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Medical Author:

Norberto Alvarez, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In people with Down syndrome, the first symptoms usually develop at age 50 years, and the disease is usually diagnosed by age 52 years. Death occurs at an average age of 60.11 years. The time from the first symptoms of Alzheimer's disease to death is usually about 9 years.

Symptoms of the early stage of Alzheimer's disease

• The main symptoms are confusion, disorientation, and wandering. These early signs are not usually recognized and are commonly misdiagnosed.
• Behavioral changes also occur.
  • Early behavior changes that are truly related to Alzheimer's disease are often seen as an exaggeration of the person's normal traits. For example, the person may refuse to follow certain directions or to do chores because of Alzheimer's-related mental changes, but this refusal may be perceived as stubbornness.
  • Because these early changes are hard to recognize, only those familiar with the individual notice these changes. Changes can include change in daily routine, change in sleeping or eating habits, inability to make decisions about clothing, getting lost in familiar environments, and inability to remember the names of familiar people.
  • Another early sign of Alzheimer's disease in highly functional individuals with Down syndrome is the inability to perform job duties.
• Visual problems can develop in the early stages of Alzheimer's disease. Because of these visual problems combined with the cognitive and memory deficits, individuals with Down syndrome:
  • can get lost in familiar environments,
  • may not be able to perform certain activities,
  • may have accidents and falls, and
  • may have difficulty learning new tasks.
• Learning is usually impaired, but it is difficult to demonstrate in people with greater disability related to Down syndrome.
• Other early signs include loss of language and other communication skills, impairment of social skills, and progressive loss of "activities of daily living" (ADL) (for example, personal hygiene, dining skills, bathroom skills).

Symptoms of the middle stage of Alzheimer's disease

• ADL markedly deteriorate. The patient may depend totally on others for activities such as dressing, eating, walking, and toilet needs.
• Communication is reduced.
• Any behavioral problems are usually exaggerated, and psychotic behavior may develop. Social activities are reduced to a minimum.

Symptoms of the advanced stage of Alzheimer's disease

• People with Down syndrome and advanced Alzheimer's disease seem almost to be in a coma.
• They totally depend on others and interact minimally with the environment.

Physical symptoms of Alzheimer's disease are similar to those in people without Down syndrome and include the following:

• Motor disorders may be observed in the early stage but become obvious in the middle stage of the disease. Walking becomes difficult, and in the advanced stage, the person is confined to bed and has almost no voluntary movements.
• Eating disorders may be observed at the beginning of the disease but are more obvious in the middle stage. The person has problems swallowing and frequently chokes.
• Epileptic seizures can develop.

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