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Symptoms and Signs of Alzheimer's Disease in Individuals With Down Syndrome

Doctor's Notes on Alzheimer's Disease in Individuals with Down Syndrome

Alzheimer's disease (AD) is the most common cause of dementia, a brain disorder that interferes with a person's ability to carry out everyday activities. It is a progressive, degenerative brain disorder. Down syndrome is a genetic disorder in which a person has extra genes because of extra chromosome 21 material, which causes delays and limitations in physical and intellectual development. People with Down syndrome have a higher risk for developing Alzheimer's disease.

The main symptoms of Alzheimer's disease in individuals with Down syndrome include confusion, disorientation, and wandering. Other symptoms of Alzheimer's disease in individuals with Down syndrome include behavior changes, inability to perform job duties in those who are higher functioning, visual problems, cognitive and memory deficits, can get lost in familiar environments, impaired learning, loss of language and communication skills, impaired social skills, and progressive loss of ability to perform daily tasks. As Alzheimer's disease progresses, symptoms in individuals with Down syndrome include total dependence on others for dressing, eating, walking, and toilet needs; reduced communication; exaggerated behavioral problems; and psychotic behavior. Physical symptoms of Alzheimer's disease are similar to those in people without Down syndrome and include motor disorders, difficulty walking, eating disorders, problems swallowing (which can lead to choking), and epileptic seizures.

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 3/11/2019

Alzheimer's Disease in Individuals with Down Syndrome Symptoms

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.

Picture of a brain with Alzheimer's disease.
Picture of a brain with Alzheimer's disease. Click to view larger image.

Dementia, Alzheimer's Disease, and Aging Brains Slideshow

Dementia, Alzheimer's Disease, and Aging Brains Slideshow

In 1906 Auguste Deter, a woman in her early 50s, became the first person diagnosed with Alzheimer's disease, a form of dementia. The disease is named after the doctor who first described it, Alois Alzheimer. The disease is characterized by odd behavior, memory problems, paranoia, disorientation, agitation, and delusions. After Deter’s death, Alzheimer performed a brain autopsy and discovered dramatic shrinkage and abnormal deposits in and around nerve cells.

In 1910 the term “Alzheimer’s Disease” was formally used. In 1974 Congress established the National Institute on Aging (NIA), the primary federal agency supporting Alzheimer’s research.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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