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Risk Factors for Alzheimer's Disease Among People With Developmental Disabilities
Aging and Developmental Disabilities
The population of the United States is living longer. The same is true for persons with developmental disabilities. In 1970, about 11% of persons with developmental disabilities were over the age of fifty-five. It is estimated that this number will double by 2040.
Alzheimer’s disease is a disorder that is progressive and degenerative. It is marked by a gradual decline in brain function that worsens with time. Research indicates that approximately 10% of persons over the age of sixty-five exhibit symptoms of Alzheimer’s disease. Some persons with developmental disabilities may be at increased risk for Alzheimer’s disease and concurrent loss of skills and functioning.
Symptoms of Alzheimer's Disease
During the onset stage of Alzheimer’s, symptoms appear very gradually. Difficulty in finding the right words and declining ability to name familiar objects mark the earliest stage of the disease. Changes in behavior and job performance may become evident.
In the second stage of the disease, symptoms become more pronounced. This stage, also called the progressive stage, is marked by a significant decline in skills. Incontinence may become an increasing problem. Loss of sense of time and place is manifested by an inability to understand or follow instructions. Confusion and disorientation may lead to frustration. Significant personality changes, characterized by paranoia and delusions, may emerge.
The terminal or third stage of Alzheimer’s disease results in substantial loss of the most basic skills such as eating and drinking. Memory for both short and long term is nearly nonexistent. Loss of skills and resulting inactivity, including the need for total care, may result in increased health risks and lead to death.
It should be noted that many disorders other than Alzheimer’s disease can cause some of the symptoms described above. Conditions such as stroke, depression and head trauma, for example, are treatable. When any of the symptoms above are noticed, a thorough medical evaluation must be the first step.
Risk Factors
In general, people with a developmental disability are at no greater risk for developing Alzheimer’s disease than anyone else in the population. However, if any of the following are present, then there is an increased risk.
- If the person has Down syndrome and is over 40 years old.
- If the person has had a serious head trauma.
- If the person has a family history of Alzheimer’s disease.
The New York State Institute for Basic Research in Developmental Disabilities estimates that 2-3% of persons over age forty who have a developmental disability will develop Alzheimer’s disease. Of that number, about 60% have Down syndrome. Persons with Down syndrome are also at increased risk for early hearing and vision changes associated with aging.
Evaluation
When a person with a developmental disability is suspected to have Alzheimer’s disease a complete medical evaluation needs to be done. This may be accomplished during a consumer’s annual physical examination. The physician can determine the need for additional tests and screening and make referrals accordingly. The Arc provides advocacy and support for persons with developmental disabilities and their friends and families. This organization has published some articles to assist in the understanding of aging and developmental disabilities, such as the effects on hearing and vision loss. Another of those articles details the risk for Alzheimer’s disease. Some of the recommendations in the article include the following items that should be discussed with a physician. Ask whether further evaluation would be helpful. The physician may suggest:
- Physical and neurological tests including sensory-motor testing.
- A mental status examination to determine orientation, recall and skill status, dependent on the person’s degree of disability.
- Psychiatric screening to rule out a possible mental health disorder.
- Routine laboratory tests.
The purpose of the evaluation is to determine if the observed changes are attributable to any other cause and treat it. These evaluations and tests may be done over a period of time as symptoms are observed and not necessarily all at once. If no other cause is found, continued observation, annual physicals and other measures should be used to determine changes in skills. Alzheimer’s disease may take eight to ten years to develop and during that period it is important to provide supports for the individual so that they can remain as independent as possible.
There are many web sites of interest to the clinical profession who wishes to know more about aging and developmental disabilities. The Alzheimer’s Association may be accessed through the links at the bottom of the Homepage of this web site. The Arc has a detailed article about the disease located at http://thearc.org/misc/alzbk.html.
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