Dementia is a common problem for older patients with Down's syndrome (Trisomy 21).


The most common form of dementia in these patients is Alzheimer's disease (AD). Accumulation of beta-amyloid with plaques and neurofibrillary tangles is seen in the brains of almost all patients with Down's syndrome, often starting at a young age.


Risk factors for early onset of Alzheimer's disease may include:

(1) parents with Alzheimer's disease

(2) one or two apoE epsilon 4 alleles

(3) male gender

(4) estrogen deficiency (in women)


Clinical findings which may precede or accompany the onset of AD:

(1) depression

(2) seizures

(3) increased levels of beta-amyloid(1-42) in the plasma


Other forms of cognitive impairment may also occur, including:

(1) dementia with Lewy bodies (DLB), which is associated with psychosis

(2) depression with pseudodementia

(3) complications of head trauma

(4) medications

(5) vascular infarcts secondary to underlying cardiac disease


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