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Transitions in Aging

Aging with Developmental Disabilities

Associated Conditions: Down Syndrome

Photo of married couple with Down Syndrome

  • Be alert for signs of vision problems and hearing loss
  • Watch for signs of fatigue and decreased endurance
  • Alzheimer's Disease
      - Annual screening beginning at age 35
  • Seizure
  • Depression
  • Other conditions: Obstructive sleep apnea, osteoarthritis, osteoporosis, Celiac disease, cervical spine concerns


NEXT: Associated Conditions: Cerebral Palsy


Notes and References

At this point, we have reviewed the definition of successful aging and discussed some behaviors that can contribute to the increased risk of developing secondary conditions in individuals aging with a developmental disability. We will further discuss some health challenges older adults with Down syndrome and cerebral palsy may face during their aging process.



Previous literature has suggested that individuals with Down syndrome may experience accelerated aging and show biological age-related changes 20 to 30 years earlier than the general population.1 For example, they may experience vision problems (e.g., cataracts, refractive errors, strabismus) and a degree of hearing loss in their 40s.1 As people with Down syndrome may have difficulties expressing or comprehending these age-related changes, it is recommended that support staff and family members monitor signs related to vision and hearing issues in order to identify proper assistive technology devices to maintain their ability for independent living and to seek professional help when needed.

Here are some signs we should pay attention to: if the individual frequently rubs or squints eyes when reading materials or watching TV, these might be the signs of having visual problems. Also, if the individual moves closer to the TV or tilts their head forward when reading, these could be signs of vision issues as well. Similarly, if the individual turns up the television volume, speaks loudly, or shows confusion during a conversation, these might be signs of hearing issues. Furthermore, another clue may be that the individual stops participating in activities that they previously enjoyed.

Next, individuals with Down syndrome are at a greater risk for developing thyroid diseases. In a 1990 study, the research found that 40% of their adults participants (ages ranging from 20 to 67 years) showed thyroid dysfunctions, with a hypothyroid condition being more common.2 It's important to know that if the hypothyroidism goes untreated, it could affect one's cognitive ability; therefore, there are risks for being misdiagnosed as having Alzheimer's disease. The frequently observed symptoms of hypothyroidism include decrease energy and motivation.3 Furthermore, it's known that individuals with Down syndrome have increased risks of cardiovascular diseases. Smith (2001) estimated that 57% of adults with Down syndrome have been diagnosed with mitral valve prolapse.4 While this condition may not be life threatening, individuals with mitral valve prolapse are at a greater risk for heart failure and cerebrovascular accident.3 The symptoms of mitral valve prolapse are fatigue and decreased endurance, which are similar to the early signs of hypothyroidism.

Third, early symptoms of Alzheimer's disease in older individuals with Down syndrome are similar to those in the general population, including loss of logical thinking and memory, confusion with time/place, diminished abilities to carry out everyday tasks, withdrawal from social activities, and changes in gait and body coordination. However, individuals with Down syndrome reported an early onset of dementia. Several studies documented the occurrence of the onset of dementia in adults with Down syndrome in their 30s, while the average age of dementia onset was 65 for the general population.5 In a study conducted in the Netherlands, the prevalence of dementia for individuals with Down syndrome under the age of 45 was 16.8%, and this rate rose to 32% in individuals aged between 55 to 59 years.6 Additionally, it was found that this population experienced a more rapid disease-related decline in function and showed a higher mortality from dementia and Alzheimer's disease, compared to the general population.7 Therefore, it's recommended for this population to receive dementia screening annually and to monitor for the signs of dementia starting at the age of 35.8

Click on the resources tab if you are interested in learning about the tools for dementia screening.

Walker and his colleague (2011) reviewed 30 articles related to depression and individuals with Down syndrome and reported that the prevalence of depression in this population ranges from 0% to 11%.9 They pointed out, however, that the signs of depression, such as low energy, decreased motivation, weight gain, and increased sleep disturbance, are similar to symptoms of Alzheimer's disease and hypothyroidism; therefore, one could have depression, yet be misdiagnosed as having Alzheimer's disease or having hypothyroidism.

Lott (2012) found a correlation between seizures and Alzheimer's disease in adults with Down syndrome.10 He reported that the increased occurrence of seizures might be related to Alzheimer's disease as 10-20% of individuals with Alzheimer's disease develop seizures.

Finally, some other conditions reported by aging individuals with Down syndrome are obstructive sleep apnea, osteoarthritis, osteoporosis, Celiac disease, cervical spine concerns.11-12

References:

  1. Strax, T. E., Luciano, L., Dunn, A. M., & Quevedo, J. P. (2010). Aging and developmental disability. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 419-427.
  2. Dinani, S. & Carpenter, S. (1990). Down syndrome and thyroid disease. Journal of Mental Deficiency Research, 34, 187-193.
  3. Barnhart, R. C., & Connolly, B. (2007). Aging and Down syndrome: Implications for physical therapy. Physical Therapy, 87(10), 1399-1406.
  4. Smith, D. S. (2001). Health care management of adults with Down syndrome. American Family Physician, 64, 1031-1038.
  5. Janicki, M. P., & Dalton, A. J. (2000). Prevalence of dementia and impact on intellectual disability services. Mental Retardation, 38(3), 276-288.
  6. Coppus, A., Evenhuis, H., Verberne, G. J., Visser, F., Van Gool, P., Eikelenboom, P., & Van Duijin, C. (2006). Dementia and mortality in persons with Down's syndrome. Journal of Intellectual Disability Research, 50(10), 768-777.
  7. Tyrer, F., & McGrother, C. (2009). Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disability. Journal of Intellectual Disability Research, 53(11), 898-904.
  8. Philadelphia Coordinated Health Care. (2015). PCHC health care projects. Retrieved from: https://www.pchc.org/about-us/pchc-initiatives
  9. Walker, J. C., Dosen, A., Buitelaar, J. K., & Janzing, J. G. E. (2011). Depression in Down syndrome: A review of the literature. Research in Developmental Disabilities, 32(5), 1432-1440.
  10. Lott, I. T. (2012). Down syndrome and dementia: Seizures and cognitive decline. Journal of Alzheimer's disease, 29, 177-185.
  11. Lal, C., White, D. R., Joseph, J. E., van Bakergem, K., & LaRosa, A. (2015). Sleep-disordered breathing in Down syndrome. Chest, 147(2), 570-579. doi: http://dx.doi.org/10.1378/chest.14-0266
  12. Charlot, L., Abend, S., Ravin, P., Mastis, K., Hunt, A., & Deutsch, C. (2011). Non-psychiatric health problems among psychiatric inpatients with intellectual disabilities. Journal of Intellectual Disability Research, 55(2), 199-209. doi: 10.1111/j.1365-2788.2010.01294.x