CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down Syndrome and Others with Intellectual Disabilities) and the criteria published by the DSMIG-USA (Down-Syndrome Medical Interest Group USA). RESULTS After ruling out somatic or other psychiatric causes, the application of the DSMIG-USA criteria resulted in diagnosing at least a probable unexplained regression in all three patients. DISCUSSION The thorough diagnostic investigation of unexplained acute regression in young adults with Down syndrome allows for quick initiation of therapeutic and supportive measures. Using the DMSIG-USA criteria facilitates the assessment of the underlying diffuse and heterogenous pathology.
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Affiliation(s)
- Olivia Wagemann
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen Standort München, München, Germany
| | - Sandra V Loosli
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany
| | - Jonathan Vöglein
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen Standort München, München, Germany
| | - Catharina Prix
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen Standort München, München, Germany
| | - Elisabeth Wlasich
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany
| | - Georg Nübling
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen Standort München, München, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, München, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen Standort München, München, Germany
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14
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Escribano Lopez P, Porto Castro S, Garrido Ceca G. Immediate sequential bilateral cataract surgery in adults with Down's syndrome. Int Ophthalmol 2022. [PMID: 35355167 DOI: 10.1007/s10792-022-02285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the cataract surgery outcomes in 34 adult patients with Down's syndrome in our center between 1996 and 2019. SETTING Clinical practice, tertiary hospital in Madrid, Spain. DESIGN Retrospective, descriptive study in which 34 patients with Down's syndrome who underwent cataract surgery in our center between 1996 and 2019 were included. METHODS Socio-demographic and clinical data such as the type of cataract, the keratometry and biometry, the type of surgery, the IOL material, and the complications before and after surgery were recovered. RESULTS Fifty-four eyes of 34 patients (23 female, 11 male, mean age 49 ± 8 years) underwent cataract surgery with general anesthesia. Immediately sequential, bilateral cataract surgery was performed in 18 patients (90% of bilateral cases). White cataract was found in 11 eyes (20.4%). Phacoemulsification technique was used in 51 eyes, extracapsular technique in 2 eyes (3.7%), and intracapsular technique in 1 eye (1.85%) (the only aphakic eye after surgery). The mean Km was 48.73 ± 4D, and the mean axial length was 25.2 ± 2.5 mm. The most frequent ocular comorbidity was myopia (27 eyes, 50%) followed by strabismus (11 eyes, 20.4%) and keratoconus (10 eyes, 18.5%). Posterior capsular rupture as a complication during surgery was found in 3 eyes (5.5%). The mean preoperative visual acuity was 0.8 ± 0.2 logMAR, and the mean postoperative visual acuity was 0.5 ± 0.18 logMAR. CONCLUSIONS Phacoemulsification technique can be performed in adults with Down's syndrome with an acceptable rate of complications. The lack of patient cooperation, the ocular comorbidities and the challenging biometric estimation must be considered in surgical planning. It seems reasonable to perform immediately sequential, bilateral cataract surgery when possible, in order to reduce the exposure to general anesthesia.
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15
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Zhang Y, Tian Z, Ye S, Mu Q, Wang X, Ren S, Hou X, Yu W, Guo J. Changes in bone mineral density in Down syndrome individuals: a systematic review and meta-analysis. Osteoporos Int 2022; 33:27-37. [PMID: 34383099 DOI: 10.1007/s00198-021-06070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Data evaluating changes in bone mineral density (BMD) in Down syndrome (DS) individuals remains controversial. Therefore, we conducted a systematic review and meta-analysis to better understand associations between BMD and DS. A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library up until 1st January 2021 was conducted. We used the keywords "bone mineral density" and "Down Syndrome." Fifteen studies were included. Overall, our results showed a significant decrease in BMD of total body (TB BMD) [MD = - 0.18; 95% CI (- 0.23 and - 0.12), P < 0.00001, I2 = 89%], total hip (TH BMD) [MD = - 0.12; 95% CI (- 0.15 and - 0.10), P < 0.00001, I2 = 0%], lumbar spine (LS BMD) [MD = - 0.12; 95% CI (- 0.14 and - 0.09), P < 0.00001, I2 = 18%], and femoral neck (FN BMD) [MD = - 0.08; 95% CI (- 0.10 and - 0.06), P < 0.00001, I2 = 0%] in DS individuals when compared with controls. Moreover, the volumetric BMD of lumbar spine (LS vBMD) [MD = - 0.01; 95% CI (- 0.02 and - 0.01), P = 0.0004, I2 = 19%] also showed a decreasing tendency while the volumetric BMD of the femoral neck (FN vBMD) [MD = 0.01; 95% CI (0.00 and 0.02), P = 0.02, I2 = 0%] was elevated in DS individuals versus controls. These findings demonstrated that individuals with DS had a decreased total and regional (TH, LS, and FN) BMD when compared with the general population. Additionally, when BMD was adjusted for skeletal volume, LS vBMD was also lower, while FN vBMD was elevated in DS individuals versus controls.
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Affiliation(s)
- Y Zhang
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Z Tian
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ye
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Q Mu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - X Wang
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ren
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - X Hou
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - W Yu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China.
| | - J Guo
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China.
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16
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Rosenberg AGW, Pater MRA, Pellikaan K, Davidse K, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, van Eeghen A, Veen JMC, van der Meulen JJ, van Aalst-van Wieringen N, Hoekstra FME, van der Lely AJ, de Graaff LCG. What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of 'Internal Medicine for Rare Genetic Syndromes'. J Clin Med 2021; 10:jcm10225457. [PMID: 34830739 PMCID: PMC8622899 DOI: 10.3390/jcm10225457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Minke R. A. Pater
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | | | - Rogier Kersseboom
- Stichting Zuidwester, 3241 LB Middelharnis, The Netherlands; (A.A.K.-M.); (R.K.)
| | - Anja G. Bos-Roubos
- Center of Excellence for Neuropsychiatry, Vincent van Gogh, 5803 DN Venray, The Netherlands;
| | - Agnies van Eeghen
- ‘s Heeren Loo, Care Group, 3818 LA Amersfoort, The Netherlands;
- Department of Pediatrics, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - José M. C. Veen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Jiske J. van der Meulen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Nina van Aalst-van Wieringen
- Department of Physical Therapy, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Franciska M. E. Hoekstra
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Department of Internal Medicine, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- ENCORE—Dutch Center of Reference for Neurodevelopmental Disorders, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Turner Syndrome, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Disorders of Sex Development, 3015 GD Rotterdam, The Netherlands
- Correspondence:
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17
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Wentworth AB, Hand JL, Davis DM, Tollefson MM. Skin concerns in patients with trisomy 21 (Down syndrome): A Mayo Clinic 22-year retrospective review. Pediatr Dermatol 2021; 38 Suppl 2:73-78. [PMID: 34409638 DOI: 10.1111/pde.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES Trisomy 21 has known associated clinical phenotypes, including skin and soft tissue concerns. However, the overall prevalence and types of findings are largely unclear. METHODS A retrospective review of children with trisomy 21 and one or more dermatologic diagnoses, seen from 1/1/1994 to 7/1/2016, was performed to record dermatologic diagnoses. If one or more diagnoses were confirmed, further data were collected, including demographics, medical specialty, referrals to dermatology, treatment, complications, and follow-up. RESULTS One hundred and seventy-four patients with a diagnosis of trisomy 21 aged 18 years or younger were confirmed to have one or more dermatologic diagnoses. In a total of 479 dermatologic diagnoses, superficial mycoses (12%), skin and soft tissue infections (10%), dermatitis (8%), and folliculitis (8%) were most common. Diagnoses were most commonly made as an outpatient (91%) and by general pediatrics (45%) or dermatology (25%). A significant difference (P < .05) in the frequency of various diagnoses made by different specialties was observed. A significant difference (P < .05) in the treatments recommended by different specialties was also observed. Referrals to dermatology were infrequent (6%). However, a frequent change in diagnosis (61%) or treatment (68%) for patients referred to dermatology was observed. CONCLUSIONS Children with trisomy 21 are most commonly diagnosed with superficial mycoses, skin and soft tissue infections, dermatitis, and folliculitis. The majority of diagnoses were made by general pediatricians and although dermatology referral was rarely necessary, consultations often resulted in change of diagnosis and/or treatment, supporting consideration of early and frequent dermatology referral.
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Affiliation(s)
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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18
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Fleming V, Piro-Gambetti B, Bazydlo A, Zammit M, Alexander AL, Christian BT, Handen B, Plante DT, Hartley SL. Sleep and White Matter in Adults with Down Syndrome. Brain Sci 2021; 11:1322. [PMID: 34679387 PMCID: PMC8533851 DOI: 10.3390/brainsci11101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Adults with Down syndrome are at a high risk for disordered sleep. These sleep problems could have marked effects on aging and Alzheimer's disease, potentially altering white matter integrity. This study examined the associations between disordered sleep assessed via an actigraph accelerometer worn on 7 consecutive nights, presence of diagnosis of obstructive sleep apnea, and diffusion tensor imaging indices of white matter integrity in 29 non-demented adults with Down Syndrome (48% female, aged 33-54 years). Average total sleep time was associated with lower mean diffusivity in the left superior longitudinal fasciculus (r = -0.398, p = 0.040). Average sleep efficiency, length of awakenings, and movement index were related to fractional anisotropy in the right inferior longitudinal fasciculus (r = -0.614 to 0.387, p ≤ 0.050). Diagnosis of obstructive sleep apnea was associated with fractional anisotropy in the right inferior longitudinal fasciculus (r = -0.373, p = 0.050). Findings suggest that more disrupted sleep is associated with lower white matter integrity in the major association tracts in middle-aged adults with Down syndrome. Longitudinal work is needed to confirm the directionally of associations. Sleep interventions could be an important component for promoting optimal brain aging in the Down syndrome population.
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Affiliation(s)
- Victoria Fleming
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Brianna Piro-Gambetti
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Austin Bazydlo
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Matthew Zammit
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Bradley T. Christian
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - David T. Plante
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Sigan L. Hartley
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
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19
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Costa R, de Asúa DR, Gullón A, De Miguel R, Bautista A, García C, Roy E, García-Vadillo JA, Suárez C, Moldenhauer F, Castañeda S. Volumetric BMD by 3D-DXA and Trabecular Bone Score in Adults With Down Syndrome. J Clin Densitom 2021; 24:630-637. [PMID: 33618949 DOI: 10.1016/j.jocd.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 01/24/2023]
Abstract
Adults with Down syndrome (DS) have lower bone mineral density (BMD) than the general population. The objective of our study was to describe bone mineral status in DS population through volumetric BMD (vBMD) and trabecular bone score (TBS). Retrospective study of 297 subjects recruited from the Adult DS Outpatient Clinic of a tertiary care hospital in Spain, who underwent a bone densitometry for clinical purposes between January 2010 and June 2015. vBMD determination and TBS analysis on conventional DXA (Hologic QDR 4500) densitometer were performed in this cohort. The mean (±SD) age of our population was 34.3 (±10.9) years; 51% were women. Trabecular vBMD at total hip and femoral neck was lower in males than in females (191.7 ± 48.4 mg/cm3 vs 206.9 ± 46.7 mg/cm3, p = 0.007, and 250.5 ± 70.1 mg/cm3 vs 275.7 ± 66.2 mg/cm3, p = 0.002, respectively). Trabecular and cortical vBMD decreased with age, but age decline in trabecular vBMD was more pronounced in males. Likewise, lumbar TBS declined with age being normal in 63%, low in 29% and very low in 8% of subjects with DS, without differences between sexes. TBS showed a positive correlation (r = 0.37; p < 0.001, Kappa index= 0.275) with conventional DXA lumbar Z-score. vBMD at the hip showed lower values in DS subjects than in the general population, especially in males. Moreover, TBS was also lower at lumbar spine. Therefore, both assessments could be used as complementary tools to areal BMD (Z-score) to assess bone status in DS subjects.
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Affiliation(s)
- Ramón Costa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - Diego Real de Asúa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Alejandra Gullón
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa De Miguel
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Azucena Bautista
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara García
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Emilia Roy
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Jesús A García-Vadillo
- Department of Rheumatology, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Santos Castañeda
- Department of Rheumatology, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid (UAM), Spain
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20
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Abstract
Purpose Keratoconus is a vision-threatening condition, and there is a need for knowledge about the occurrence in subgroups of the population. The progression of the disease can be effectively stopped, and vision may be restored, if keratoconus is diagnosed at an early stage. The purpose of this review was to evaluate the literature of the prevalence of keratoconus in persons with Down syndrome. Methods We conducted a literature review of keratoconus prevalence in persons with Down syndrome. A thorough search was performed in Pubmed (Medline), and the quality of evidence was evaluated. Results The literature review identified 20 relevant studies, which reported keratoconus in 0%–71% of persons with Down syndrome. These studies varied greatly in design, patient selection, sample sizes and mean age, and the quality of evidence concerning estimates for the prevalence of keratoconus was generally evaluated as low. Most studies that included adults reported high prevalences of keratoconus–in many studies more than 10-fold the prevalence in the general population. No large screening studies in persons with Down syndrome were identified. Conclusions The present review showed that the prevalence of keratoconus in persons with Down syndrome is higher than in the general population. However, estimates from previous studies vary widely. Screening for keratoconus in this group should be considered.
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Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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21
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Marentette JO, Anderson CC, Prutton KM, Jennings EQ, Rauniyar AK, Galligan JJ, Roede JR. Trisomy 21 impairs PGE2 production in dermal fibroblasts. Prostaglandins Other Lipid Mediat 2021; 153:106524. [PMID: 33418267 DOI: 10.1016/j.prostaglandins.2020.106524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/03/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Abstract
The triplication of human chromosome 21 results in Down syndrome (DS), the most common genetic form of intellectual disability. This aneuploid condition also results in an enhanced risk of a spectrum of comorbid conditions, such as leukemia, early onset Alzheimer's disease, and diabetes. Individuals with DS also display an increased incidence of wound healing complications and resistance to solid tumor development. Due to this unique phenotype and the involvement of eicosanoids in key comorbidities like poor healing and tumor development, we hypothesized that cells from DS individuals would display altered eicosanoid production. Using age- and sex-matched dermal fibroblasts we interrogated this hypothesis. Briefly, assessment of over 90 metabolites derived from cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome p450 systems revealed a possible deficiency in the COX system. Basal gene expression and Western blotting experiments showed significantly decreased gene expression of COX1 and 2, and COX2 protein abundance in DS fibroblasts compared to euploid controls. Further, using two different stressors, scratch wound or LPS, we found that DS fibroblasts could not upregulate COX2 abundance and prostaglandin E2 production. Together, these findings show that dermal fibroblasts from DS individuals have a deficient COX2 response, which may contribute to wound healing complications and tumor resistance in DS.
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Affiliation(s)
- John O Marentette
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, USA; Linda Crnic Institute for Down Syndrome, Aurora, Colorado, USA
| | - Colin C Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, USA; Linda Crnic Institute for Down Syndrome, Aurora, Colorado, USA
| | - Kendra M Prutton
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, USA; Linda Crnic Institute for Down Syndrome, Aurora, Colorado, USA
| | - Erin Q Jennings
- Skaggs School of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Abhishek K Rauniyar
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, USA; Linda Crnic Institute for Down Syndrome, Aurora, Colorado, USA
| | - James J Galligan
- Skaggs School of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - James R Roede
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, USA; Linda Crnic Institute for Down Syndrome, Aurora, Colorado, USA.
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22
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Wang S, Wang Y, Qiu K, Zhu J, Wu Y. RCAN1 in cardiovascular diseases: molecular mechanisms and a potential therapeutic target. Mol Med 2020; 26:118. [PMID: 33267791 PMCID: PMC7709393 DOI: 10.1186/s10020-020-00249-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Considerable efforts are needed to elucidate the underlying mechanisms for the prevention and treatment of CVDs. Regulator of calcineurin 1 (RCAN1) is involved in both development/maintenance of the cardiovascular system and the pathogenesis of CVDs. RCAN1 reduction protects against atherosclerosis by reducing the uptake of oxidized low-density lipoproteins, whereas RCAN1 has a protective effect on myocardial ischemia/reperfusion injury, myocardial hypertrophy and intramural hematoma/aortic rupture mainly mediated by maintaining mitochondrial function and inhibiting calcineurin and Rho kinase activity, respectively. In this review, the regulation and the function of RCAN1 are summarized. Moreover, the dysregulation of RCAN1 in CVDs is reviewed. In addition, the beneficial role of RCAN1 reduction in atherosclerosis and the protective role of RCAN1 in myocardial ischemia/reperfusion injury, myocardial hypertrophy and intramural hematoma /aortic rupture are discussed, as well as underlying mechanisms. Furthermore, the therapeutic potential and challenges of targeting RCAN1 for CVDs treatment are also discussed.
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Affiliation(s)
- Shuai Wang
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China
| | - Yuqing Wang
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Cheeloo College of Medicine, Shandong University, Wenhua West Road No. 44, Lixia District, JinanShandong, 250012, China
| | - Kaixin Qiu
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Cheeloo College of Medicine, Shandong University, Wenhua West Road No. 44, Lixia District, JinanShandong, 250012, China
| | - Jin Zhu
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China
| | - Yili Wu
- Shandong Collaborative Innovation Center for Diagnosis, Treatment and Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China. .,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jianshe South Road No. 45, Rencheng District, Jining, 272013, Shandong, China.
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23
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Aparicio P, Barba R, Moldenhauer F, Suárez C, Real de Asúa D. Characteristics of adults with Down syndrome hospitalised in Spanish internal medicine departments during 2005-2014. Rev Clin Esp 2020; 220:553-560. [PMID: 31837747 DOI: 10.1016/j.rce.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/18/2019] [Accepted: 11/09/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The clinical problems of adults with Down syndrome seem to differ from those of the general population. To better understand these differences, we list the demographic and clinical characteristics of adults with Down syndrome admitted to Spanish internal medicine departments during 2005-2014. PATIENTS AND METHODS We conducted an observational retrospective study using data collected from the minimum basic data set on hospitalisation episodes of adults with Down syndrome in the internal medicine departments of Spain's National Health System from 2005 to 2014. We analysed the patients' epidemiological, clinical and societal data. RESULTS A total of 7548 hospitalisation episodes from 3786 patients were recorded. Some 56.6% of the patients were male with a mean age (±SD) of 47±13 years, and 715 of the patients died (18.9%). The age-adjusted mortality was 26.6%, and the mean stay was 9.6±12 days. The hospitalisation was for respiratory disease in 3684 episodes (48.8%) and for cardiac origin in 760 (10%). The most common comorbidities were hypothyroidism (27.1%, 2043 episodes), epilepsy (24.1%, 1819 episodes) and dementia (15.4%, 1162 episodes). CONCLUSIONS The hospitalisation of adults with Down syndrome in internal medicine departments has increased in the past decade. Although the reasons for hospitalisation, mean stay and cost per episode for this population are similar to those of the general population treated by internal medicine departments, the age-adjusted hospital mortality was significantly greater.
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Affiliation(s)
- P Aparicio
- Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Madrid, España.
| | - R Barba
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles (Madrid), España; Grupo de Trabajo de Gestión Clínica, Sociedad Española de Medicina Interna, Madrid, España; Universidad Rey Juan Carlos, Móstoles (Madrid), España
| | - F Moldenhauer
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España; Universidad Autónoma de Madrid, Madrid, España
| | - C Suárez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España; Universidad Autónoma de Madrid, Madrid, España
| | - D Real de Asúa
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España; Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, Nueva York, Estados Unidos
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24
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Aparicio P, Barba R, Moldenhauer F, Suárez C, Real de Asúa D. Characteristics of adults with Down syndrome hospitalized in Spanish internal medicine departments during 2005–2014. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Del Hoyo Soriano L, Rosser T, Hamilton D, Wood T, Abbeduto L, Sherman S. Gestational age is related to symptoms of attention-deficit/hyperactivity disorder in late-preterm to full-term children and adolescents with down syndrome. Sci Rep 2020; 10:20345. [PMID: 33230240 DOI: 10.1038/s41598-020-77392-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
Attention-deficit/hyperactivity disorder is frequently reported in individuals with Down syndrome, with considerable variation in the expression and severity of the symptoms. Despite growing evidence that gestational age predicts later symptoms of attention-deficit/hyperactivity disorder in the euploid population, this has not been studied in down syndrome. The current study is designed to investigate the influence of gestational age in later symptoms of attention-deficit/hyperactivity disorder in 105 individuals (49 males and 56 females; aged 6–18 years) with Down syndrome who were born at or after 35 weeks gestation. Maternal age at birth, maternal level of education, household income, as well as sex, chronological age, and cognitive level of the participant with Down syndrome were considered in our analysis. Results from this study show that gestational age is related to inattentive and hyperactive/impulsive symptoms in children and adolescents with Down syndrome. Therefore, gestational age should be addressed when considering symptoms of attention-deficit/hyperactivity disorder, as it may have implications for early interventions. More attention is needed toward the advancement of care and follow-up for infants with down syndrome who are born even late preterm or early term.
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26
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Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, Martin BA, McGuire DE, McKelvey KD, Peterson M, Tyler C, Wells M, Whitten MS. Medical Care of Adults With Down Syndrome: A Clinical Guideline. JAMA 2020; 324:1543-1556. [PMID: 33079159 DOI: 10.1001/jama.2020.17024] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. OBJECTIVE To develop an evidence-based clinical practice guideline for adults with Down syndrome. EVIDENCE REVIEW The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. FINDINGS From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. CONCLUSIONS AND RELEVANCE These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.
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Affiliation(s)
- Amy Y Tsou
- Evidence-Based Practice Center, ECRI Center for Clinical Excellence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Peter Bulova
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois
| | - Bryn Gelaro
- Global Down Syndrome Foundation, Denver, Colorado
| | - Terry Odell Harville
- Division of Hematology, Department of Pathology and Laboratory Services, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Barry A Martin
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Center, Aurora
| | | | | | - Moya Peterson
- University of Kansas Medical Center Schools of Nursing and Medicine, Kansas City
| | - Carl Tyler
- Developmental Disabilities-Practice-Based Research Network, Cleveland, Ohio
- Family Medicine and Community Health, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael Wells
- Developmental Disabilities-Practice-Based Research Network, Cleveland, Ohio
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27
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Santoro SL, Chicoine B, Jasien JM, Kim JL, Stephens M, Bulova P, Capone G. Pneumonia and respiratory infections in Down syndrome: A scoping review of the literature. Am J Med Genet A 2020; 185:286-299. [PMID: 33073471 DOI: 10.1002/ajmg.a.61924] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/14/2020] [Accepted: 09/26/2020] [Indexed: 12/15/2022]
Abstract
Pneumonia and respiratory infections impact infants and children with Down syndrome; pneumonia is a leading cause of mortality in adults with Down syndrome. We aimed to review the literature to evaluate gaps and address key questions. A series of key questions were formulated a priori to inform the search strategy and review process; addressed prevalence, severity, etiology, risk factors, preventive methods, screening, and financial costs, potential benefits or harms of screening. Using the National Library of Medicine database, PubMed, detailed literature searches on pneumonia and respiratory infections in Down syndrome were performed. Previously identified review articles were also assessed. The quality of available evidence was then evaluated and knowledge gaps were identified. Forty-two relevant original articles were identified which addressed at least one key question. Study details including research design, internal validity, external validity, and relevant results are presented. Pneumonia and respiratory infections are more prevalent and more severe in individuals with Down syndrome compared to healthy controls through literature review, yet there are gaps in the literature regarding the etiology of pneumonia, the infectious organism, risk factors for infection, and to guide options for prevention and screening. There is urgent need for additional research studies in Down syndrome, especially in the time of the current COVID-19 pandemic.
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Affiliation(s)
- Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois, USA
| | - Joan M Jasien
- Division of Child Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Judy Lu Kim
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Stephens
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter Bulova
- Division of General Internal Medicine, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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28
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Boer PH. The effect of 8 weeks of freestyle swim training on the functional fitness of adults with Down syndrome. J Intellect Disabil Res 2020; 64:770-781. [PMID: 32808345 DOI: 10.1111/jir.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/27/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Studies conducted on adults with Down syndrome have demonstrated the improvement of functional fitness (aerobic capacity, muscular strength, balance, flexibility, functional ability, body mass or body mass index) with varying exercise modalities but often with one or two components in isolation. Such modalities included walking, running, cycling, rowing or resistance training. Freestyle swim training has shown significant improvements of all parameters associated with functional fitness in the general population. Swimming is an aerobic activity where many of the large muscle groups are involved and may provide more functional fitness benefits. As a consequence, the purpose of our study was to investigate the effect of freestyle swim training on the functional fitness of adults with Down syndrome. METHODS Twenty-six adults with Down syndrome (33 ± 6 years; 34 ± 9 kg/m2 ) were randomly allocated to an exercise (n = 13; 81.3 kg) or control group (n = 13; 81.5 kg). The exercise group performed 8 weeks of freestyle swim training, three times a week, 30 min per session (increased to 40 min after 4 weeks). To evaluate differences between groups, a one-way analysis of variance was used, controlling for differences at baseline. RESULTS After 8 weeks of training, the results showed significant differences between the exercise and control group for body mass, body mass index, aerobic capacity, dynamic balance, muscular strength, 12-m swim time and functional ability (P < 0.05). Effect sizes ranged from small to large. CONCLUSIONS Various components of functional fitness improved significantly after an intervention period of freestyle swim training. The collective improvement of many functional fitness parameters shown by this study may hold benefits for these often-neglected and in many cases functionally impaired individuals.
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Affiliation(s)
- P H Boer
- Department of Human Movement Science, Faculty of Education, Cape Peninsula University of Technology, Wellington, South Africa
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29
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Bermudez BEBV, de Souza do Amaral ME, da Silva Gomes C, Novadzki IM, de Oliveira CM, Serpe CC. Ophthalmological abnormalities in Down syndrome among Brazilian patients. Am J Med Genet A 2020; 182:2641-2645. [PMID: 32945116 DOI: 10.1002/ajmg.a.61845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/16/2020] [Accepted: 08/01/2020] [Indexed: 11/09/2022]
Abstract
Down syndrome is the most common chromosomal disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of visual disorders that, if left untreated, can negatively affect child development. The aim of this study was to determine the prevalence of ophthalmological findings among patients who attended an outpatient clinic for patients with Down syndrome in southern Brazil between 2005 and 2016. A cross-sectional study including 1,207 patients medical records were done, which 492 (40.8%) had some ophthalmological disorder. These data were subjected to descriptive analysis using Statistica software. Among the 492 patients with any ophthalmological disease, the need for glasses was found in 434 (36%) patients, keratoconus in 254 (42.1%), congenital cataract in 27 (15.1%), nasolacrimal duct obstruction in 25 (2.0%), strabismus in 22 (1.9%), nystagmus in four (0.3%), and juvenile cataract in two (0.2%). Two young adults with keratoconus underwent corneal transplantation. Although the prevalence of an ophthalmological disease among the present sample (40.8%) was lower than described in the current literature, it still reinforced the importance of routine and early evaluations in infants. These should begin at 6 months of age and be repeated half-year until 2 years old, annually until 7 years old, biennial in adolescents, and triennial in adults and elderly. Our findings of a high frequency of keratoconus support a detailed corneal study in such patients for early detection and treatment.
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Affiliation(s)
- Beatriz Elizabeth Bagatin Veleda Bermudez
- Down Syndrome Outpatient Clinic, Federal University of Paraná, Paraná, Brazil.,Integrated Medicine Department, Federal University of Paraná Curitiba, Paraná, Brazil
| | | | | | | | - Camila Maciel de Oliveira
- Integrated Medicine Department, Federal University of Paraná Curitiba, Paraná, Brazil.,Researcher at Global Co-Creation Lab, MIT, Boston, Massachusetts, USA
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30
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Mathan JJ, Gokul A, Simkin SK, Meyer JJ, Patel DV, McGhee CNJ. Topographic screening reveals keratoconus to be extremely common in Down syndrome. Clin Exp Ophthalmol 2020; 48:1160-1167. [DOI: 10.1111/ceo.13852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Joyce J. Mathan
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Samantha K. Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Jay J. Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Dipika V. Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
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31
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Roy-Vallejo E, Galván-Román JM, Moldenhauer F, Real de Asúa D. Adults with Down syndrome challenge another paradigm: When aging no longer entails arterial hypertension. J Clin Hypertens (Greenwich) 2020; 22:1127-1133. [PMID: 32644285 DOI: 10.1111/jch.13930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/09/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Abstract
The paradigmatic relationship between aging and atherosclerotic cardiovascular events does not apply to all patient populations. Though trisomy 21 (T21) and its phenotypic expression, Down syndrome (DS), are conditions that involve premature aging, the cardiovascular system of adults with DS appears to be particularly spared from this early senescence. Despite a higher prevalence of some classic cardiovascular risk factors in adults with DS than in the general population, such as dyslipidemia, obesity, or sedentarism, these individuals do not develop hypertension or suffer major cardiovascular events as they age. The protective factors that prevent the development of hypertension in T21 are not well established. Genes like RCAN1 and DYRK1A, both on chromosome 21 and over-expressed in adults with DS, appear to play a major role in cardiovascular prevention. Their regulation of the renin-angiotensin-aldosterone system (RAAS) and neprilysin synthesis could underlie the constitutive protection against arterial hypertension in adults with DS and explain the absence of increased arterial stiffness in this population. A better understanding of these molecular pathways could have enormous implications for the clinical management of adults with DS and might foster the development of novel therapeutic targets in cardiovascular prevention for the general population.
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Affiliation(s)
- Emilia Roy-Vallejo
- Adult Down Syndrome Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - José María Galván-Román
- Adult Down Syndrome Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Adult Down Syndrome Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
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Roy-Vallejo E, Alonso E, Galván-Román J, Ibañez P, Moldenhauer F, Suárez Fernández C, Real de Asúa D. Hemodynamic profile of Spanish adults with Down syndrome. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Carfì A, Romano A, Zaccaria G, Villani ER, Manes Gravina E, Vetrano DL, Bernabei R, Onder G. The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome. Am J Med Genet A 2020; 182:1735-1743. [PMID: 32449279 DOI: 10.1002/ajmg.a.61636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
Data on clinical characteristics of adults with Down syndrome (DS) are limited and the clinical phenotype of these persons is poorly described. This study aimed to describe the occurrence of chronic diseases and pattern of medication use in a population of adults with DS. Participants were 421 community dwelling adults with DS, aged 18 years or older. Individuals were assessed through a standardized clinical protocol. Multimorbidity was defined as the occurrence of two or more chronic conditions and polypharmacy as the concomitant use of five or more medications. The mean age of study participants was 38.3 ± 12.8 years and 214 (51%) were women. Three hundred and seventy-four participants (88.8%) presented with multimorbidity. The most prevalent condition was visual impairment (72.9%), followed by thyroid disease (50.1%) and hearing impairment (26.8%). Chronic diseases were more prevalent among participants aged >40 years. The mean number of medications used was 2.09 and polypharmacy was observed in 10.5% of the study sample. Psychotropic medications were used by a mean of 0.7 individuals of the total sample. The high prevalence of multimorbidity and the common use of multiple medications contributes to a high level of clinical complexity, which appears to be similar to the degree of complexity of the older non-trisomic population. A comprehensive and holistic approach, commonly adopted in geriatric medicine, may provide the most appropriate care to persons with DS as they grow into adulthood.
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Affiliation(s)
- Angelo Carfì
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Allegra Romano
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Zaccaria
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rocco Villani
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ester Manes Gravina
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Liborio Vetrano
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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Capone G, Stephens M, Santoro S, Chicoine B, Bulova P, Peterson M, Jasien J, Smith AJ. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II. Am J Med Genet A 2020; 182:1832-1845. [PMID: 32338447 DOI: 10.1002/ajmg.a.61604] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co-occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk-factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The creation of evidence-based clinical guidance for this population will not be possible until these gaps are addressed.
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Affiliation(s)
- George Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Mary Stephens
- Adult Down Syndrome Clinic, Christiana Care Health System, Wilmington, Delaware, USA
| | | | - Brian Chicoine
- Lutheran General Hospital, Advocate Adult Down Syndrome Center, Park Ridge, Illinois, USA
| | - Peter Bulova
- Adult Down Syndrome Clinic, Montefiore Hospital, Pittsburgh, Pennsylvania, USA
| | - Moya Peterson
- Adults with Down Syndrome Specialty Clinic, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Joan Jasien
- Department of Pediatrics and Child Neurology, Lenox Baker Children's Hospital, Durham, North Carolina, USA
| | - Anna Jo Smith
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Hussain R, Wark S, Janicki MP, Parmenter T, Knox M. Multimorbidity in older people with intellectual disability. J Appl Res Intellect Disabil 2020; 33:1234-1244. [PMID: 32307771 DOI: 10.1111/jar.12743] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. METHODS A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. RESULTS Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). CONCLUSIONS There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.
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Affiliation(s)
- Rafat Hussain
- Australian National University, Canberra, ACT, Australia
| | - Stuart Wark
- University of New England, Armidale, NSW, Australia
| | | | | | - Marie Knox
- University of Sydney, Sydney, NSW, Australia
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Xicota L, Rodríguez J, Langohr K, Fitó M, Dierssen M, de la Torre R. Effect of epigallocatechin gallate on the body composition and lipid profile of down syndrome individuals: Implications for clinical management. Clin Nutr 2020; 39:1292-1300. [DOI: 10.1016/j.clnu.2019.05.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/29/2022]
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Ferrari G, Rama P. The keratoconus enigma: A review with emphasis on pathogenesis. Ocul Surf 2020; 18:363-373. [PMID: 32234342 DOI: 10.1016/j.jtos.2020.03.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the literature on the etiopathogenesis of keratoconus (KC). METHODS A literature search was conducted using PUBMED and Google Scholar for keratoconus. The authors analyzed epidemiology studies, reviews, and case reports. RESULTS Atopy and ocular surface inflammation are a common features of KC and should lead to a reconsideration of the traditional definition of KC as a "non inflammatory" condition. Co-morbidities suggest that KC may be the ocular manifestation of a systemic disease. Finally, KC shows higher prevalence in certain ethnicities, which calls into question the status of KC as a rare disease, at least in these communities. CONCLUSION We believe that future studies should test whether selected, high prevalence populations exhibit specific genetic background and/or ethno-specific environmental risk factors.
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Affiliation(s)
- Giulio Ferrari
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy.
| | - Paolo Rama
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy
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38
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Roy-Vallejo E, Alonso E, Galván-Román JM, Ibañez P, Moldenhauer F, Suárez Fernández C, Real de Asúa D. Haemodynamic profile of Spanish adults with Down syndrome. Rev Clin Esp 2019; 220:275-281. [PMID: 31761414 DOI: 10.1016/j.rce.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Although the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD. METHODS We conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants. RESULTS Twenty-six participants (mean age, 45±11years) participated in the study (50% men). The sample's mean blood pressure (BP) was 109/69±11/9mmHg, with a mean heart rate of 60±12bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65%), normal BP (96%), hypochronotropism (46%), normal inotropism (50%) and hypervolaemia (54%), with normal peripheral vascular resistance values (58%). Twelve participants underwent OBPM (46%). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105±11mmHg, 67±11mmHg, 80±11mmHg and 61±6bpm, respectively. CONCLUSIONS The most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample.
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Affiliation(s)
- E Roy-Vallejo
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España.
| | - E Alonso
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - J M Galván-Román
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - P Ibañez
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - F Moldenhauer
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - C Suárez Fernández
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - D Real de Asúa
- Unidad de Atención a Adultos con síndrome de Down, Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
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Bayen E, Possin KL, Chen Y, Cleret de Langavant L, Yaffe K. Prevalence of Aging, Dementia, and Multimorbidity in Older Adults With Down Syndrome. JAMA Neurol 2019; 75:1399-1406. [PMID: 30032260 DOI: 10.1001/jamaneurol.2018.2210] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance As the life expectancy of people with Down syndrome (DS) has markedly increased over the past decades, older adults with DS may be experiencing a higher incidence of aging conditions. In addition to longevity, the amyloid precursor protein gene located on chromosome 21 places individuals with DS at a high risk for developing Alzheimer disease. Yet, few studies have determined prevalence of dementia and comorbidities among older people with DS. Objective To determine the prevalence of dementia and aging-related comorbidities in older adult individuals with DS. Design, Setting, and Participants Cross-sectional analysis of 2015 California Medicare claims data. We examined 1 year of cross-sectional Medicare claims data that included 100% of Californian Medicare beneficiaries enrolled in both Medicare Part A and B in 2015. Of these 3 001 977 Californian Medicare beneficiaries 45 years or older, 878 individuals were identified as having a diagnosis of DS. Data were analyzed between April 2017 and February 2018. Main Outcomes and Measures The frequency of DS dementia was assessed across different age categories. The number and frequency of 27 comorbidities were compared among individuals with DS with and without dementia and by age and sex groups. Results A total of 353 DS individuals (40%) were identified as having dementia diagnoses (mean, 58.7 years; 173 women [49%]) and 525 without dementia diagnoses (mean, 55.9 years; 250 women [48%]). The frequency of DS dementia among those 65 years or older rose to 49%. The mean number of comorbidities per individual increased with age in general. Comorbid conditions were more numerous among those with dementia compared with those with DS without dementia (mean, 3.4 vs 2.5, respectively), especially among those younger than 65 years. In particular, 4 treatable conditions, hypothyroidism, epilepsy, anemia, and weight loss, were much more frequent in DS dementia. Conclusions and Relevance Older Medicare beneficiaries in California with DS, especially those with dementia, have a high level of multimorbidity including several treatable conditions. While DS follow-up has long been confined to the pediatric sphere, we found that longevity in individuals with DS will necessitate complex adult and geriatric care. More evidenced-based and standardized follow-up could support better long-term comorbidity management and dementia care among aging adults with DS.
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Affiliation(s)
- Eleonore Bayen
- Sorbonne Université Faculté de Médecine, Hôpital Pitié-Salpêtrière-Assistance Publique Hôpitaux de Paris, Département de Rééducation Neurologique, Paris, France.,Laboratoire d'Economie LEDa-LEGOS, Université Paris-Dauphine, PSL Research University, Paris, France.,Global Brain Health Institute, University of California, San Francisco
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco.,Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Yingjia Chen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Laurent Cleret de Langavant
- Global Brain Health Institute, University of California, San Francisco.,Université Paris Est Faculté de Médecine, Hôpital Henri Mondor-Assistance Publique Hôpitaux de Paris, Centre de référence Maladie de Huntington et service de neurologie, Créteil, France.,Département d'Etudes Cognitives, Ecole Normale Supérieure, PSL Research University et Inserm U955, Equipe E01 Neuropsychologie Interventionnelle, Paris, France
| | - Kristine Yaffe
- Global Brain Health Institute, University of California, San Francisco.,Departments of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco
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Carmona-Iragui M, Videla L, Lleó A, Fortea J. Down syndrome, Alzheimer disease, and cerebral amyloid angiopathy: The complex triangle of brain amyloidosis. Dev Neurobiol 2019; 79:716-737. [PMID: 31278851 DOI: 10.1002/dneu.22709] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/04/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
Down syndrome (DS) is the main genetic cause of intellectual disability worldwide. The overexpression of the Amyloid Precursor Protein, present in chromosome 21, leads to β-amyloid deposition that results in Alzheimer disease (AD) and, in most cases, also to cerebral amyloid angiopathy (CAA) neuropathology. People with DS invariably develop the neuropathological hallmarks of AD at the age of 40, and they are at an ultra high risk for suffering AD-related cognitive impairment thereafter. In the general population, cerebrovascular disease is a significant contributor to AD-related cognitive impairment, while in DS remains understudied. This review describes the current knowledge on cerebrovascular disease in DS and reviews the potential biomarkers that could be useful in the future studies, focusing on CAA. We also discuss available evidence on sporadic AD or other genetically determined forms of AD. We highlight the urgent need of large biomarker-characterized cohorts, including neuropathological correlations, to study the exact contribution of CAA and related vascular factors that play a role in cognition and occur with aging, their characterization and interrelationships. DS represents a unique context in which to perform these studies as this population is relatively protected from some conventional vascular risk factors and they develop significant CAA, DS represents a particular atheroma-free model to study AD-related vascular pathologies. Only deepening on these underlying mechanisms, new preventive and therapeutic strategies could be designed to improve the quality of life of this population and their caregivers and lead to new avenues of treatment also in the general AD population.
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Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Laura Videla
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Carfì A, Vetrano DL, Mascia D, Meloni E, Villani ER, Acampora N, Brandi V, Fries BE, Martin L, Bernabei R, Onder G. Adults with Down syndrome: a comprehensive approach to manage complexity. J Intellect Disabil Res 2019; 63:624-629. [PMID: 30628132 DOI: 10.1111/jir.12588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Down syndrome (DS) is characterised by premature ageing that affects selected organ systems, and persons with this condition can present patterns of co-morbidities and deficits often observed in the older population without DS. However, information on the characteristics of adult persons with DS is limited. The objective of the study is to describe characteristics of adults with DS collected with a standardised, comprehensive assessment instrument. METHODS Cross-sectional study. Four hundred thirty adults with DS (age range 18/75 years) from three countries (Italy, n = 95; USA, n = 175; and Canada, n = 160). A standardised assessment instrument (interRAI intellectual disability) was used to assess sample characteristics. RESULTS Mean age ranged from 35.2 (standard deviation 12.0) years in the US sample to 48.8 (standard deviation 9.0) years in the Canadian sample. Most participants in the Italian and US sample were living in private homes, while more than half of those in the Canadian sample were institutionalised. Prevalences of geriatric conditions, including cognitive deficits, disability in the common activities of daily living, symptoms of withdrawal or anhedonia, aggressive behaviour, communication problems, falls and hearing problems were high in the study sample. Gastrointestinal symptoms, skin and dental problems and obesity were also frequently observed. CONCLUSIONS Adults with DS present with a high level of complexity, which may suggest the need for an approach based on a comprehensive assessment and management that can provide adequate care. Further research is needed to understand better the effectiveness of such an approach in the DS population.
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Affiliation(s)
- A Carfì
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D L Vetrano
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Mascia
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Meloni
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E R Villani
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Acampora
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Brandi
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B E Fries
- Department of Geriatrics and Palliative Care, Department of Internal Medicine and Department of Health, Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - L Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - R Bernabei
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Onder
- Centro Medicina dell'Invecchiamento, Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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Chenbhanich J, Wu A, Phupitakphol T, Atsawarungruangkit A, Treadwell T. Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital. J Intellect Disabil Res 2019; 63:266-276. [PMID: 30484927 DOI: 10.1111/jir.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 11/07/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co-morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co-morbidities and pattern of hospitalisation in adult patients with DS during a 10-year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years. METHOD We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10-year period and compared with those of the general adult population during the same time. Co-morbidities were also described. RESULTS Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co-morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%. CONCLUSIONS Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co-morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co-morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.
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Affiliation(s)
- J Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - A Wu
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - T Phupitakphol
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | | | - T Treadwell
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston School of Medicine, Boston, MA, USA
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González-cerrajero M, Quero-escalada M, Moldenhauer F, Suárez Fernández C. Recomendaciones para la atención a los adultos con síndrome de Down. Revisión de la literatura. Semergen 2018; 44:342-350. [DOI: 10.1016/j.semerg.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
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Abstract
Down syndrome (DS) is the commonest chromosomal disorder among live born infants. DS is associated with increased risk of endocrine abnormalities particularly thyroid gland disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism (autoimmune - non autoimmune), and hyperthyroidism. This review will focus on the characteristics of the different presentations of thyroid abnormalities in DS, screening and management recommendations. (www.actabiomedica.it)
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Affiliation(s)
- Nermine H Amr
- Department of Paediatrics Ain Shams University, Cairo, Egypt.
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Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A 2017; 176:116-133. [PMID: 29130597 DOI: 10.1002/ajmg.a.38512] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.
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Affiliation(s)
- George T Capone
- Kennedy Krieger Institute, Down Syndrome Clinic & Research Center, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Adult Down Syndrome Center, Park Ridge, Illinois
| | - Peter Bulova
- Montefiore Hospital, Adult Down Syndrome Clinic, Pittsburgh, Pennsylvania
| | - Mary Stephens
- Christiana Care Health System, Adult Down Syndrome Clinic, Wilmington, Delaware
| | - Sarah Hart
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrea Videlefsky
- The Adult Disability Medical Home, Urban Family Practice, Marietta, Georgia
| | | | - Nancy Roizen
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Moya Peterson
- University of Kansas Medical Center, Adults with Down Syndrome Specialty Clinic, Kansas City, Kansas
| | | | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Barry Martin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Smith
- Children's Hospital of Wisconsin, Down Syndrome Clinic of Wisconsin, Milwaukee, Wisconsin
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Hayes SA, Kutty S, Thomas J, Johnson JT, Yetman AT. Cardiovascular and general health status of adults with Trisomy 21. Int J Cardiol 2017; 241:173-176. [DOI: 10.1016/j.ijcard.2017.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/09/2017] [Indexed: 11/25/2022]
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Abstract
Patients with Down syndrome have a number of risk factors that theoretically could predispose them to osteoporosis, such as early aging, development disorders, reduced physical activity, limited sun exposure, frequent comorbidities and use of drug therapies which could affect bone metabolism. In addition, the bone mass of these people may be affected by their anthropometric and body composition peculiarities. In general terms, studies in adults with Down syndrome reported that these people have lower areal bone mineral density (g/cm2) than the general population. However, most of them have not taken the smaller bone size of people with Down syndrome into account. In fact, when body mineral density is adjusted by bone size and we obtain volumetric body mineral density (g/cm3), the difference between both populations disappears. On the other hand, although people with Down syndrome have risk factor of hypovitaminosis D, the results of studies regarding 25(OH)D in this population are not clear. Likewise, the studies about biochemical bone markers or the prevalence of fractures are not conclusive.
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Affiliation(s)
- Marta García-Hoyos
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - José Antonio Riancho
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
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García-Hoyos M, García-Unzueta MT, de Luis D, Valero C, Riancho JA. Diverging results of areal and volumetric bone mineral density in Down syndrome. Osteoporos Int 2017; 28:965-972. [PMID: 27838733 DOI: 10.1007/s00198-016-3814-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Population with Down syndrome (DS) has lower areal BMD, in association with their smaller skeletal size. However, volumetric BMD and other indices of bone microarchitecture, such as trabecular bone score (TBS) and calcaneal ultrasound (QUS), were normal. INTRODUCTION Patients with DS have a number of risk factors that could predispose them to osteoporosis. Several studies reported that people with DS also have lower areal bone mineral density, but differences in the skeletal size could bias the analysis. METHODS Seventy-five patients with DS and 76 controls without intellectual disability were recruited. Controls were matched for age and sex. Bone mineral density (BMD) was measure by Dual-energy X-ray Absorptiometry (DXA), and volumetric bone mineral density (vBMD) was calculated by published formulas. Body composition was also measured by DXA. Microarchitecture was measured by TBS and QUS. Serum 25-hidroxyvitamin D (25OHD), parathyroid hormone (PTH), aminoterminal propeptide of type collagen (P1NP), and C-terminal telopeptide of type I collagen (CTX) were also determined. Physical activity was assessed by the International Physical Activity Questionnaires (IPAQ-short form). To evaluate nutritional intake, we recorded three consecutive days of food. RESULTS DS individuals had lower height (151 ± 11 vs. 169 ± 9 cm). BMD was higher in the controls (lumbar spine (LS) 0.903 ± 0.124 g/cm2 in patients and 0.997 ± 0.115 g/cm2 in the controls; femoral neck (FN) 0.761 ± .126 g/cm2 and 0.838 ± 0.115 g/cm2, respectively). vBMD was similar in the DS group (LS 0.244 ± 0.124 g/cm3; FN 0.325 ± .0.073 g/cm3) and the controls (LS 0.255 ± 0.033 g/cm3; FN 0.309 ± 0.043 g/cm3). Microarchitecture measured by QUS was slightly better in DS, and TBS measures were similar in both groups. 25OHD, PTH, and CTX were similar in both groups. P1NP was higher in the DS group. Time spent on exercise was similar in both groups, but intensity was higher in the control group. Population with DS has correct nutrition. CONCLUSIONS Areal BMD is reduced in DS, but it seems to be related to the smaller body and skeletal size. In fact, the estimated volumetric BMD is similar in patients with DS and in control individuals. Furthermore, people with DS have normal bone microarchitecture.
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Affiliation(s)
- M García-Hoyos
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
| | - M T García-Unzueta
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
| | - D de Luis
- Department of Internal Medicine, University Hospital Rio Hortega, Valladolid, Spain
| | - C Valero
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain.
| | - J A Riancho
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
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Gholipour T, Mitchell S, Sarkis RA, Chemali Z. The clinical and neurobehavioral course of Down syndrome and dementia with or without new-onset epilepsy. Epilepsy Behav 2017; 68:11-16. [PMID: 28109983 DOI: 10.1016/j.yebeh.2016.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/26/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adult patients with Down syndrome (DS) are at higher risk of developing Alzheimer-type dementia and epilepsy. The relationship between developing dementia and the risk of developing seizures in DS is poorly characterized to date. In addition, treatment response and medication tolerability have not been rigorously studied. METHODS We identified 220 patients with a diagnosis of DS and dementia. Those without a history of developing seizures (DD) were compared to patients with new-onset seizures (DD+S) after the age of 35. Electronic records were reviewed for demographics, seizure characteristics, cognitive status, and psychiatric comorbidities. RESULTS Of the patients included for analysis, twenty-six out of 60 patients had new-onset seizures or developed seizures during the follow-up period (the DD+S group) with a median onset of 2.0years after the dementia diagnosis. Generalized tonic-clonic seizures were the most common seizure type (61.5% of DD+S). Sixteen (61.5%) patients were reported to have myoclonus. Levetiracetam was the most commonly used initial medication, with the majority (73%) of patients treated achieving partial or complete seizure control. The DD+S patients tended to have a similar burden of new-onset neuropsychiatric symptoms compared to the DD group. DISCUSSION New-onset epilepsy seems to occur early in the course of dementia in DS patients. Patients generally respond to treatment. A great burden of neuropsychiatric symptoms is seen. Future studies need to explore the relationship between β-amyloid accumulation and epileptiform activity and attend to the care and needs of DS patients with dementia and seizures.
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Affiliation(s)
- Taha Gholipour
- Department of Neurology, Edward B. Bromfield Epilepsy Center, Brigham and Women's Hospital, Boston, 75 Francis Street, Boston, MA 02115, USA; Department of Neurology, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
| | - Sara Mitchell
- Department of Psychiatry, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
| | - Rani A Sarkis
- Department of Neurology, Edward B. Bromfield Epilepsy Center, Brigham and Women's Hospital, Boston, 75 Francis Street, Boston, MA 02115, USA.
| | - Zeina Chemali
- Department of Neurology, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
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Khaled ML, Helwa I, Drewry M, Seremwe M, Estes A, Liu Y. Molecular and Histopathological Changes Associated with Keratoconus. Biomed Res Int 2017; 2017:7803029. [PMID: 28251158 DOI: 10.1155/2017/7803029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Keratoconus (KC) is a corneal thinning disorder that leads to loss of visual acuity through ectasia, opacity, and irregular astigmatism. It is one of the leading indicators for corneal transplantation in the Western countries. KC usually starts at puberty and progresses until the third or fourth decade; however its progression differs among patients. In the keratoconic cornea, all layers except the endothelium have been shown to have histopathological structural changes. Despite numerous studies in the last several decades, the mechanisms of KC development and progression remain unclear. Both genetic and environmental factors may contribute to the pathogenesis of KC. Many previous articles have reviewed the genetic aspects of KC, but in this review we summarize the histopathological features of different layers of cornea and discuss the differentially expressed proteins in the KC-affected cornea. This summary will help emphasize the major molecular defects in KC and identify additional research areas related to KC, potentially opening up possibilities for novel methods of KC prevention and therapeutic intervention.
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