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The challenges of diagnosis and treatment of dementia in Down’s syndrome

Published online by Cambridge University Press:  03 February 2016

R. M. Vaughan Open the ORCID record for R. M. Vaughan [Opens in a new window] ,
C. McGee ,
S. Guerin ,
J. Tyrrell  and
P. Dodd
R. M. Vaughan*
Affiliation:
Department of Old Age Psychiatry, St Ita’s Hospital, Portrane, Co. Dublin, Ireland
C. McGee
Affiliation:
Department of Psychiatry, Our Lady’s Hospital, Navan, Co. Meath, Ireland
S. Guerin
Affiliation:
School of Psychology, Centre for Disability Studies, University College Dublin, Dublin, Ireland
J. Tyrrell
Affiliation:
St Michael’s House Intellectual Disability Service, Dublin, Ireland
P. Dodd
Affiliation:
St Michael’s House Intellectual Disability Service, Dublin, Ireland School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
*
*Address for correspondence: Dr R. M. Vaughan, Department of Old Age Psychiatry, St Ita’s Hospital, Portrane, Co. Dublin, Ireland. (Email: roisvaughan@gmail.com)
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Abstract

Objectives

People with Down syndrome (DS) are at high risk for developing dementia and early diagnosis is vital in enhancing quality of life. Our aim was to compare our practice to consensus recommendations on evaluation, diagnosis and pharmacological treatment of individuals with DS who develop dementia. We also aimed to establish the average time taken to make a diagnosis of dementia and to commence pharmacotherapy, and to assess tolerability to acetylcholinesterase inhibitors.

Methods

Retrospective chart review in an exhaustive sample containing all current service users attending our service with DS and a diagnosis of dementia (n=20).

Results

The sample was 75% female and 70% had a moderate intellectual disability. The average age at diagnosis of dementia was 52.42 years old. The average time to diagnosis from first symptom was 1.13 years and the average time to commence pharmacotherapy was 0.23 years. A total of 17 patients commenced on acetylcholinesterase inhibitors, and of these seven discontinued medication due to side-effects or lack of efficacy.

Conclusions

The results on anticholinesterases add to the limited pool of data on treatment of dementia in DS. There was an identified need to improve the rates of medical, vision and hearing assessments, and prospective screening. Deficiencies in screening and diagnosis may be addressed by implementing a standardised dementia assessment pathway to include prospective screening and longitudinal assessment using easily administered scales. We highlight the importance of improving the diagnostic process, as a vital window of opportunity to commence a comprehensive care plan may be lost.

Keywords

Acetylcholinesterase inhibitorsAlzheimer’s diseasedementiaDown syndromeintellectual disability
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 3 , September 2016 , pp. 151 - 158
Copyright
© College of Psychiatrists of Ireland 2016 

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