Age of Alzheimer's disease diagnosis in people with Down syndrome and associated factors: Results from the Horizon 21 European Down syndrome consortium.

INTRODUCTION: People with Down syndrome (DS) have high risk of developing Alzheimer's disease (AD). This study examined mean ages of AD diagnosis and associations with co-occurring conditions among adults with DS from five European countries. METHODS: Data from 1335 people with DS from the Horizon 21 European DS Consortium were used for the analysis. RESULTS: Mean ages of AD diagnosis ranged between 51.4 (SD 7.0) years (United Kingdom) and 55.6 (SD 6.8) years (France). Sleep-related and mental health problems were associated with earlier age of AD diagnosis. The higher number of co-occurring conditions the more likely the person with DS is diagnosed with AD at an earlier age. DISCUSSION: Mean age of AD diagnosis in DS was relatively consistent across countries. However, co-occurring conditions varied and impacted on age of diagnosis, suggesting that improvements can be made in diagnosing and managing these conditions to delay onset of AD in DS. HIGHLIGHTS: Mean age of AD diagnosis was relatively consistent between countries Sleep problems and mental health problems were associated with earlier age of AD diagnosis APOE ε4 carriers were diagnosed with AD at an earlier age compared to non-carriers Number of co-occurring conditions was associated with earlier age of AD diagnosis No differences between level of intellectual disability and mean age of AD diagnosis.

Factors associated with non-completion of and scores on physical capability tests in health surveys: The North Health in Intellectual Disability Study.

BACKGROUND: This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities. METHOD: Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests. RESULTS: The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < .001) and lower BMI (OR = 0.859, p = .001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity. CONCLUSIONS: Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.

Perspectives on family caregiving of people aging with intellectual disability affected by dementia: Commentary from the International Summit on Intellectual Disability and Dementia.

This article, an output of the 2016 International Summit on Intellectual Disability and Dementia, examines familial caregiving situations within the context of a support-staging model for adults with intellectual disability (ID) affected by dementia. Seven narratives offer context to this support-staging model to interpret situations experienced by caregivers. The multidimensional model has two fundamental aspects: identifying the role and nature of caregiving as either primary (direct) or secondary (supportive); and defining how caregiving is influenced by stage of dementia. We propose staging can affect caregiving via different expressions: (1) the "diagnostic phase," (2) the "explorative phase," (3) the "adaptive phase," and (4) the "closure phase." The international narratives illustrate direct and indirect caregiving with commonality being extent of caregiver involvement and attention to the needs of an adult with ID. We conclude that the model is the first to empirically formalize the variability of caregiving within families of people with ID that is distinct from other caregiving groups, and that many of these caregivers have idiosyncratic needs. A support-staging model that recognizes the changing roles and demands of carers of people with ID and dementia can be useful in constructing research, defining family-based support services, and setting public policy.

[A community short-term crisis unit does not reduce acute admissions to psychiatric wards]. / Krisepost ved distriktspsykiatrisk senter reduserer ikke akuttinnleggelser i sykehus.

BACKGROUND: Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. MATERIAL AND METHODS: The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. RESULTS: 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). INTERPRETATION: None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.

[Can psychiatric acute teams reduce acute admissions to psychiatric wards?]. / Kan psykiatrisk akutteam redusere bruk av akuttplasser ved sykehus?

BACKGROUND: Treatment by psychiatric acute teams - as an alternative to admission in psychiatric acute wards - has been introduced in Norway, based on positive experience in other countries. The effect of establishing such acute teams in Norway has not been studied. In January 2004, Notodden/Seljord Community Mental Health Centre established an acute team for one part of their catchment area. MATERIAL AND METHODS: The material consists of information on the patients admitted to the acute ward in the psychiatric hospital Sykehuset Telemark from area 1 (with an acute team) and from area 2 (without an acute team) in 2003 and 2004, and on all patients treated by the acute team in 2004. RESULTS: From 2004 to 2003, admissions to the acute ward at Sykehuset Telemark decreased by 25 % from Area 1 and by 13 % from Area 2. The acute team treated 22 patients, of whom five were admitted as in-patients at the community mental health centre. Most of the patients with psychosis or severe depression were admitted to the acute hospital ward. INTERPRETATION: An acute team in a well-staffed community mental health centre may contribute to less use of acute admissions to psychiatric wards by treating patients with moderately severe disorders, while patients with the most severe disorders are still admitted to acute psychiatric wards.

International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans.

The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.