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Hillerstrom H, Fisher R, Janicki MP, Chicoine B, Christian BT, Esbensen A, Esralew L, Fortea J, Hartley S, Hassenstab J, Keller SM, Krinsky‐McHale S, Lai F, Levin J, McCarron M, McDade E, Rebillat AS, Rosas HD, Silverman W, Strydom A, Zaman SH, Zetterberg H. Adapting prescribing criteria for amyloid-targeted antibodies for adults with Down syndrome. Alzheimers Dement 2024; 20:3649-3656. [PMID: 38480678 PMCID: PMC11095423 DOI: 10.1002/alz.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Abstract
Prior authorization criteria for Federal Drug Administration (FDA) approved immunotherapeutics, among the class of anti-amyloid monoclonal antibodies (mAbs), established by state drug formulary committees, are tailored for adults with late-onset Alzheimer's disease. This overlooks adults with Down syndrome (DS), who often experience dementia at a younger age and with different diagnostic assessment outcomes. This exclusion may deny DS adults access to potential disease-modifying treatments. To address this issue, an international expert panel convened to establish adaptations of prescribing criteria suitable for DS patients and parameters for access to Centers for Medicare & Medicaid Services (CMS) registries. The panel proposed mitigating disparities by modifying CMS and payer criteria to account for younger onset age, using alternative language and assessment instruments validated for cognitive decline in the DS population. The panel also recommended enhancing prescribing clinicians' diagnostic capabilities for DS and initiated awareness-raising activities within healthcare organizations. These efforts facilitated discussions with federal officials, aimed at achieving equity in access to anti-amyloid immunotherapeutics, with implications for national authorities worldwide evaluating these and other new disease-modifying therapeutics for Alzheimer's disease.
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Affiliation(s)
| | | | - Matthew P. Janicki
- Department of Disability and Human DevelopmentUniversity of Illinois ChicagoChicagoIllinoisUSA
- National Task Group on Intellectual Disabilities and Dementia PracticesRockportMaineUSA
| | - Brian Chicoine
- Advocate Health, Advocate Medical Group Adult Down Syndrome CenterAdvocate Lutheran General Hospital Family Medicine ResidencyPark RidgeIllinoisUSA
| | | | - Anna Esbensen
- Division of Developmental and Behavioral PediatricsCincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnati Children's HospitalCincinnatiOhioUSA
| | - Lucille Esralew
- California Department of Developmental ServicesSacramentoCaliforniaUSA
| | - Juan Fortea
- Biomedical Research Institute Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of NeurologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Sigan Hartley
- Waisman Center IDDRCUniversity of WisconsinMadisonWisconsinUSA
| | - Jason Hassenstab
- Departments of Neurology and Psychological & Brain SciencesKnight Alzheimer Disease Research CenterWashington UniversitySt. LouisMissouriUSA
| | - Seth M. Keller
- National Task Group on Intellectual Disabilities and Dementia PracticesRockportMaineUSA
- Neurology Associates of South JerseyLumbertonNew JerseyUSA
| | - Sharon Krinsky‐McHale
- Department of PsychologyNew York State Institute for Basic Research in Developmental DisabilitiesIslandNew YorkUSA
| | - Florence Lai
- MGH Neurology ResearchMass General Brigham HospitalMassachusetts General HospitalBostonMassachusettsUSA
| | - Johannes Levin
- Department of Neurology & German Center of Neurodegenerative Diseases (DZNE) e.V.Ludwig‐Maximilians UniversityMunichGermany
- Department of NeurologySahgrenska University HospitalMölndalSweden
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual DisabilityTrinity College, University of DublinDublinIreland
| | - Eric McDade
- Departments of Neurology and Psychological & Brain SciencesKnight Alzheimer Disease Research CenterWashington UniversitySt. LouisMissouriUSA
| | | | - Herminia Diana Rosas
- MGH Neurology ResearchMass General Brigham HospitalMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Wayne Silverman
- Department of PediatricsUniversity of California IrvineIrvineCaliforniaUSA
| | - Andre Strydom
- Institute of PsychiatryPsychology and Neuroscience, Kings CollegeLondonUK
| | - Shahid H. Zaman
- Department of PsychiatryCambridge Intellectual and Developmental Disabilities Research GroupCambridge UniversityCambridgeUK
| | - Henrik Zetterberg
- Institute for Stroke and Dementia ResearchSahlgrenska Academy at the University of GothenburgMolndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMolndalSweden
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
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2
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Sukreet S, Rafii MS, Rissman RA. From understanding to action: Exploring molecular connections of Down syndrome to Alzheimer's disease for targeted therapeutic approach. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12580. [PMID: 38623383 PMCID: PMC11016820 DOI: 10.1002/dad2.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
Down syndrome (DS) is caused by a third copy of chromosome 21. Alzheimer's disease (AD) is a neurodegenerative condition characterized by the deposition of amyloid-beta (Aβ) plaques and neurofibrillary tangles in the brain. Both disorders have elevated Aβ, tau, dysregulated immune response, and inflammation. In people with DS, Hsa21 genes like APP and DYRK1A are overexpressed, causing an accumulation of amyloid and neurofibrillary tangles, and potentially contributing to an increased risk of AD. As a result, people with DS are a key demographic for research into AD therapeutics and prevention. The molecular links between DS and AD shed insights into the underlying causes of both diseases and highlight potential therapeutic targets. Also, using biomarkers for early diagnosis and treatment monitoring is an active area of research, and genetic screening for high-risk individuals may enable earlier intervention. Finally, the fundamental mechanistic parallels between DS and AD emphasize the necessity for continued research into effective treatments and prevention measures for DS patients at risk for AD. Genetic screening with customized therapy approaches may help the DS population in current clinical studies and future biomarkers.
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Affiliation(s)
- Sonal Sukreet
- Department of NeurosciencesUniversity of California‐San DiegoLa JollaCaliforniaUSA
| | - Michael S. Rafii
- Department of Neurology, Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Robert A. Rissman
- Department of NeurosciencesUniversity of California‐San DiegoLa JollaCaliforniaUSA
- Department Physiology and Neuroscience, Alzheimer’s Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
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3
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Grasso M, Fidilio A, L’Episcopo F, Recupero M, Barone C, Bacalini MG, Benatti C, Giambirtone MC, Caruso G, Greco D, Di Nuovo S, Romano C, Ferri R, Buono S, Cuello AC, Blom JMC, Tascedda F, Piazza PV, De La Torre R, Caraci F. Low TGF-β1 plasma levels are associated with cognitive decline in Down syndrome. Front Pharmacol 2024; 15:1379965. [PMID: 38576478 PMCID: PMC10991739 DOI: 10.3389/fphar.2024.1379965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Almost all individuals with Down's syndrome (DS) show the characteristic neuropathological features of Alzheimer's disease (AD) by the age of 40, yet not every individual with DS experiences symptoms of AD later in life. Similar to neurotypical developing subjects, AD in people with DS lasts for a long preclinical phase in which biomarkers follow a predictable order of changes. Hence, a prolonged asymptomatic period precedes the onset of dementia, underscoring the importance of identifying new biomarkers for the early detection and monitoring of cognitive decline in individuals with DS. Blood-based biomarkers may offer an alternative non-invasive strategy for the detection of peripheral biological alterations paralleling nervous system pathology in an early phase of the AD continuum. In the last few years, a strong neurobiological link has been demonstrated between the deficit of transforming growth factor-β1 (TGF-β1) levels, an anti-inflammatory cytokine endowed with neuroprotective activity, and early pro-inflammatory processes in the AD brain. In this clinical prospective observational study, we found significant lower plasma TGF-β1 concentrations at the first neuropsychological evaluation (baseline = T0) both in young adult DS individuals (19-35 years) and older DS subjects without AD (35-60 years) compared to age- and sex-matched healthy controls. Interestingly, we found that the lower TGF-β1 plasma concentrations at T0 were strongly correlated with the following cognitive decline at 12 months. In addition, in young individuals with DS, we found, for the first time, a negative correlation between low TGF-β1 concentrations and high TNF-α plasma concentrations, a pro-inflammatory cytokine that is known to be associated with cognitive impairment in DS individuals with AD. Finally, adopting an ex vivo approach, we found that TGF-β1 concentrations were reduced in parallel both in the plasma and in the peripheral blood mononuclear cells (PBMCs) of DS subjects, and interestingly, therapeutic concentrations of fluoxetine (FLX) applied to cultured PBMCs (1 µM for 24 h) were able to rescue TGF-β1 concentrations in the culture media from DS PBMCs, suggesting that FLX, a selective serotonin reuptake inhibitor (SSRI) endowed with neuroprotective activity, might rescue TGF-β1 concentrations in DS subjects at higher risk to develop cognitive decline.
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Affiliation(s)
| | | | | | | | | | | | - Cristina Benatti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Caruso
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
| | | | - Santo Di Nuovo
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Corrado Romano
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | | | - Johanna M. C. Blom
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Department of Life Sciences and Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Rafael De La Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Research Institute /HMRI, Barcelona, Spain
| | - Filippo Caraci
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
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4
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Pendl D, Glatz M, Gasteiger-Klicpera B. Intellectual disabilities and dementia: New tasks and experiences of Austrian formal caregivers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13165. [PMID: 37849394 DOI: 10.1111/jar.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/18/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND In Austria, due to its history, only relatively little research on the topic of intellectual disabilities and dementia has been conducted to date. The present study thus aims to explore the challenges and tasks currently facing formal caregivers, together with assessing their wishes for further development. METHODS Ten semi-structured interviews were held with formal caregivers. Interviews were transcribed and analysed by means of structured qualitative content analysis. RESULTS Caregivers must deal with conflicts between residents, and with increasing demands for care and emotional support. Education and training on dementia and intellectual disability are mostly of high quality, but still remain insufficient. Caregivers would like to see suitable adaptation of care premises, smaller groups, more staff and better training on dementia and intellectual disability. CONCLUSION To ensure quality care and 'ageing in place', caregivers and providers need to pay greater attention to dementia-related changes when planning and adapting services.
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Affiliation(s)
- Dominik Pendl
- Inclusive Education Unit, University of Graz, Institute of Education Research and Teacher Education, Graz, Austria
| | - Mathieu Glatz
- Inclusive Education Unit, University of Graz, Institute of Education Research and Teacher Education, Graz, Austria
| | - Barbara Gasteiger-Klicpera
- Inclusive Education Unit, University of Graz, Institute of Education Research and Teacher Education, Graz, Austria
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5
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Videla L, Benejam B, Carmona-Iragui M, Barroeta I, Fernández S, Arranz J, Azzahchi SE, Altuna M, Padilla C, Valldeneu S, Pegueroles J, Montal V, Aranha MR, Vaqué-Alcázar L, Iulita MF, Alcolea D, Bejanin A, Videla S, Blesa R, Lleó A, Fortea J. Cross-sectional versus longitudinal cognitive assessments for the diagnosis of symptomatic Alzheimer's disease in adults with Down syndrome. Alzheimers Dement 2023; 19:3916-3925. [PMID: 37038748 DOI: 10.1002/alz.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Down syndrome (DS) is a genetic form of Alzheimer's disease (AD). However, clinical diagnosis is difficult, and experts emphasize the need for detecting intra-individual cognitive decline. OBJECTIVE To compare the performance of baseline and longitudinal neuropsychological assessments for the diagnosis of symptomatic AD in DS. METHODS Longitudinal cohort study of adults with DS. Individuals were classified as asymptomatic, prodromal AD, or AD dementia. We performed receiver operating characteristic curve analyses to compare baseline and longitudinal changes of CAMCOG-DS and mCRT. RESULTS We included 562 adults with DS. Baseline assessments showed good to excellent diagnostic performance for AD dementia (AUCs between 0.82 and 0.99) and prodromal AD, higher than the 1-year intra-individual cognitive decline (area under the ROC curve between 0.59 and 0.79 for AD dementia, lower for prodromal AD). Longer follow-ups increased the diagnostic performance of the intra-individual cognitive decline. DISCUSSION Baseline cognitive assessment outperforms the 1-year intra-individual cognitive decline in adults with DS.
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Affiliation(s)
- Laura Videla
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de 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 en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de 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 en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Javier Arranz
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sumia Elbachiri Azzahchi
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- CITA-alzheimer foundation, Donostia-San Sebsatián, Spain
| | - Concepción Padilla
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Valldeneu
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jordi Pegueroles
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Víctor Montal
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Mateus Rozalem Aranha
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lídia Vaqué-Alcázar
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alexandre Bejanin
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Sebastià Videla
- Clinical Research Support Unit-[HUB-IDIBELL], Clinical Pharmacology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau Hospital de 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 en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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6
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Videla L, Benejam B, Pegueroles J, Carmona-Iragui M, Padilla C, Fernández S, Barroeta I, Altuna M, Valldeneu S, Garzón D, Ribas L, Montal V, Arranz Martínez J, Rozalem Aranha M, Alcolea D, Bejanin A, Iulita MF, Videla Cés S, Blesa R, Lleó A, Fortea J. Longitudinal Clinical and Cognitive Changes Along the Alzheimer Disease Continuum in Down Syndrome. JAMA Netw Open 2022; 5:e2225573. [PMID: 35930282 PMCID: PMC9356319 DOI: 10.1001/jamanetworkopen.2022.25573] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Alzheimer disease (AD) is the main medical problem in adults with Down syndrome (DS). However, the associations of age, intellectual disability (ID), and clinical status with progression and longitudinal cognitive decline have not been established. OBJECTIVE To examine clinical progression along the AD continuum and its related cognitive decline and to explore the presence of practice effects and floor effects with repeated assessments. DESIGN, SETTING, AND PARTICIPANTS This is a single-center cohort study of adults (aged >18 years) with DS with different ID levels and at least 6 months of follow-up between November 2012 and December 2021. The data are from a population-based health plan designed to screen for AD in adults with DS in Catalonia, Spain. Individuals were classified as being asymptomatic, having prodromal AD, or having AD dementia. EXPOSURES Neurological and neuropsychological assessments. MAIN OUTCOMES AND MEASURES The main outcome was clinical change along the AD continuum. Cognitive decline was measured by the Cambridge Cognitive Examination for Older Adults With Down Syndrome and the modified Cued Recall Test. RESULTS A total of 632 adults with DS (mean [SD] age, 42.6 [11.4] years; 292 women [46.2%]) with 2847 evaluations (mean [SD] follow-up, 28.8 [18.7] months) were assessed. At baseline, there were 436 asymptomatic individuals, 69 patients with prodromal AD, and 127 with AD dementia. After 5 years of follow-up, 17.1% (95% CI, 12.5%-21.5%) of asymptomatic individuals progressed to symptomatic AD in an age-dependent manner (0.6% [95% CI, 0%-1.8%] for age <40 years; 21.1% [95% CI, 8.0%-32.5%] for age 40-44 years; 41.4% [95% CI, 23.1%-55.3%] for age 45-49 years; 57.5% [95% CI, 38.2%-70.8%] for age ≥50 years; P < .001), and 94.1% (95% CI, 84.6%-98.0%) of patients with prodromal AD progressed to dementia with no age dependency. Cognitive decline in the older individuals was most common among those who progressed to symptomatic AD and symptomatic individuals themselves. Importantly, individuals with mild and moderate ID had no differences in longitudinal cognitive decline despite having different performance at baseline. This study also found practice and floor effects, which obscured the assessment of longitudinal cognitive decline. CONCLUSIONS AND RELEVANCE This study found an association between the development of symptomatic AD and a high risk of progressive cognitive decline among patients with DS. These results support the need for population health plans to screen for AD-related cognitive decline from the fourth decade of life and provide important longitudinal data to inform clinical trials in adults with DS to prevent AD.
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Affiliation(s)
- Laura Videla
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Jordi Pegueroles
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María Carmona-Iragui
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Concepción Padilla
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Silvia Valldeneu
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Diana Garzón
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Ribas
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Montal
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Javier Arranz Martínez
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mateus Rozalem Aranha
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alexandre Bejanin
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Sebastià Videla Cés
- Clinical Research Support Unit, Bellvitge Biomedical Research Institute, Department of Clinical Pharmacology, University of Barcelona, Barcelona, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Institut d’Investigacions Biomèdiques Sant Pau–Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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7
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Shirai Y, Bishop K, Kushner M. National Dementia Capable Care Training: A Model Implementation and Evaluation. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:422-435. [PMID: 34551102 DOI: 10.1352/1934-9556-59.5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 10/05/2020] [Indexed: 06/13/2023]
Abstract
With a growing need for specialized training for direct caregivers and support staff of persons with intellectual and developmental disabilities (IDD) affected by dementia, the National Task Group on Developmental Disabilities and Dementia Practices (NTG) developed a comprehensive evidence-informed Dementia Capable Care Training (DCCT). To overcome the challenge of the training length and cost, and to extend its dissemination, the Sonoran Center developed a shorter version of the NTG-DCCT while retaining its core components, and implemented it in seven cities in the U. S. Southwest (N = 368). The pre- and post-training evaluation (n =260) demonstrated that the short version of the NTG-DCCT is effective in significantly improving participants' knowledge and/or confidence in dementia capable care. The follow-up semi-structured interviews of participants (n = 7) provide some insights.
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Affiliation(s)
- Yumi Shirai
- Yumi Shirai, Sonoran Center for Excellence in Disabilities
| | - Kathleen Bishop
- Kathleen Bishop, National Task Group on ID and Dementia Practices
| | - Melissa Kushner
- Melissa Kushner, Sonoran Center for Excellence in Disabilities
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8
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Cognitive Function during the Prodromal Stage of Alzheimer's Disease in Down Syndrome: Comparing Models. Brain Sci 2021; 11:brainsci11091220. [PMID: 34573242 PMCID: PMC8471085 DOI: 10.3390/brainsci11091220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022] Open
Abstract
Accurate identification of the prodromal stage of Alzheimer’s disease (AD), known as mild cognitive impairment (MCI), in adults with Down syndrome (MCI-DS) has been challenging because there are no established diagnostic criteria that can be applied for people with lifelong intellectual disabilities (ID). As such, the sequence of cognitive decline in adults with DS has been difficult to ascertain, and it is possible that domain constructs characterizing cognitive function in neurotypical adults do not generalize to this high-risk population. The present study examined associations among multiple measures of cognitive function in adults with DS, either prior to or during the prodromal stage of AD to determine, through multiple statistical techniques, the measures that reflected the same underlying domains of processing. Participants included 144 adults with DS 40–82 years of age, all enrolled in a larger, multidisciplinary study examining biomarkers of AD in adults with DS. All participants had mild or moderate lifelong intellectual disabilities. Overall AD-related clinical status was rated for each individual during a personalized consensus conference that considered performance as well as health status, with 103 participants considered cognitively stable (CS) and 41 to have MCI-DS. Analyses of 17 variables derived from 10 tests of cognition indicated that performance reflected three underlying factors: language/executive function, memory, and visuomotor. All three domain composite scores significantly predicted MCI-DS status. Based upon path modeling, the language/executive function composite score was the most affected by prodromal AD. However, based upon structural equation modeling, tests assessing the latent construct of memory were the most impacted, followed by those assessing visuomotor, and then those assessing language/executive function. Our study provides clear evidence that cognitive functioning in older adults with DS can be characterized at the cognitive domain level, but the statistical methods selected and the inclusion or exclusion of certain covariates may lead to different conclusions. Best practice requires investigators to understand the internal structure of their variables and to provide evidence that their variables assess their intended constructs.
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Montoliu-Gaya L, Strydom A, Blennow K, Zetterberg H, Ashton NJ. Blood Biomarkers for Alzheimer's Disease in Down Syndrome. J Clin Med 2021; 10:3639. [PMID: 34441934 PMCID: PMC8397053 DOI: 10.3390/jcm10163639] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022] Open
Abstract
Epidemiological evidence suggests that by the age of 40 years, all individuals with Down syndrome (DS) have Alzheimer's disease (AD) neuropathology. Clinical diagnosis of dementia by cognitive assessment is complex in these patients due to the pre-existing and varying intellectual disability, which may mask subtle declines in cognitive functioning. Cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers, although accurate, are expensive, invasive, and particularly challenging in such a vulnerable population. The advances in ultra-sensitive detection methods have highlighted blood biomarkers as a valuable and realistic tool for AD diagnosis. Studies with DS patients have proven the potential blood-based biomarkers for sporadic AD (amyloid-β, tau, phosphorylated tau, and neurofilament light chain) to be useful in this population. In addition, biomarkers related to other pathologies that could aggravate dementia progression-such as inflammatory dysregulation, energetic imbalance, or oxidative stress-have been explored. This review serves to provide a brief overview of the main findings from the limited neuroimaging and CSF studies, outline the current state of blood biomarkers to diagnose AD in patients with DS, discuss possible past limitations of the research, and suggest considerations for developing and validating blood-based biomarkers in the future.
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Affiliation(s)
- Laia Montoliu-Gaya
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden; (K.B.); (H.Z.); (N.J.A.)
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- London Down Syndrome Consortium (LonDowns), London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden; (K.B.); (H.Z.); (N.J.A.)
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden; (K.B.); (H.Z.); (N.J.A.)
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London WC1E 6BT, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Nicholas James Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden; (K.B.); (H.Z.); (N.J.A.)
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Old Age Psychiatry, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK
- NIHR Biomedical Research Centre for Mental Health, Biomedical Research Unit for Dementia at South London, Maudsley NHS Foundation, London SE5 8AF, UK
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10
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Carmona-Iragui M, Alcolea D, Barroeta I, Videla L, Muñoz L, Van Pelt KL, Schmitt FA, Lightner DD, Koehl LM, Jicha G, Sacco S, Mircher C, Pape SE, Hithersay R, Clare ICH, Holland AJ, Nübling G, Levin J, Zaman SH, Strydom A, Rebillat AS, Head E, Blesa R, Lleó A, Fortea J. Diagnostic and prognostic performance and longitudinal changes in plasma neurofilament light chain concentrations in adults with Down syndrome: a cohort study. Lancet Neurol 2021; 20:605-614. [PMID: 34302785 PMCID: PMC8852333 DOI: 10.1016/s1474-4422(21)00129-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adults with Down syndrome are at an ultra-high risk of Alzheimer's disease, but diagnosis of Alzheimer's disease in this population is challenging. We aimed to validate the clinical utility of plasma neurofilament light chain (NfL) for the diagnosis of symptomatic Alzheimer's disease in Down syndrome, assess its prognostic value, and establish longitudinal changes in adults with Down syndrome. METHODS We did a multicentre cohort study, including adults with Down syndrome (≥18 years), recruited from six hospitals and university medical centres in France, Germany, Spain, the UK, and the USA, who had been assessed, followed up, and provided at least two plasma samples. Participants were classified by local clinicians, who were masked to biomarker data, as asymptomatic (ie, no clinical suspicion of Alzheimer's disease), prodromal Alzheimer's disease, or Alzheimer's disease dementia. We classified individuals who progressed along the Alzheimer's disease continuum during follow-up as progressors. Plasma samples were analysed retrospectively; NfL concentrations were measured centrally using commercial kits for biomarker detection. We used ANOVA to evaluate differences in baseline NfL concentrations, Cox regression to study their prognostic value, and linear mixed models to estimate longitudinal changes. To account for potential confounders, we included age, sex, and intellectual disability as covariates in the analyses. FINDINGS Between Aug 2, 2010, and July 16, 2019, we analysed 608 samples from 236 people with Down syndrome: 165 (70%) were asymptomatic, 32 (14%) had prodromal Alzheimer's disease, and 29 (12%) had Alzheimer's disease dementia; ten [4%] participants were excluded because their classification was uncertain. Mean follow-up was 3·6 years (SD 1·6, range 0·6-9·2). Baseline plasma NfL concentrations showed an area under the receiver operating characteristic curve of 0·83 (95% CI 0·76-0·91) in the prodromal group and 0·94 (0·90-0·97) in the dementia group for differentiating from participants who were asymptomatic. An increase of 1 pg/mL in baseline NfL concentrations was associated with a 1·04-fold risk of clinical progression (95% CI 1·01-1·07; p=0·0034). Plasma NfL concentrations showed an annual increase of 3·0% (95% CI 0·4-5·8) per year in the asymptomatic non-progressors group, 11·5% (4·9-18·5) per year in the asymptomatic progressors group, and 16·0% (8·4-24·0) per year in the prodromal Alzheimer's disease progressors group. In participants with Alzheimer's disease dementia, NfL concentrations increased by a mean of 24·3% (15·3-34·1). INTERPRETATION Plasma NfL concentrations have excellent diagnostic and prognostic performance for symptomatic Alzheimer's disease in Down syndrome. The longitudinal trajectory of plasma NfL supports its use as a theragnostic marker in clinical trials. FUNDING AC Immune, La Caixa Foundation, Instituto de Salud Carlos III, National Institute on Aging, Wellcome Trust, Jérôme Lejeune Foundation, Medical Research Council, National Institute for Health Research, EU Joint Programme-Neurodegenerative Disease Research, Alzheimer's society, Deutsche Forschungsgemeinschaft, Stiftung für die Erforschung von Verhaltens und Umwelteinflüssen auf die menschliche Gesundheit, and NHS National Institute of Health Research Applied Research Collaborations East of England, UK.
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Affiliation(s)
- Maria Carmona-Iragui
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain; Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain; Horizon 21 Consortium, Paris, France.
| | - Daniel Alcolea
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain; Horizon 21 Consortium, Paris, France
| | - Laura Videla
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain; Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain; Horizon 21 Consortium, Paris, France
| | - Laia Muñoz
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain
| | - Kathyrn L Van Pelt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Frederick A Schmitt
- Department of Neurology, University of Kentucky, Lexington, KY, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | | | - Lisa M Koehl
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Gregory Jicha
- Department of Neurology, University of Kentucky, Lexington, KY, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Silvia Sacco
- Horizon 21 Consortium, Paris, France; Institut Jérôme Lejeune, Paris, France
| | | | - Sarah E Pape
- Horizon 21 Consortium, Paris, France; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and the Maudsley Foundation NHS Trust, London, UK; The LonDownS consortium, London, UK
| | - Rosalyn Hithersay
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; The LonDownS consortium, London, UK
| | - Isabel C H Clare
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; National Institute of Health Research, Applied Research Collaboration, East of England, Cambridge, UK
| | | | - Georg Nübling
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Levin
- Horizon 21 Consortium, Paris, France; Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany
| | - Shahid H Zaman
- Horizon 21 Consortium, Paris, France; Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andre Strydom
- Horizon 21 Consortium, Paris, France; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and the Maudsley Foundation NHS Trust, London, UK; The LonDownS consortium, London, UK
| | | | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - Rafael Blesa
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Neurology Department, 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 de Enfermedades Neurodegenerativas, Madrid, Spain; Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain; Horizon 21 Consortium, Paris, France.
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11
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De Vreese LP, Gomiero T, De Bastiani E, Marangoni A, Weger E, Mantesso U. Short forms of Prudhoe Cognitive Function Test in adults and aging people with intellectual disabilities: Italian validation study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:162-172. [PMID: 33230890 DOI: 10.1111/jir.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/22/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND We aimed to validate the Italian version of the two parallel short forms of the Prudhoe Cognitive Function Test (s-PCFT-I) in adults and seniors with intellectual disabilities (ID) of any aetiology and level of severity. METHODS Our validation is a multicentre study attended by 211 subjects with ID, 125 male and 86 female, aged 40 years and above for people with Down syndrome and aged 50 years for people with other forms of disabilities. RESULTS The s-PCFT-I shows a wide range of scores in the absence of floor effects with minimal ceiling effects. A Cronbach's α coefficient of 0.85 and a mean inter-item correlation of 0.21 indicate high internal consistency. The tool demonstrates good agreement between testers and near excellent temporal stability with intraclass correlation coefficients respectively of 0.85 and 0.90. s-PCFT-I total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Moderate to good and highly significant correlations (-0.40 to -0.66) among the s-PCFT-I total scores and subscores and the Sum of Cognitive Score of the informant-based Dementia Questionnaire for Persons with Intellectual Disabilities suggest an acceptable level of concurrent criterion validity. Cognitive decliners according to Prasher's Dementia Questionnaire for Persons with Intellectual Disabilities cut-off scores perform significantly lower on s-PCFT-I than non-decliners. CONCLUSIONS The s-PCFT-I has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of cognition in aging people with ID.
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Affiliation(s)
- L P De Vreese
- Fondazione Luigi Boni Onlus, Health Director Geriatric Center, Suzzara, Italy
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - T Gomiero
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - E De Bastiani
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - A Marangoni
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
- Fondazione Trentina per l'Autismo, Mezzolombardo, Italy
| | - E Weger
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - U Mantesso
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
- Azienda Provinciale per i Servizi Sanitari, Public health general practitioner, Trento, Italy
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12
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Rafii MS, Ances BM, Schupf N, Krinsky‐McHale SJ, Mapstone M, Silverman W, Lott I, Klunk W, Head E, Christian B, Lai F, Rosas HD, Zaman S, Petersen ME, Strydom A, Fortea J, Handen B, O'Bryant S. The AT(N) framework for Alzheimer's disease in adults with Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12062. [PMID: 33134477 PMCID: PMC7588820 DOI: 10.1002/dad2.12062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
The National Institute on Aging in conjunction with the Alzheimer's Association (NIA-AA) recently proposed a biological framework for defining the Alzheimer's disease (AD) continuum. This new framework is based upon the key AD biomarkers (amyloid, tau, neurodegeneration, AT[N]) instead of clinical symptoms and represents the latest understanding that the pathological processes underlying AD begin decades before the manifestation of symptoms. By using these same biomarkers, individuals with Down syndrome (DS), who are genetically predisposed to developing AD, can also be placed more precisely along the AD continuum. The A/T(N) framework is therefore thought to provide an objective manner by which to select and enrich samples for clinical trials. This new framework is highly flexible and allows the addition of newly confirmed AD biomarkers into the existing AT(N) groups. As biomarkers for other pathological processes are validated, they can also be added to the AT(N) classification scheme, which will allow for better characterization and staging of AD in DS. These biological classifications can then be merged with clinical staging for an examination of factors that impact the biological and clinical progression of the disease. Here, we leverage previously published guidelines for the AT(N) framework to generate such a plan for AD among adults with DS.
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Affiliation(s)
- Michael S. Rafii
- Alzheimer's Therapeutic Research Institute (ATRI)Keck School of MedicineUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Beau M. Ances
- Center for Advanced Medicine NeuroscienceWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain/G.H. Sergievsky CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyNeurological Institute of New York, Columbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Sharon J. Krinsky‐McHale
- Department of PsychologyNYS Institute for Basic Research in Developmental DisabilitiesStaten IslandNew YorkUSA
| | - Mark Mapstone
- Department of NeurologyUniversity of CaliforniaIrvineCaliforniaUSA
| | - Wayne Silverman
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ira Lott
- Department of PediatricsSchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | - William Klunk
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Elizabeth Head
- Department of PathologyGillespie Neuroscience Research Facility, University of CaliforniaIrvineCaliforniaUSA
| | - Brad Christian
- Department of Medical Physics and PsychiatryUniversity of Wisconsin MadisonMadisonWisconsinUSA
| | - Florence Lai
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - H. Diana Rosas
- Departments of Neurology and RadiologyMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Shahid Zaman
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustFulbourn HospitalCambridgeUK
| | - Melissa E. Petersen
- Department of Family Medicine and Institute for Translational ResearchUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Juan Fortea
- Sant Pau Memory UnitDepartment of NeurologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Benjamin Handen
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sid O'Bryant
- Institute for Translational Research and Department of Pharmacology and NeuroscienceUniversity of North Texas Health Science CenterFort WorthTexasUSA
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13
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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] [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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14
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Hospitalized Adults With Intellectual and Developmental Disabilities: Confronting Challenges. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Santoro JD, Pagarkar D, Chu DT, Rosso M, Paulsen KC, Levitt P, Rafii MS. Neurologic complications of Down syndrome: a systematic review. J Neurol 2020; 268:4495-4509. [PMID: 32920658 DOI: 10.1007/s00415-020-10179-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
Down syndrome (DS) is one of the most well-recognized genetic disorders. Persons with DS are known to have a variety of co-morbid medical problems, affecting nearly all organ systems. Improved healthcare interventions and research have allowed for increased life span of persons with DS, although disorders of the neurologic system remain underexplored. The purpose of this systematic review is to provide clinically pertinent information on the neurological phenotypes of frequently occurring or clinically relevant conditions. A retrospective review of MEDLINE, Scopus, and Pubmed were used to identify sources among seventeen, clinically relevant, search categories. MeSH terms all contained the phrase "Down Syndrome" in conjunction with the topic of interest. 'Frequently-occurring' was defined as prevalent in more than 10% of persons with DS across their lifespan, whereas 'clinically-relevant' was defined as a disease condition where early diagnosis or intervention can augment the disease course. In total, 4896 sources were identified with 159 sources meeting criteria for inclusion. Seventeen clinical conditions were grouped under the following subjects: hypotonia, intellectual and learning disability, cervical instability, autism spectrum disorder, epilepsy, cerebrovascular disease, Alzheimer's disease and neuropsychiatric disease. The results of this review provide a blueprint for the clinical neurologist taking care of persons with DS across the age spectrum and indicate that there are many underrecognized and misdiagnosed co-occurring conditions in DS, highlighting the need for further research.
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Affiliation(s)
- Jonathan D Santoro
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA. .,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Dania Pagarkar
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Duong T Chu
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Mattia Rosso
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelli C Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pat Levitt
- Department of Pediatrics and Program in Developmental Neuroscience and Developmental Neurogenetics, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael S Rafii
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Rafii MS. Alzheimer's Disease in Down Syndrome: Progress in the Design and Conduct of Drug Prevention Trials. CNS Drugs 2020; 34:785-794. [PMID: 32506291 PMCID: PMC7395870 DOI: 10.1007/s40263-020-00740-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Individuals with Down syndrome (DS) are at high risk for developing Alzheimer's disease (AD) pathology and this has provided significant insights into our understanding of the genetic basis of AD. The present review summarizes recent clinical, neuropathologic, imaging, and fluid biomarker studies of AD in DS (DSAD), highlighting the striking similarities, as well as some notable differences, between DSAD and the more common late-onset form of AD (LOAD) in the general population, as well as the much rarer, autosomal-dominant form of AD (ADAD). There has been significant progress in our understanding of the natural history of AD biomarkers in DS and their relationship to clinically meaningful changes. Additional work is needed to clearly define the continuum of AD that has been described in the general population, such as the preclinical, prodromal, and dementia stages of AD. Multiple therapeutic approaches, including those targeting not only β-amyloid but also tau and the amyloid precursor protein itself, require consideration. Recent developments in the field are presented within the context of such efforts to conduct clinical trials to treat and potentially prevent AD in DS.
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17
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Snyder HM, Bain LJ, Brickman AM, Carrillo MC, Esbensen AJ, Espinosa JM, Fernandez F, Fortea J, Hartley SL, Head E, Hendrix J, Kishnani PS, Lai F, Lao P, Lemere C, Mobley W, Mufson EJ, Potter H, Zaman SH, Granholm AC, Rosas HD, Strydom A, Whitten MS, Rafii MS. Further understanding the connection between Alzheimer's disease and Down syndrome. Alzheimers Dement 2020; 16:1065-1077. [PMID: 32544310 PMCID: PMC8865308 DOI: 10.1002/alz.12112] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Improved medical care of individuals with Down syndrome (DS) has led to an increase in life expectancy to over the age of 60 years. In conjunction, there has been an increase in age-related co-occurring conditions including Alzheimer's disease (AD). Understanding the factors that underlie symptom and age of clinical presentation of dementia in people with DS may provide insights into the mechanisms of sporadic and DS-associated AD (DS-AD). In March 2019, the Alzheimer's Association, Global Down Syndrome Foundation and the LuMind IDSC Foundation partnered to convene a workshop to explore the state of the research on the intersection of AD and DS research; to identify research gaps and unmet needs; and to consider how best to advance the field. This article provides a summary of discussions, including noting areas of emerging science and discovery, considerations for future studies, and identifying open gaps in our understanding for future focus.
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Affiliation(s)
- Heather M. Snyder
- Alzheimer’s Association, Medical & Scientific Relations, Chicago, Illinois, USA
| | - Lisa J. Bain
- Independent Science Writer, Elverson, Pennsylvania, USA
| | - Adam M. Brickman
- Department of Neurology, College of Physicians and Surgeons, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Maria C. Carrillo
- Alzheimer’s Association, Medical & Scientific Relations, Chicago, Illinois, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joaquin M. Espinosa
- Department of Pharmacology, Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Fabian Fernandez
- Departments of Psychology and Neurology, BIO5 Institute, and The Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Juan Fortea
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autonoma de Barcelona, CIBERNED, Barcelona, Spain
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | - Sigan L. Hartley
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Elizabeth Head
- Department of Pathology & Laboratory Medicine, University of California, Irvine, Irvine, California, USA
| | - James Hendrix
- LuMind IDSC Foundation, Burlington, Massachusetts, USA
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Florence Lai
- Department of Neurology, Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick Lao
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Cynthia Lemere
- Department of Neurology, Brigham & Women’s Hospital and Harvard University, Boston, Massachusetts, USA
| | - William Mobley
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
| | | | - Huntington Potter
- Rocky Mountain Alzheimer’s Disease Center and Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Shahid H. Zaman
- Cambridge Intellectual & Developmental Disability Research Group, Department of Psychiatry University of Cambridge, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ann-Charlotte Granholm
- Knoebel Institute for Healthy Aging, University of Denver, Denver, Colorado, USA
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - H. Diana Rosas
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Psychology and Neuroscience, King’s College London, South London and the Maudsley NHS Foundation Trust, LonDowns Consortium, Institute of Psychiatry, London, UK
| | | | - Michael S. Rafii
- Alzheimer’s Therapeutics Research Institute and Department of Neurology, University of Southern California, Los Angeles, California, USA
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18
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Takenoshita S, Terada S, Kuwano R, Inoue T, Cyoju A, Suemitsu S, Yamada N. Prevalence of dementia in people with intellectual disabilities: Cross-sectional study. Int J Geriatr Psychiatry 2020; 35:414-422. [PMID: 31894597 DOI: 10.1002/gps.5258] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are only a few studies of the prevalence of dementia in people with intellectual disability (ID) without Down syndrome (DS), and there is a large difference in the prevalences between reported studies. Moreover, the prevalence of mild cognitive impairment (MCI) in ID has not been reported. We aimed to evaluate the prevalence of dementia in adults of all ages and the prevalence of MCI in people with ID. Furthermore, we tried to clarify the differences depending on the various diagnostic criteria. METHODS The survey included 493 adults with ID at 28 facilities in Japan. The caregivers answered a questionnaire, and physicians directly examined the participants who were suspected of cognitive decline. Dementia and MCI were diagnosed according to ICD-10, DC-LD, and DSM-5 criteria. RESULTS The prevalence of dementia was 0.8% for the 45 to 54 years old group, 3.5% for the 55 to 64 years old group, and 13.9% for the 65 to 74 years old group in people with ID without DS. The prevalence of MCI was 3.1% for patients 45 to 54, 3.5% for patients 55 to 64, and 2.8% for patients 65 to 74 with ID without DS. DSM-5 was the most inclusive in diagnosing dementia and MCI in people with ID. CONCLUSIONS People with ID without DS may develop dementia and MCI at an earlier age and higher rate than the general population. Among the diagnostic criteria, DSM-5 was the most useful for diagnosing their cognitive impairment.
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Affiliation(s)
- Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryozo Kuwano
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Tomokazu Inoue
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Atsushi Cyoju
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Shigeru Suemitsu
- Asahigawaso Research Institute, Asahigawa Medical Welfare Center, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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19
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Weber GE, Koenig KA, Khrestian M, Shao Y, Tuason ED, Gramm M, Lal D, Leverenz JB, Bekris LM. An Altered Relationship between Soluble TREM2 and Inflammatory Markers in Young Adults with Down Syndrome: A Preliminary Report. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2020; 204:1111-1118. [PMID: 31959733 PMCID: PMC7033027 DOI: 10.4049/jimmunol.1901166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/13/2019] [Indexed: 01/13/2023]
Abstract
Individuals with Down syndrome (DS) develop Alzheimer's disease (AD)-related neuropathology, characterized by amyloid plaques with amyloid β (Aβ) and neurofibrillary tangles with tau accumulation. Peripheral inflammation and the innate immune response are elevated in DS. Triggering receptor expressed in myeloid cells 2 (TREM2) genetic variants are risk factors for AD and other neurodegenerative diseases. Soluble TREM2 (sTREM2), a soluble cleavage product of TREM2, is elevated in AD cerebrospinal fluid and positively correlates with cognitive decline. There is relatively little information about TREM2 in DS. Our objective was to examine the relationship between sTREM2 and inflammatory markers in young adults with DS, prior to the development of dementia symptoms. Because TREM2 plays a role in the innate immune response and has been associated with dementia, the hypothesis of this exploratory study was that young adults with DS predementia (n = 15, mean age = 29.5 y) would exhibit a different relationship between sTREM2 and inflammatory markers in plasma, compared with neurotypical, age-matched controls (n = 16, mean age = 29.6 y). Indeed, young adults with DS had significantly elevated plasma sTREM2 and inflammatory markers. Additionally, in young adults with DS, sTREM2 correlated positively with 24 of the measured cytokines, whereas there were no significant correlations in the control group. Hierarchical clustering of sTREM2 and cytokine concentrations also differed between the groups, supporting the hypothesis that its function is altered in people with DS predementia. This preliminary report of human plasma provides a basis for future studies investigating the relationship between TREM2 and the broader immune response predementia.
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Affiliation(s)
- Grace E Weber
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | | | - Maria Khrestian
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Yvonne Shao
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | | | - Marie Gramm
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany; and
| | - Dennis Lal
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | - James B Leverenz
- Cleveland Clinic Lou Ruvo Center for Brain Health, Neurological Institute, Clevland Clinic, Cleveland, OH 44195
| | - Lynn M Bekris
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195;
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20
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Rafii MS, Zaman S, Handen BL. Integrating Biomarker Outcomes into Clinical Trials for Alzheimer's Disease in Down Syndrome. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2020; 8:48-51. [PMID: 33336224 DOI: 10.14283/jpad.2020.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The NIH-funded Alzheimer's Biomarker Consortium Down Syndrome (ABC-DS) and the European Horizon 21 Consortium are collecting critical new information on the natural history of Alzheimer's Disease (AD) biomarkers in adults with Down syndrome (DS), a population genetically predisposed to developing AD. These studies are also providing key insights into which biomarkers best represent clinically meaningful outcomes that are most feasible in clinical trials. This paper considers how these data can be integrated in clinical trials for individuals with DS. The Alzheimer's Clinical Trial Consortium - Down syndrome (ACTC-DS) is a platform that brings expert researchers from both networks together to conduct clinical trials for AD in DS across international sites while building on their expertise and experience.
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Affiliation(s)
- M S Rafii
- Michael S. Rafii, Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, USA,
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21
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Rafii MS, Santoro SL. Prevalence and Severity of Alzheimer Disease in Individuals With Down Syndrome. JAMA Neurol 2019; 76:142-143. [PMID: 30452497 DOI: 10.1001/jamaneurol.2018.3443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael S Rafii
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine of the University of Southern California, San Diego
| | - Stephanie L Santoro
- Down Syndrome Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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22
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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23
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Dodd K, Watchman K, Janicki MP, Coppus A, Gaertner C, Fortea J, Santos FH, Keller SM, Strydom A. Consensus statement of the international summit on intellectual disability and Dementia related to post-diagnostic support . Aging Ment Health 2018; 22:1406-1415. [PMID: 28880125 DOI: 10.1080/13607863.2017.1373065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Post diagnostic support (PDS) has varied definitions within mainstream dementia services and different health and social care organizations, encompassing a range of supports that are offered to adults once diagnosed with dementia until death. METHOD An international summit on intellectual disability and dementia held in Glasgow, Scotland in 2016 identified how PDS applies to adults with an intellectual disability and dementia. The Summit proposed a model that encompassed seven focal areas: post-diagnostic counseling; psychological and medical surveillance; periodic reviews and adjustments to the dementia care plan; early identification of behaviour and psychological symptoms; reviews of care practices and supports for advanced dementia and end of life; supports to carers/ support staff; and evaluation of quality of life. It also explored current practices in providing PDS in intellectual disability services. RESULTS The Summit concluded that although there is limited research evidence for pharmacological or non-pharmacological interventions for people with intellectual disability and dementia, viable resources and guidelines describe practical approaches drawn from clinical practice. Post diagnostic support is essential, and the model components in place for the general population, and proposed here for use within the intellectual disability field, need to be individualized and adapted to the person's needs as dementia progresses. CONCLUSIONS Recommendations for future research include examining the prevalence and nature of behavioral and psychological symptoms (BPSD) in adults with an intellectual disability who develop dementia, the effectiveness of different non-pharmacological interventions, the interaction between pharmacological and non-pharmacological interventions, and the utility of different models of support.
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Affiliation(s)
- Karen Dodd
- a Department of Psychology , Surrey and Borders Partnership NHS Foundation Trust , Leatherhead , UK
| | | | | | - Antonia Coppus
- d Radboudumc , Nijmegen , The Netherlands.,e Dichterbij Centre of the Intellectual Disabled , Gennep , The Netherlands
| | | | - Juan Fortea
- g Hospital De La Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau , Barcelona , Spain.,h Down Medical Center, Fundació Catalana Síndrome de Down , Barcelona , Spain
| | - Flavia H Santos
- i University of Minho , Braga , Portugal.,j UNESP - São Paulo State University , Bauru , Brazil
| | - Seth M Keller
- k Advocare Neurology South Jersey , Lumberton , NJ USA
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24
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De Vreese LP, Mantesso U, De Bastiani E, Marangoni A, Weger E, Gomiero T. Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study. PLoS One 2018; 13:e0205897. [PMID: 30379948 PMCID: PMC6209221 DOI: 10.1371/journal.pone.0205897] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/03/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population. AIM To probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure. METHODS The 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed. RESULTS Overall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08-19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32-43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08-80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32-12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003). CONCLUSIONS Psychotropics drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.
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Affiliation(s)
- Luc Pieter De Vreese
- Geriatric Center, Luigi Boni Foundation, Suzzara, Italy
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Ulrico Mantesso
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Elisa De Bastiani
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | | | - Elisabeth Weger
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Tiziano Gomiero
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
- * E-mail:
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25
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Fortea J, Carmona-Iragui M, Benejam B, Fernández S, Videla L, Barroeta I, Alcolea D, Pegueroles J, Muñoz L, Belbin O, de Leon MJ, Maceski AM, Hirtz C, Clarimón J, Videla S, Delaby C, Lehmann S, Blesa R, Lleó A. Plasma and CSF biomarkers for the diagnosis of Alzheimer's disease in adults with Down syndrome: a cross-sectional study. Lancet Neurol 2018; 17:860-869. [DOI: 10.1016/s1474-4422(18)30285-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022]
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26
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Rafii MS. Diagnostic biomarkers of Alzheimer's disease in Down syndrome. Lancet Neurol 2018; 17:831-832. [PMID: 30172623 DOI: 10.1016/s1474-4422(18)30293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Michael S Rafii
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine of University of Southern California, San Diego, CA 92121, USA.
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27
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O’Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf 2018; 9:535-557. [PMID: 30181861 PMCID: PMC6116771 DOI: 10.1177/2042098618782785] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023] Open
Abstract
It is known that for all adults, prevalence of potentially inappropriate prescribing (PIP) and polypharmacy increases with advancing age and morbidity. This has been associated with adverse drug reactions and poor outcomes. As a result, screening tools have been developed to identify PIP and to improve prescribing and health outcomes. A growing body of evidence supports the fact that there are even greater concerns among older adults with intellectual disability (ID) who are living longer than before but still have premature mortality and poorer health outcomes compared with the general population. They have different patterns of multimorbidity, with higher rates of epilepsy and mental health conditions. Polypharmacy is prevalent and some prescribing practices may be inappropriate. High exposure to anticholinergic and sedative medicines has additional adverse effects on quality of life. There may also be underutilization of clinically needed therapies. There has been substantial controversy internationally relating to extensive use of psychotropic medicines, particularly off-label use for challenging behaviours. Despite the mounting evidence and concerns about the impact of PIP on quality of life, health and safety for people with ID, appropriate methods to measure PIP are lacking, which represents an important gap in the research literature. Differences in morbidity and medicines use patterns in this population mean instruments used to identify inappropriate medicines in the older population are not suitable. In this perspective article we outline the specific health and medicinal needs for people with ID, the prevalence of polypharmacy and presentation of chronic health conditions in older adults with ID. We provide an overview of the psychotropic medicine classes most frequently used in people with ID which carry substantial risk. We highlight studies to date that have attempted to assess PIP and present research priorities to improve prescribing, health outcomes and quality of life for people with ID.
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Affiliation(s)
- Maire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Trinity College Dublin, Dublin,
Ireland
| | - Philip McCallion
- School of Social Work, College of Public Health,
Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Faculty of Health Sciences, University of Dublin
Trinity College, Dublin, Ireland
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Dublin, Ireland
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28
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Holst G, Johansson M, Ahlström G. Signs in People with Intellectual Disabilities: Interviews with Managers and Staff on the Identification Process of Dementia. Healthcare (Basel) 2018; 6:healthcare6030103. [PMID: 30149606 PMCID: PMC6164955 DOI: 10.3390/healthcare6030103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The aim of the present study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with an ID within intellectual disability services (ID-services). Twenty managers and 24 staff within an ID-service were interviewed and qualitative latent content analysis was applied. A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identify deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed a need for early and continuous guidance and education from specialists in dementia and primary healthcare. This finding indicates an urgent need for intervention research and digital support for staff in dementia care.
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Affiliation(s)
- Göran Holst
- The Swedish Red Cross University College, Box 1059, SE-141 21 Stockholm, Sweden.
| | - Maria Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, SE-221 00 Lund, Sweden.
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Heller T, Scott HM, Janicki MP. Caregiving, intellectual disability, and dementia: Report of the Summit Workgroup on Caregiving and Intellectual and Developmental Disabilities. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2018; 4:272-282. [PMID: 30090847 PMCID: PMC6078103 DOI: 10.1016/j.trci.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION A specially commissioned working group produced a report on caregiving, intellectual and developmental disabilities (IDDs), and dementia for the National Institutes of Health-located National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers. METHODS Experts in caregiving, dementia, and IDDs examined the current state of research, policy, and practice related to caregiving and supports; identified the similarities and dissimilarities between IDD-related care and services and the general population affected by dementia; and considered how these findings might contribute to the conversation on developing a dementia care research and services development agenda. RESULTS Five major areas related to programs and caregiving were assessed: (1) challenges of dementia; (2) family caregiving interventions; (3) supportive care settings; (4) effects of diversity; and (5) bridging service networks of aging and disability. DISCUSSION Recommendations included increasing supports for caregivers of adults with IDDs and dementia; increasing research on community living settings and including caregivers of persons with IDDs in dementia research; acknowledging cultural values and practice diversity in caregiving; increasing screening for dementia and raising awareness; and leveraging integration of aging and disability networks.
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Affiliation(s)
- Tamar Heller
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
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Cipriani G, Danti S, Carlesi C, Di Fiorino M. Aging With Down Syndrome: The Dual Diagnosis: Alzheimer's Disease and Down Syndrome. Am J Alzheimers Dis Other Demen 2018; 33:253-262. [PMID: 29504408 PMCID: PMC10852513 DOI: 10.1177/1533317518761093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with Down syndrome (DS) enjoy a longer life expectancy now than they ever have before and are therefore at greater risk of developing conditions associated with aging, including dementia. OBJECTIVES To explore the phenomenon of dementia in DS. METHODS Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published until 2017. Search terms included Alzheimer's disease, cognitive impairment, dementia, DS, and trisomy 21. Publications found through this indexed search were reviewed for further references. RESULTS AND CONCLUSIONS Virtually, all subject aged 35 to 40 show key neuropathologic changes characteristic of Alzheimer's disease, but only a part of them show clinical signs of dementia, usually around the age of 50 years. Early signs of dementia in people with DS may be different from those experienced by the general population. Failure to recognize this can delay diagnosis and subsequent interventions.
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Affiliation(s)
- Gabriele Cipriani
- Neurology Unit, Hospital of Versilia, Lido di Camaiore, Lucca (LU), Italy
- Psychiatry Unit, Hospital of Versilia, Lido di Camaiore, Lucca (Lu), Italy
| | - Sabrina Danti
- Clinical and Health Psychology Unit, Hospital of Pontedera, Pontedera (PI), Italy
| | - Cecilia Carlesi
- Neurology Unit, Hospital of Versilia, Lido di Camaiore, Lucca (LU), Italy
| | - Mario Di Fiorino
- Psychiatry Unit, Hospital of Versilia, Lido di Camaiore, Lucca (Lu), Italy
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Kuske B, Müller SV. Demenz-Früherkennung bei Menschen mit Intelligenzminderung – eine Pilotstudie zur Anwendbarkeit des Demenztests für Menschen mit Intelligenzminderung (DTIM). ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Im Rahmen dieser Studie wurde ein Untersuchungsverfahren zur Demenzfrüherkennung und Verlaufsdiagnostik bei Menschen mit Intelligenzminderung (IM) entwickelt, welches aus einer Fremdbefragung und einer neuropsychologischen Testung besteht. Die Anwendung des Demenztests für Menschen mit Intelligenzminderung (DTIM) wurde in einer prospektiven zweijährigen Verlaufsstudie evaluiert. 102 Personen mit unterschiedlichen Schweregraden einer Intelligenzminderung (IM) wurden zu vier Testzeitpunkten in sechsmonatigen Abständen untersucht. Anhand der individuellen Verlaufsprofile konnten vier Gruppen identifiziert werden: (1) Verdacht bestätigt, (2) Kein Verdacht bestätigt, (3) Verdacht nicht bestätigt und (4) Früher Verdacht. Der DTIM konnte bei 90 %-100 % aller Teilnehmenden mit leichter bis mittelschwerer IM und bis zu 50 % bei Menschen mit schwerer IM eingesetzt werden. Signifikante Unterschiede zeigten sich zwischen Gruppe 1 und 2 zu allen Messzeitpunkten.
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Affiliation(s)
- Bettina Kuske
- Ostfalia Hochschule für angewandte Wissenschaften Wolfenbüttel, Fakultät Soziale Arbeit
| | - Sandra Verena Müller
- Ostfalia Hochschule für angewandte Wissenschaften Wolfenbüttel, Fakultät Soziale Arbeit
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Moro TT, Savage TA, Gehlert S. Agency, social and healthcare supports for adults with intellectual disability at the end of life in out-of-home, non-institutional community residences in Western nations: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1045-1056. [PMID: 28585240 DOI: 10.1111/jar.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The nature and quality of end-of-life care received by adults with intellectual disabilities in out-of-home, non-institutional community agency residences in Western nations is not well understood. METHOD A range of databases and search engines were used to locate conceptual, clinical and research articles from relevant peer-reviewed journals. RESULTS The present authors present a literature review of the agency, social and healthcare supports that impact end-of-life care for adults with intellectual disabilities. More information is needed about where people with intellectual disabilities are living at the very end of life and where they die. CONCLUSIONS The support needs for adults with intellectual disabilities will change over time, particularly at the end of life. There are some areas, such as removing barriers to providing services, staff training, partnerships between agencies and palliative care providers, and advocacy, where further research may help to improve the end-of-life care for adults with intellectual disabilities.
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Affiliation(s)
- Teresa T Moro
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Teresa A Savage
- Department of Women, Children, and Family Health Science, College of Nursing, Chicago, IL, USA
| | - Sarah Gehlert
- E. Desmond Lee Professor of Racial and Ethnic Diversity, George Warren Brown School of Social Work, St. Louis, MO, USA
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Kuske B, Wolff C, Gövert U, Müller SV. Early detection of dementia in people with an intellectual disability - A German pilot study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30 Suppl 1:49-57. [DOI: 10.1111/jar.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bettina Kuske
- Faculty of Social Work; Ostfalia University of Applied Sciences; Wolfenbüttel Germany
| | - Christian Wolff
- Faculty of Social Work; Ostfalia University of Applied Sciences; Wolfenbüttel Germany
| | - Uwe Gövert
- Faculty of Social Work; Ostfalia University of Applied Sciences; Wolfenbüttel Germany
| | - Sandra Verena Müller
- Faculty of Social Work; Ostfalia University of Applied Sciences; Wolfenbüttel Germany
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Cleary J, Doody O. Professional carers' experiences of caring for individuals with intellectual disability and dementia. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2017; 21:68-86. [PMID: 26976618 DOI: 10.1177/1744629516638245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The number of people with intellectual disability living into old age and developing dementia continues to increase. Dementia presents a wide range of challenges for staff due to progressive deterioration. This article presents the findings from a narrative literature review of professional caregivers' experiences of caring for individuals with intellectual disability and dementia. Seven electronic databases were searched using Boolean operators and truncation to identify relevant literature. Search results were combined and narrowed to articles relevant to staff working with individuals with intellectual disability and dementia, and 14 articles met the criteria for review. Themes outlined in the review include staff knowledge of dementia, staff training in dementia, caregiving, challenging behaviour, pain management, mealtime support and coping strategies. Overall carers must review and adjust their care delivery and support to people with intellectual disability and dementia, not only in terms of identifying and responding to their health needs but also through collaborative team working within and across services.
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Renfro M, Bainbridge DB, Smith ML. Validation of Evidence-Based Fall Prevention Programs for Adults with Intellectual and/or Developmental Disorders: A Modified Otago Exercise Program. Front Public Health 2016; 4:261. [PMID: 27999771 PMCID: PMC5138240 DOI: 10.3389/fpubh.2016.00261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Evidence-based fall prevention (EBFP) programs significantly decrease fall risk, falls, and fall-related injuries in community-dwelling older adults. To date, EBFP programs are only validated for use among people with normal cognition and, therefore, are not evidence-based for adults with intellectual and/or developmental disorders (IDD) such as Alzheimer's disease and related dementias, cerebral vascular accident, or traumatic brain injury. BACKGROUND Adults with IDD experience not only a higher rate of falls than their community-dwelling, cognitively intact peers but also higher rates and earlier onset of chronic diseases, also known to increase fall risk. Adults with IDD experience many barriers to health care and health promotion programs. As the lifespan for people with IDD continues to increase, issues of aging (including falls with associated injury) are on the rise and require effective and efficient prevention. METHODS A modified group-based version of the Otago Exercise Program (OEP) was developed and implemented at a worksite employing adults with IDD in Montana. Participants were tested pre- and post-intervention using the Center for Disease Control and Prevention's (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) tool kit. Participants participated in progressive once weekly, 1-h group exercise classes and home programs over a 7-week period. Discharge planning with consumers and caregivers included home exercise, walking, and an optional home assessment. RESULTS Despite the limited number of participants (n = 15) and short length of participation, improvements were observed in the 30-s Chair Stand Test, 4-Stage Balance Test, and 2-Minute Walk Test. Additionally, three individuals experienced an improvement in ambulation independence. Participants reported no falls during the study period. DISCUSSION Promising results of this preliminary project underline the need for further study of this modified OEP among adults with IDD. Future multicenter study should include more participants in diverse geographic regions with longer lengths of participation and follow-up.
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Affiliation(s)
- Mindy Renfro
- MonTECH/Rural Institute, University of Montana , Missoula, MT , USA
| | | | - Matthew Lee Smith
- College of Public Health, Institute of Gerontology, The University of Georgia, Athens, GA, USA; Texas A&M School of Public Health, College Station, TX, USA
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Prasher VP, Mahmood H, Mitra M. Challenges faced in managing dementia in Alzheimer's disease in patients with Down syndrome. Degener Neurol Neuromuscul Dis 2016; 6:85-94. [PMID: 30050371 PMCID: PMC6053091 DOI: 10.2147/dnnd.s91754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dementia in Alzheimer’s disease (DAD) is more common in adults with Down syndrome (DS), with characteristically an earlier onset. The treatment of DAD is not too dissimilar in the general population and in people with intellectual disabilities. However, the underlying intellectual disability can make the management of DAD more challenging in older adults with DS. This literature review aimed to look at the management of DAD in people with DS. The management of dementia is holistic. This includes treating reversible factors, aiming to slow the cognitive decline, psychological therapies, ensuring that the environment is appropriate, and use of psychotropic medication when necessary to manage behavioral problems, psychotic symptoms, depressive symptoms, and sleep difficulty. Antidementia medications have a role to play but remain limited. The management of DAD in the DS population can be at times challenging, but good clinical practice should involve accurate diagnosis of dementia, treating any reversible additional factors, consideration of psychological and behavioral management, use of antidementia medication, and a multidisciplinary team approach.
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Affiliation(s)
- Vee P Prasher
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
| | - Hassan Mahmood
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
| | - Madhumanti Mitra
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
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37
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Prevalence of dementia and organization of dementia care in Swiss disability care homes. Disabil Health J 2016; 9:719-23. [PMID: 27431767 DOI: 10.1016/j.dhjo.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 04/19/2016] [Accepted: 05/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND With higher life expectancy an increasing number of people with intellectual disability (PWID) are at risk for developing dementia. OBJECTIVE Since PWID are an often neglected patient population, the objective of this study was to investigate the prevalence of dementia in residential disability homes in Switzerland and to describe how residential homes organize dementia care. METHODS All residential homes for adults with disabilities in Switzerland (N = 437) were invited to participate in a cross-sectional survey. A subset of questions covered the number of residents with diagnosed and suspected dementia and the organization of dementia care. The response rate to the dementia-related questions was 32% (n = 140 care homes with 10403 residents). RESULTS In residential homes specialised in PWID, 5.8% of the residents were reported to have a diagnosed or suspected dementia. In 140 deaths of PWID, 26% (n = 37) died with a diagnosed or suspected dementia. Residential homes for PWID mostly rely on internal resources (67.7%), general practitioners (61.3%) or psychiatrists (45.2%) for the care of residents with dementia, while specialized dementia nurses are rarely involved (16.1%). CONCLUSION This is the first study in Switzerland to assess the prevalence of dementia in PWID. The study indicates a diagnostic gap. Dementia care is provided in a heterogeneous way across Swiss residential homes for people with disability. Since the number of PWID requiring such care will likely increase in the future, best-practice examples and guidelines are needed.
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Elliott-King J, Shaw S, Bandelow S, Devshi R, Kassam S, Hogervorst E. A critical literature review of the effectiveness of various instruments in the diagnosis of dementia in adults with intellectual disabilities. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 4:126-148. [PMID: 27752536 PMCID: PMC5061450 DOI: 10.1016/j.dadm.2016.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Currently, there is no consensus on dementia diagnostics in adults with intellectual disabilities (ID). There are three types of assessments available: direct cognitive tests, test batteries, and informant reports. Methods A systematic literature search was conducted in four databases yielding 9840 records. Relevant studies were identified and selected using predefined inclusion and exclusion criteria and then coded and classified according to assessment type. This was completed by two independent researchers, with a third consulted when discrepancies arose. The review collates diagnostic instruments and presents strengths and weaknesses. Results Overall 47 studies met the search criteria, and 43 instruments were extracted from the selected studies. Of which, 10 instruments were classified as test batteries, 23 were classified as direct cognitive tests, and the remaining 10 were informant reports. Discussion This review can recommend that cognitive test batteries can offer the most practical and efficient method for dementia diagnosis in individuals with ID.
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Affiliation(s)
- Jordan Elliott-King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Sarah Shaw
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephan Bandelow
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rajal Devshi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Shelina Kassam
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Jacobs J, Schwartz A, McDougle CJ, Skotko BG. Rapid clinical deterioration in an individual with Down syndrome. Am J Med Genet A 2016; 170:1899-902. [PMID: 27149638 DOI: 10.1002/ajmg.a.37674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/07/2016] [Indexed: 11/07/2022]
Abstract
A small percentage of adolescents and young adults with Down syndrome experience a rapid and unexplained deterioration in cognitive, adaptive, and behavioral functioning. Currently, there is no standardized work-up available to evaluate these patients or treat them. Their decline typically involves intellectual deterioration, a loss of skills of daily living, and prominent behavioral changes. Certain cases follow significant life events such as completion of secondary school with friends who proceed on to college or employment beyond the individual with DS. Others develop this condition seemingly unprovoked. Increased attention in the medical community to clinical deterioration in adolescents and young adults with Down syndrome could provide a framework for improved diagnosis, evaluation, and treatment. This report presents a young adult male with Down syndrome who experienced severe and unexplained clinical deterioration, highlighting specific challenges in the systematic evaluation and treatment of these patients. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Julia Jacobs
- Tufts University School of Medicine, Boston, Massachusetts
| | - Alison Schwartz
- Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher J McDougle
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Prasher VP, Sachdeva N, Tarrant N. Diagnosing dementia in adults with Down's syndrome. Neurodegener Dis Manag 2016; 5:249-56. [PMID: 26107323 DOI: 10.2217/nmt.15.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Individuals with Down's syndrome (DS) are living longer and many will survive into their fifth or sixth decade of life. Among the DS population, the prevalence of dementia in Alzheimer's disease increases from 9.4% in age group 30-39 years to 54.5% age group 60-69 years. The psychopathology of dementia in Alzheimer's disease is similar to that seen in the general population although differences are apparent due to the underlying intellectual disability in DS and on the reliance on collateral information from informants. The diagnostic workup follows accepted practice although neuropsychological tests and neuroimaging will only be adjuncts to the clinical assessment; such investigations have limited diagnostic value. Presently, research is focused on identifying genetic and biological measures of Alzheimer's disease in DS.
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Affiliation(s)
- Vee P Prasher
- Birmingham Community Healthcare NHS Trust, Birmingham Learning Disability Service, The Greenfields, 30 Brookfield Road, Birmingham, B30 3QY, UK
| | - Niyati Sachdeva
- Birmingham Community Healthcare NHS Trust, Birmingham Learning Disability Service, The Greenfields, 30 Brookfield Road, Birmingham, B30 3QY, UK
| | - Nick Tarrant
- Birmingham Community Healthcare NHS Trust, Birmingham Learning Disability Service, The Greenfields, 30 Brookfield Road, Birmingham, B30 3QY, UK
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Matthews DC, Lukic AS, Andrews RD, Marendic B, Brewer J, Rissman RA, Mosconi L, Strother SC, Wernick MN, Mobley WC, Ness S, Schmidt ME, Rafii MS. Dissociation of Down syndrome and Alzheimer's disease effects with imaging. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016. [PMID: 28642933 PMCID: PMC5477635 DOI: 10.1016/j.trci.2016.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction Down Syndrome (DS) adults experience accumulation of Alzheimer's disease (AD)–like amyloid plaques and tangles and a high incidence of dementia and could provide an enriched population to study AD-targeted treatments. However, to evaluate effects of therapeutic intervention, it is necessary to dissociate the contributions of DS and AD from overall phenotype. Imaging biomarkers offer the potential to characterize and stratify patients who will worsen clinically but have yielded mixed findings in DS subjects. Methods We evaluated 18F fluorodeoxyglucose positron emission tomography (PET), florbetapir PET, and structural magnetic resonance (sMR) image data from 12 nondemented DS adults using advanced multivariate machine learning methods. Results Our results showed distinctive patterns of glucose metabolism and brain volume enabling dissociation of DS and AD effects. AD-like pattern expression corresponded to amyloid burden and clinical measures. Discussion These findings lay groundwork to enable AD clinical trials with characterization and disease-specific tracking of DS adults.
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Affiliation(s)
| | | | | | | | - James Brewer
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Robert A Rissman
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Lisa Mosconi
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY, USA
| | - Stephen C Strother
- ADM Diagnostics, Northbrook, IL, USA.,Rotman Research Institute, Baycrest Hospital and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Miles N Wernick
- ADM Diagnostics, Northbrook, IL, USA.,Departments of Electrical and Computer Engineering and Biomedical Engineering, Medical Imaging Research Center, Illinois Institute of Technology, Chicago, IL, USA
| | - William C Mobley
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Seth Ness
- Janssen Research and Development LLC, Raritan, NJ, USA
| | | | - Michael S Rafii
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, USA
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Gutman M, Moskovic E, Jeret JS. Computerised cognitive testing of individuals with Down's syndrome and Alzheimer's disease. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:179-181. [PMID: 26373353 DOI: 10.1111/jir.12227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 08/15/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Although Alzheimer's disease neuropathology is present by age 40 years, in Down's syndrome, ante-mortem diagnosis is difficult. No standard for cognitive assessment is well established or easy to administer. METHOD We used a simple, widely available computerised test (NeuroTrax Moderate to Severe Impairment Assessment Battery, Mindstreams, Newark, NJ) to evaluate 14 patients in this population. Orientation, memory, executive function, verbal function and visual spatial function were evaluated every 6 months for 18 months. RESULTS Mean scaled scores in this longitudinal study were evaluated with repeated measures analysis of variance. Memory, executive function, verbal function and visual spatial function scores did not significantly change. There was no significant depression or anxiety on self-reported measures. CONCLUSIONS Reproducibility of test results supports the reliability of this battery to quantify function and prospectively follow performance in this population over an 18-month period.
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Affiliation(s)
| | - Ethan Moskovic
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Joseph S Jeret
- Neurology, Mercy Medical Center, Rockville Centre, NY, USA
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43
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Rafii MS, Wishnek H, Brewer JB, Donohue MC, Ness S, Mobley WC, Aisen PS, Rissman RA. The down syndrome biomarker initiative (DSBI) pilot: proof of concept for deep phenotyping of Alzheimer's disease biomarkers in down syndrome. Front Behav Neurosci 2015; 9:239. [PMID: 26441570 PMCID: PMC4568340 DOI: 10.3389/fnbeh.2015.00239] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/21/2015] [Indexed: 12/24/2022] Open
Abstract
To gain further knowledge on the preclinical phase of Alzheimer’s disease (AD), we sought to characterize cognitive performance, neuroimaging and plasma-based AD biomarkers in a cohort of non-demented adults with down syndrome (DS). The goal of the down syndrome biomarker Initiative (DSBI) pilot is to test feasibility of this approach for future multicenter studies. We enrolled 12 non-demented participants with DS between the ages of 30–60 years old. Participants underwent extensive cognitive testing, volumetric MRI, amyloid positron emission tomography (PET; 18F-florbetapir), fluorodeoxyglucose (FDG) PET (18F-fluorodeoxyglucose) and retinal amyloid imaging. In addition, plasma beta-amyloid (Aβ) species were measured and Apolipoprotein E (ApoE) genotyping was performed. Results from our multimodal analysis suggest greater hippocampal atrophy with amyloid load. Additionally, we identified an inverse relationship between amyloid load and regional glucose metabolism. Cognitive and functional measures did not correlate with amyloid load in DS but did correlate with regional FDG PET measures. Biomarkers of AD can be readily studied in adults with DS as in other preclinical AD populations. Importantly, all subjects in this feasibility study were able to complete all test procedures. The data indicate that a large, multicenter longitudinal study is feasible to better understand the trajectories of AD biomarkers in this enriched population. This trial is registered with ClinicalTrials.gov, number NCT02141971.
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Affiliation(s)
- Michael S Rafii
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UC San Diego School of Medicine, University of California, San Diego La Jolla, CA, USA
| | - Hannah Wishnek
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UC San Diego School of Medicine, University of California, San Diego La Jolla, CA, USA
| | - James B Brewer
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UC San Diego School of Medicine, University of California, San Diego La Jolla, CA, USA
| | - Michael C Donohue
- Department of Neurology, University of Southern California Los Angeles, CA, USA
| | - Seth Ness
- Janssen Research and Development LLC Titusville, NJ, USA
| | - William C Mobley
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UC San Diego School of Medicine, University of California, San Diego La Jolla, CA, USA
| | - Paul S Aisen
- Department of Neurology, University of Southern California Los Angeles, CA, USA
| | - Robert A Rissman
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UC San Diego School of Medicine, University of California, San Diego La Jolla, CA, USA
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44
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Janicki MP, Keller SM. Why do we need national guidelines for adults with intellectual disability and dementia? ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 1:325-7. [PMID: 27239513 PMCID: PMC4878319 DOI: 10.1016/j.dadm.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew P Janicki
- University of Illinois at Chicago, USA; National Task Group on Intellectual Disability and Dementia Practices, USA
| | - Seth M Keller
- National Task Group on Intellectual Disability and Dementia Practices, USA; American Academy of Developmental Medicine and Dentistry, USA
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Bishop KM, Hogan M, Janicki MP, Keller SM, Lucchino R, Mughal DT, Perkins EA, Singh BK, Service K, Wolfson S. Guidelines for dementia-related health advocacy for adults with intellectual disability and dementia: National Task Group on Intellectual Disabilities and Dementia Practices. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 53:2-29. [PMID: 25633379 DOI: 10.1352/1934-9556-53.1.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increasing numbers of adults with intellectual disabilities (ID) are living into old age. Though this indicates the positive effects of improved health care and quality of life, the end result is that more adults with ID are and will be experiencing age-related health problems and also exhibiting symptoms of cognitive impairment and decline, some attributable to dementia. Early symptoms of dementia can be subtle and in adults with ID are often masked by their lifelong cognitive impairment, combined with the benign effects of aging. A challenge for caregivers is to recognize and communicate symptoms, as well as find appropriate practitioners familiar with the medical issues presented by aging adults with lifelong disabilities. Noting changes in behavior and function and raising suspicions with a healthcare practitioner, during routine or ad hoc visits, can help focus the examination and potentially validate that the decline is the result of the onset or progression of dementia. It can also help in ruling out reversible conditions that may have similar presentation of symptoms typical for Alzheimer's disease and related dementias. To enable caregivers, whether family members or staff, to prepare for and advocate during health visits, the National Task Group on Intellectual Disabilities and Dementia Practices has developed guidelines and recommendations for dementia-related health advocacy preparation and assistance that can be undertaken by provider and advocacy organizations.
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Janicki MP, Keller SM. Viability of a Dementia Advocacy Effort for Adults with Intellectual Disability: Using a National Task Group Approach. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2014. [DOI: 10.1111/jppi.12085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Seth M. Keller
- American Academy of Developmental Medicine and Dentistry; Lumberton NJ USA
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Abstract
PURPOSE OF REVIEW Dementia is emerging as a significant condition in the population with intellectual disability. This review is aimed at clinicians working in the field. We revisit what is known on the subject and expand on this with results from recent research. The emphasis of this review is on the clinical research rather than laboratory or molecular research. RECENT FINDINGS Research has encompassed all aspects of dementia in intellectual disability, from epidemiology, assessment and diagnosis, through to management. There remains a lack of evidence concerning both pharmacological and nonpharmacological treatment of dementia in people with intellectual disability. Recent research has tended to focus on dementia in Down syndrome. SUMMARY More research is necessary in order to translate improvements in the understanding of the neuropathology of intellectual disability and dementia into effective treatments. There is also a need to investigate the optimum environment in which to provide holistic care for individuals affected.
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