Psych · intellectual-disability
Down syndrome and mental health
Also known as Trisomy 21 psychiatry · Down syndrome depression · Down syndrome Alzheimer dementia · DS-AD · Down syndrome mental ill-health · Dementia in Down syndrome · CAMDEX-DS · DSQIID
Exam-exhaustive Down syndrome mental health for FRANZCP and global boards: behavioural phenotype, depression versus Alzheimer dementia, medical confounders, adapted assessment and dementia tools, start-low go-slow psychopharmacology, capacity and dementia-capable services.
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Red flags
- New functional decline in adult Down syndrome without excluding depression, hypothyroidism, sensory loss, sleep apnoea, pain and medication effects
- Assuming Alzheimer dementia is the only explanation for mid-life behavioural change
- Food or fluid refusal, suicide risk or severe self-neglect in suspected depression
- New seizure or rapid fluctuating confusion — medical emergency pathway, not behaviour alone
- Diagnostic overshadowing: attributing all new behaviour to 'just Down syndrome'
- Antipsychotics as first-line for communication-driven behaviour without medical screen or functional analysis
Meet the patient
A 48-year-old woman with Down syndrome is brought by her supported-living carer. Over three months she has stopped joining the group for meals, speaks less, has lost weight, and sits alone in her room for hours. Her mother died eight months ago. The carer's first sentence is: "I think it's the Alzheimer's."[3][8]
Two questions dominate the viva: is this depression or dementia — and what reversible causes have you excluded today? The temptation to leap straight to "Alzheimer's" is exactly the trap this topic exists to dismantle.[2][3][8]
References12ShowHide
- [1]Antonarakis SE, Skotko BG, Rafii MS, et al. Down syndrome Nat Rev Dis Primers, 2020.PMID 32029743
- [2]Zigman WB, Lott IT Alzheimer's disease in Down syndrome: neurobiology and risk Ment Retard Dev Disabil Res Rev, 2007.PMID 17910085
- [3]Holland AJ, Hon J, Huppert FA, Stevens F, Watson P Population-based study of the prevalence and presentation of dementia in adults with Down's syndrome Br J Psychiatry, 1998.PMID 9828989
- [4]Fortea J, Vilaplana E, Carmona-Iragui M, et al. Clinical and biomarker changes of Alzheimer's disease in adults with Down syndrome: a cross-sectional study Lancet, 2020.PMID 32593336
- [5]Ball SL, Holland AJ, Huppert FA, Treppner P, Watson P, Hon J The modified CAMDEX informant interview is a valid and reliable tool for use in the diagnosis of dementia in adults with Down's syndrome J Intellect Disabil Res, 2004.PMID 15312062
- [6]Deb S, Hare M, Prior L, Bhaumik S Dementia screening questionnaire for individuals with intellectual disabilities Br J Psychiatry, 2007.PMID 17470960
- [7]Mantry D, Cooper SA, Smiley E, et al. The prevalence and incidence of mental ill-health in adults with Down syndrome J Intellect Disabil Res, 2008.PMID 18197953
- [8]Walker JC, Dosen A, Buitelaar JK, Janzing JG Depression in Down syndrome: a review of the literature Res Dev Disabil, 2011.PMID 21392935
- [9]Myers BA, Pueschel SM Psychiatric disorders in persons with Down syndrome J Nerv Ment Dis, 1991.PMID 1833506
- [10]Krinsky-McHale SJ, Zigman WB, Lee JH, et al. Promising outcome measures of early Alzheimer's dementia in adults with Down syndrome Alzheimers Dement (Amst), 2020.PMID 32647741
- [11]Dykens EM Measuring behavioral phenotypes: provocations from the "new genetics" Am J Ment Retard, 1995.PMID 7779347
- [12]Bayen E, Possin KL, Chen Y, Cleret de Langavant L, Yaffe K Prevalence of Aging, Dementia, and Multimorbidity in Older Adults With Down Syndrome JAMA Neurol, 2018.PMID 30032260