Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort.

BACKGROUND: To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity. METHODS: We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity. RESULTS: Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity. CONCLUSIONS: The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

Compulsions in Prader-Willi syndrome: occurrence and severity as a function of genetic subtype.

INTRODUCTION: Compulsions are among the most typical behaviors in Prader-Willi syndrome (PWS). The most frequent causes of PWS are deletion of the genes located in the segment 15q11-q13 of the paternal allele and maternal uniparental disomy of cromosome 15. The aim of the present work was to study compulsive behavior in a sample of adults with PWS and analyze potential differences as a function of the genetic cause/subtype. MATERIAL AND METHODS: In the 27 study participants, existence of type I deletion (n=7), type II deletion (n=13), and maternal disomy (n=7) was determined by means of genetic tests. The Yale-Brown Obsessive Compulsive Scale, the Compulsive Behavior Checklist, and the Repetitive Behavior Questionnaire were used to assess occurrence and severity of compulsions. RESULTS: Most of the participants showed compulsive behavior, the most frequent compulsions were those of inappropriate grooming (skin picking) and order (hoarding). The occurrence of compulsions was less frequent in the maternal disomy group than in the deletion groups. Severe compulsions were more frequent in those participants with type II deletion than in the other groups. CONCLUSIONS: Differences in occurrence and severity of compulsions exist as a function of PWS genetic subtype. Our results support the idea that individuals with maternal disomy are less affected by compulsive behavior. More research on the severity of compulsions as a function of deletion type should be done, as the studies conducted so far have shown contradictory results.

Compulsiones en el síndrome de Prader-Willi: presencia y gravedad en función del subtipo genético / Compulsions in Prader-Willi syndrome: occurrence and severity as a function of genetic subtype

Introducción: Las compulsiones forman parte de las conductas más características del síndrome de Prader-Willi (SPW). Las causas más frecuentes del SPW son la deleción de los genes localizados en el segmento 15q11-q13 del alelo paterno y la disomía uniparental materna del cromosoma 15. El objetivo de este trabajo fue estudiar las conductas compulsivas en una muestra de adultos con SPW y analizar posibles diferencias en función de la causa/subtipo genético. Material y métodos. En los 27 participantes del estudio, la presencia de deleción tipo I (n = 7), deleción tipo II (n = 13), y disomía materna (n = 7) fue determinada mediante pruebas genéticas. La presencia y gravedad de las compulsiones fueron evaluadas mediante los cuestionarios Yale-Brown Ob-sessive Compulsive Scale, Compulsive Behavior Checklist, y Repetitive Behavior Questionnaire. Resultados. La mayoría de los participantes presenta-ba conductas compulsivas, las más frecuentes eran las de cuidado inapropiado (excoriación) y orden (acumulación). La presencia de compulsiones era menor en el grupo con disomía materna que en los grupos de deleción. Las compulsiones graves eran más frecuentes en los participantes con deleción tipo II que en los otros grupos. Conclusiones. Existen diferencias en la presencia y gravedad de compulsiones en función del subtipo genético del SPW. Los resultados apoyan la idea que las personas con disomía materna están menos afectadas por las conductas compulsivas. Hay que seguir investigando sobre la gravedad de las compulsiones en función de los dos tipos de deleción, ya que los hallazgos de los distintos estudios son contradictorios

Introduction: Compulsions are among the most typical behaviors in Prader-Willi syndrome (PWS). The most frequent causes of PWS are deletion of the genes located in the segment 15q11-q13 of the paternal allele and maternal uniparental disomy of cromosome 15. The aim of the present work was to study compulsive behavior in a sample of adults with PWS and analyze potential differences as a function of the genetic cause/subtype. Material and methods. In the 27 study participants, existence of type I deletion (n = 7), type II deletion (n = 13), and maternal disomy (n = 7) was determined by means of genetic tests. The Yale-Brown Obsessive Compulsive Scale, the Compulsive Behavior Checklist, and the Repetitive Behavior Questionnaire were used to assess occurrence and severity of compulsions. Results. Most of the participants showed compulsive behavior, the most frequent compulsions were those of in-appropriate grooming (skin picking) and order (hoarding). The occurrence of compulsions was less frequent in the maternal disomy group than in the deletion groups. Severe compulsions were more frequent in those participants with type II deletion than in the other groups. Conclusions. Differences in occurrence and severity of compulsions exist as a function of PWS genetic subtype. Our results support the idea that individuals with maternal diso-my are less affected by compulsive behavior. More research on the severity of compulsions as a function of deletion type should be done, as the studies conducted so far have shown contradictory results

Traducción y validación de la versión española de la escala Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) / Translation and validation of the Spanish version of the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD)

Introducción: La escala Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) fue creada para evaluar de forma breve el funcionamiento de las personas con trastorno de desarrollo intelectual y problemas de salud mental/trastornos de conducta. El objetivo del presente trabajo fue estudiar las evidencias sobre la validez de las puntuaciones obtenidas con la escala HoNOS-LD traducida al castellano. Material y método: La muestra estaba formada por 111 participantes que fueron evaluados con la HoNOS-LD traducida al castellano y otros cuestionarios relacionados. Para estudiar la fiabilidad entre examinadores y la fiabilidad test-retest, 33 participantes fueron evaluados por 2 examinadores y reevaluados al cabo de 7 días. Resultados: De acuerdo con criterios clínicos y conceptuales, y con el resultado del análisis paralelo, se seleccionó una solución factorial con único factor. La consistencia interna fue buena (coeficiente omega de 0,87). Las fiabilidades entre examinadores y test-retest fueron excelentes (coeficientes de correlación intraclase de 0,95 y 0,98, respectivamente). Las correlaciones entre secciones de la HoNOS-LD y los instrumentos relacionados fueron en el sentido esperado y altamente significativas (p<0,001), y la puntuación HoNOS-LD aumentaba con el nivel de apoyos necesario de los participantes, resultados que aportaron evidencia sobre la validez de asociación con otras variables externas. Conclusiones: La versión en castellano de la HoNOS-LD representa un instrumento breve, válido y fiable, que permitirá la evaluación rutinaria del funcionamiento con distintas finalidades, incluyendo el diagnóstico y la intervención

Introduction: The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is a brief instrument that assesses functioning in people with intellectual development disorder and mental health problems/behaviour disorders. The aim of the present study was to examine the evidence on the validity of the scores based on the Spanish version of the HoNOS-LD. Material and methods: The study included 111 participants that were assessed by the Spanish version of the HoNOS-LD and other questionnaires that measured different variables related to the scale. Thirty-three participants were assessed by 2 examiners, and retested 7 days later, in order to study inter-examiner reliability and test-retest reliabilities. Results: Based on clinical and conceptual criteria, and on the results of the parallel analysis, a factorial solution with one factor was selected. Internal consistency was good (Omega coefficient of 0.87). Inter-examiner and test-retest reliabilities were excellent (intraclass correlation coefficients of 0.95 and 0.98, respectively). Correlations between sections of the HoNOS-LD and the related instruments showed the expected direction, and were highly significant (P<.001), and the HoNOS-LD score increased with the intensity of the support required by the participants. These results showed evidence of the validity of association with other external variables. Conclusions: The Spanish version of the HoNOS-LD is a brief, valid and reliable instrument, which will enable a routine assessment of functioning for different uses, including diagnosis and intervention

Translation and validation of the Spanish version of the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD). / Traducción y validación de la versión española de la escala Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD).

INTRODUCTION: The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is a brief instrument that assesses functioning in people with intellectual development disorder and mental health problems/behaviour disorders. The aim of the present study was to examine the evidence on the validity of the scores based on the Spanish version of the HoNOS-LD. MATERIAL AND METHODS: The study included 111 participants that were assessed by the Spanish version of the HoNOS-LD and other questionnaires that measured different variables related to the scale. Thirty-three participants were assessed by 2 examiners, and retested 7 days later, in order to study inter-examiner reliability and test-retest reliabilities. RESULTS: Based on clinical and conceptual criteria, and on the results of the parallel analysis, a factorial solution with one factor was selected. Internal consistency was good (Omega coefficient of 0.87). Inter-examiner and test-retest reliabilities were excellent (intraclass correlation coefficients of 0.95 and 0.98, respectively). Correlations between sections of the HoNOS-LD and the related instruments showed the expected direction, and were highly significant (P<.001), and the HoNOS-LD score increased with the intensity of the support required by the participants. These results showed evidence of the validity of association with other external variables. CONCLUSIONS: The Spanish version of the HoNOS-LD is a brief, valid and reliable instrument, which will enable a routine assessment of functioning for different uses, including diagnosis and intervention.

Validation and Normalization of the Tower of London-Drexel University Test 2nd Edition in an Adult Population with Intellectual Disability.

Despite how important it is to assess executive functioning in persons with Intellectual Disability (ID), instruments adapted and validated for this population are scarce. This study's primary goal was to find evidence for the validity of the ID version of the Tower of London (TOLDXtm) test in persons with mild (IDMi) and moderate (IDMo) levels of ID with Down Syndrome (DS). A multicenter study was carried out. Subjects (n = 63, ≥ 39 years old) had DS with mild (n = 39) or moderate ID (n = 24) with no minor neurocognitive disorder or Alzheimer's disease. Assessment protocol: TOLDXtm for ID, Kaufman Brief Intelligence Test Second Edition (K-BIT II), Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), Weigl's Color-Form Sorting Test (WCFST), Barcelona Test for Intellectual Disability (BT-ID), and the Behavior Rating Inventory of Executive Function (BRIEF-P). The internal consistency (IDMi and IDMo), factor structure of the different subscales, and relationship between TOLDXtm subscales and other cognitive measures (BT-ID, WCFST, and BRIEF-P) were analyzed. A normative data table with ID population quartiles is provided. TOLDXtm for ID showed a robust one factor structure and coherentassociations with other, related neuropsychological instruments. Significant differences between IDMi and IDMo on movement-related variables like Correct (Corr; p = .002) and Moves (Mov; p = .042) were observed, along with good internal consistency values, Corr (α = .75), Mov (α = .52). Regarding internal consistency, no between-groups differences were observed (all p-value > 0.05). The TOLDXtm for ID is thus an instrument, supported by good validity evidence, to evaluate problem-solving and planning in ID. It distinguishes between individuals with mild and moderate ID, and is highly associated with other measures of executive functioning.

Test Barcelona para discapacidad intelectual: un nuevo instrumento para la valoración neuropsicológica clínica de adultos con discapacidad intelectual / Barcelona Test for Intellectual Disability: a new instrument for the neuropsychological assessment of adults with intellectual disability

Introducción. La evaluación neuropsicológica en las personas con discapacidad intelectual es importante para determinar los déficits cognitivos específicos que subyacen a la afectación cerebral, limitan el funcionamiento intelectual y afectan al comportamiento adaptativo. A pesar de ello, no existen baterías neuropsicológicas en castellano adaptadas y validadas para esta población. Objetivo. Adaptar el programa integrado de exploración neuropsicológica-test Barcelona y validar la nueva versión, el test Barcelona para discapacidad intelectual (TB-DI), estableciendo datos normativos para el empleo clínico. Sujetos y métodos. A partir de los datos obtenidos en una muestra piloto de 65 personas con discapacidad intelectual, se realizaron cambios en el test original. Para estudiar las propiedades psicométricas del TB-DI, se administró a una muestra de 170 personas con discapacidad intelectual y a un grupo de 60 personas sin ella. Mediante modelos de regresión, se determinó qué variables eran importantes para la estratificación de los datos normativos. Resultados. El TB-DI, compuesto de 67 subtests agrupados en ocho dominios cognitivos, muestra unas buenas propiedades psicométricas. Se crean datos normativos para cinco grupos en función del nivel de discapacidad intelectual, la edad y la competencia curricular. Estos datos se organizan en percentiles, lo que permite trazar perfiles cognitivos en el ámbito clínico y experimental. Conclusión. El TB-DI es un instrumento de alta aplicabilidad para la población con discapacidad intelectual, y muestra una validez y una fiabilidad adecuadas, y con buenas propiedades psicométricas. Los perfiles cognitivos determinados mediante el TB-DI proporcionarán información valiosa para el tratamiento integral de las personas adultas con discapacidad intelectual leve y moderada (AU)

Introduction: Neuropsychological assessment in individuals with intellectual disability is of utmost importance in order to determine the cognitive deficits underlying brain dysfunction and limiting intellectual functioning and adaptive behavior. However, no neuropsychological batteries in Spanish language have been created and validated for this population. Aim: To adapt the ‘programa integrado de exploración neuropsicológica-test Barcelona’ and to validate the new version, the Barcelona Test for Intellectual Disability (TB-DI). To create normative data for its clinical use. Subjects and Methods: The original test was modified based on data from a pilot sample of 65 individuals with intellectual disability. In order to study the psychometric properties of the TB-DI, it was administered to a sample of 170 individuals with intellectual disability and to a group of 60 individuals without it. The relevant variables for stratification of normative data were determined by means of regression models. Results: The TB-DI was finally composed by 67 subtests grouped in eight cognitive domains and it showed good psychometric properties. Normative data were created for five groups taking into account intellectual disability level, age and acquired curricular competence. These data were organized in percentiles in a way that allows the creation of cognitive profiles in the clinical and experimental fields. CONCLUSION. The TB-DI constitutes a tool of high applicability in the population with intellectual disability. It shows adequate validity and reliability, and it has good psychometric properties. The cognitive profiles obtained by the TB-DI will provide valuable information for the treatment of adult adults with mild and moderate intellectual disability (AU)

Anomalous White Matter Structure and the Effect of Age in Down Syndrome Patients.

BACKGROUND: Neural tissue alterations in Down syndrome are fully expressed at relatively late developmental stages. In addition, there is an early presence of neurodegenerative changes in the late life stages. OBJECTIVE: The aims of this study were both to characterize white matter abnormalities in the brain of adult Down syndrome patients using diffusion tensor imaging (DTI) and to investigate whether degenerative alterations in white matter structure are detectable before dementia is clinically evident. METHODS: Forty-five adult non-demented Down syndrome patients showing a wide age range (18-52 years) and a matched 45-subject control group were assessed. DTI fractional anisotropy (FA) brain maps were generated and selected cognitive tests were administered. RESULTS: Compared with healthy controls, non-demented Down syndrome patients showed lower DTI FA in white matter involving the major pathways, but with more severe alterations in the frontal-subcortical circuits. White matter FA decreased with age at a similar rate in both DS and control groups. CONCLUSIONS: Our results contribute to characterizing the expression of white matter structural alterations in adult Down syndrome. However, an accelerated aging effect was not demonstrated, which may suggest that the FA measurements used are not sufficiently sensitive or, alternatively, age-related white matter neurodegeneration is not obvious prior to overt clinical dementia.

Validation and normalization of the tower of London-Drexel University Test 2nd edition in an adult population with intellectual disability

Despite how important it is to assess executive functioning in persons with Intellectual Disability (ID), instruments adapted and validated for this population are scarce. This study’s primary goal was to find evidence for the validity of the ID version of the Tower of London (TOLDXtm) test in persons with mild (IDMi) and moderate (IDMo) levels of ID with Down Syndrome (DS). A multicenter study was carried out. Subjects (n = 63, ≥ 39 years old) had DS with mild (n = 39) or moderate ID (n = 24) with no minor neurocognitive disorder or Alzheimer’s disease. Assessment protocol: TOLDXtm for ID, Kaufman Brief Intelligence Test Second Edition (K-BIT II), Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), Weigl’s Color-Form Sorting Test (WCFST), Barcelona Test for Intellectual Disability (BT-ID), and the Behavior Rating Inventory of Executive Function (BRIEF-P). The internal consistency (IDMi and IDMo), factor structure of the different subscales, and relationship between TOLDXtm subscales and other cognitive measures (BT-ID, WCFST, and BRIEF-P) were analyzed. A normative data table with ID population quartiles is provided. TOLDXtm for ID showed a robust one factor structure and coherentassociations with other, related neuropsychological instruments. Significant differences between IDMi and IDMo on movement-related variables like Correct (Corr; p = .002) and Moves (Mov; p = .042) were observed, along with good internal consistency values, Corr (α = .75), Mov (α = .52). Regarding internal consistency, no between-groups differences were observed (all p-value > 0.05). The TOLDXtm for ID is thus an instrument, supported by good validity evidence, to evaluate problemsolving and planning in ID. It distinguishes between individuals with mild and moderate ID, and is highly associated with other measures of executive functioning (AU)

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Anomalous basal ganglia connectivity and obsessive-compulsive behaviour in patients with Prader Willi syndrome.

BACKGROUND: Prader Willi syndrome is a genetic disorder with a behavioural expression characterized by the presence of obsessive-compulsive phenomena ranging from elaborate obsessive eating behaviour to repetitive skin picking. Obsessive-compulsive disorder (OCD) has been recently associated with abnormal functional coupling between the frontal cortex and basal ganglia. We have tested the potential association of functional connectivity anomalies in basal ganglia circuits with obsessive-compulsive behaviour in patients with Prader Willi syndrome. METHODS: We analyzed resting-state functional MRI in adult patients and healthy controls. Whole-brain functional connectivity maps were generated for the dorsal and ventral aspects of the caudate nucleus and putamen. A selected obsessive-compulsive behaviour assessment included typical OCD compulsions, self picking and obsessive eating behaviour. RESULTS: We included 24 adults with Prader Willi syndrome and 29 controls in our study. Patients with Prader Willi syndrome showed abnormal functional connectivity between the prefrontal cortex and basal ganglia and within subcortical structures that correlated with the presence and severity of obsessive-compulsive behaviours. In addition, abnormally heightened functional connectivity was identified in the primary sensorimotor cortex-putamen loop, which was strongly associated with self picking. Finally, obsessive eating behaviour correlated with abnormal functional connectivity both within the basal ganglia loops and between the striatum and the hypothalamus and the amygdala. LIMITATIONS: Limitations of the study include the difficulty in evaluating the nature of content of obsessions in patients with Prader Willi Syndrome and the risk of excessive head motion artifact on brain imaging. CONCLUSION: Patients with Prader Willi syndrome showed broad functional connectivity anomalies combining prefrontal loop alterations characteristic of OCD with 1) enhanced coupling in the primary sensorimotor loop that correlated with the most impulsive aspects of the behaviour and 2) reduced coupling of the ventral striatum with limbic structures for basic internal homeostasis that correlated with the obsession to eat.

[Adaptation and validation of CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and others with intellectual disabilities) in Spanish population with intellectual disabilities]. / Adaptacion y validacion del Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en poblacion española con discapacidad intelectual.

INTRODUCTION: Dementia caused by Alzheimer's disease commonly affects the adult population with Down's syndrome. This population presents two characteristic clinical features: a semiologic pattern that differs from the typical Alzheimer's disease, and previous intellectual deficits that may confound the clinical diagnosis. There is a clear need to validate specific instruments adapted to Spanish population. AIM: To adapt and to validate CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities) in Spanish population. PATIENTS AND METHODS: 146 patients with intellectual disability (mild to moderate) were recruited and assessed with CAMDEX-DS, K-BIT I and DMR tests. Test-retest reliability, inter-rater concordance and validity statistic were performed between CAMDEX-DS and clinical diagnosis. This is an observational, multicenter, cross-sectional and validation study. RESULTS: Test-retest and inter-rater reliability achieved kappa coefficient values of 0.92 and 0.91, respectively. Agreement (kappa index) for CAMDEX-DS on clinical diagnosis compared to other clinical criteria was high: CAMDEX-DS vs DSM-IV (kappa = 0.95; p < 0,001); CAMDEX-DS vs ICD-10 (kappa = 0.97; p < 0.001). All item-test correlations ranged between 0,31 and 0,69. Internal reliability-calculated using Chronbach's alpha scored 0.93. CONCLUSIONS: The Spanish version of CAMDEX-DS is a valid instrument with high applicability for people with intellectual disability. It shows good psychometric properties. The Cambridge Cognitive Examination for Older Adults with Down's Syndrome (CAMCOG-DS) can set two key points by the level of intellectual disability on the suspicion of cognitive impairment in people with Down's syndrome.

TITLE: Adaptacion y validacion del Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en poblacion española con discapacidad intelectual.Introduccion. La demencia causada por la enfermedad de Alzheimer afecta comunmente a la poblacion adulta con sindrome de Down. Esta poblacion presenta dos rasgos clinicos caracteristicos: la presencia de demencia con semiologia distinta a la enfermedad de Alzheimer tipica y deficits intelectuales previos que pueden confundir el diagnostico clinico. Existe una evidente necesidad de validar instrumentos especificos en castellano adaptados a esta poblacion. Objetivo. Adaptar y validar el Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en poblacion española. Pacientes y metodos. Se consideraron 146 pacientes con discapacidad intelectual (leve-moderada). Se realizo un estudio de validacion de tipo observacional, transversal y multicentrico. Se administraron los siguientes tests: CAMDEX-DS, test breve de inteligencia de Kaufman y Dementia Questionnaire for Persons with Mental Retardation. Se calculo la fiabilidad test-retest, la fiabilidad interjueces, la concordancia del CAMDEX-DS para el diagnostico clinico y la validez. Resultados. La fiabilidad test-retest e interjueces obtuvo un coeficiente kappa de 0,92 y 0,91, respectivamente. El indice kappa del CAMDEX-DS para el diagnostico clinico respecto al resto de los criterios clinicos utilizados fue alto: CAMDEX-DS frente a DSM-IV (kappa = 0,95; p < 0,001); CAMDEX-DS frente a Clasificacion Internacional de Enfermedades, decima revision (kappa = 0,97; p = 0,000). Todas las correlaciones item-test oscilaban entre 0,31 y 0,69. La fiabilidad interna calculada mediante el alfa de Cronbach fue de 0,93. Conclusiones. La version española del CAMDEX-DS es un instrumento valido, de alta aplicabilidad a personas con discapacidad intelectual, que muestra buenas propiedades psicometricas. El Cambridge Cognitive Examination for Older Adults with Down's Syndrome (CAMCOG-DS) permite establecer dos puntos de corte para la sospecha de deterioro cognitivo en el grupo de personas con sindrome de Down en funcion del nivel de discapacidad intelectual previo.

Adaptación y validación del Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en población española con discapacidad intelectual / Adaptation and validation of CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities) in Spanish population with intellectual disabilities

síndrome de Down. Esta población presenta dos rasgos clínicos característicos: la presencia de demencia con semiología distinta a la enfermedad de Alzheimer típica y déficits intelectuales previos que pueden confundir el diagnóstico clínico. Existe una evidente necesidad de validar instrumentos específicos en castellano adaptados a esta población. Objetivo. Adaptar y validar el Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en población española. Pacientes y métodos. Se consideraron 146 pacientes con discapacidad intelectual (leve-moderada). Se realizó un estudio de validación de tipo observacional, transversal y multicéntrico. Se administraron los siguientes tests: CAMDEX-DS, testbreve de inteligencia de Kaufman y Dementia Questionnaire for Persons with Mental Retardation. Se calculó la fiabilidad test-retest, la fiabilidad interjueces, la concordancia del CAMDEX-DS para el diagnóstico clínico y la validez. Resultados. La fiabilidad test-retest e interjueces obtuvo un coeficiente kappa de 0,92 y 0,91, respectivamente. El índice kappa del CAMDEX-DS para el diagnóstico clínico respecto al resto de los criterios clínicos utilizados fue alto: CAMDEX-DS frente a DSM-IV (kappa = 0,95; p < 0,001); CAMDEX-DS frente a Clasificación Internacional de Enfermedades, décima revisión (kappa = 0,97; p = 0,000). Todas las correlaciones ítem-test oscilaban entre 0,31 y 0,69. La fiabilidad interna calculada mediante el alfa de Cronbach fue de 0,93. Conclusiones. La versión española del CAMDEX-DS es un instrumento válido, de alta aplicabilidad a personas con discapacidad intelectual, que muestra buenas propiedades psicométricas. El Cambridge Cognitive Examination for Older Adults with Down’s Syndrome (CAMCOG-DS) permite establecer dos puntos de corte para la sospecha de deterioro cognitivo en el grupo de personas con síndrome de Down en función del nivel de discapacidad intelectual previo (AU)

Introduction. Dementia caused by Alzheimer’s disease commonly affects the adult population with Down’s syndrome. This population presents two characteristic clinical features: a semiologic pattern that differs from the typical Alzheimer’s disease, and previous intellectual deficits that may confound the clinical diagnosis. There is a clear need to validate specific instruments adapted to Spanish population. Aim. To adapt and to validate CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities) in Spanish population. Patients and methods. 146 patients with intellectual disability (mild to moderate) were recruited and assessed with CAMDEX-DS, K-BIT I and DMR tests. Test-retest reliability, inter-rater concordance and validity statistic were performed between CAMDEX-DS and clinical diagnosis. This is an observational, multicenter, cross-sectional and validation study. Results. Test-retest and inter-rater reliability achieved kappa coefficient values of 0.92 and 0.91, respectively. Agreement (kappa index) for CAMDEX-DS on clinical diagnosis compared to other clinical criteria was high: CAMDEX-DS vs DSM-IV (kappa = 0.95; p < 0,001); CAMDEX-DS vs ICD-10 (kappa = 0.97; p < 0.001). All item-test correlations ranged between 0,31 and 0,69. Internal reliability-calculated using Chronbach’s alpha scored 0.93.Conclusions. The Spanish version of CAMDEX-DS is a valid instrument with high applicability for people with intellectual disability. It shows good psychometric properties. The Cambridge Cognitive Examination for Older Adults with Down’s Syndrome (CAMCOG-DS) can set two key points by the level of intellectual disability on the suspicion of cognitive impairment in people with Down’s syndrome (AU)

[Health among persons with intellectual disability in Spain: the European POMONA-II study]. / La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II.

INTRODUCTION: International studies show that both the pattern of health and the healthcare provided for persons with intellectual disability (ID) and the general population are different. AIMS: To obtain data about the state of health of persons with ID and to compare them with data about the general population. PATIENTS AND METHODS: The P15 set of health indicators was used in a sample of 111 subjects with ID. The health data that were found were compared according to the subjects' type of residence and the 2006 National Health Survey was used to compare these data with those for the general population. RESULTS; The sample with ID presented 25 times more cases of epilepsy and twice as many cases of obesity. Twenty per cent presented pain in the mouth and the presence of sensory and mobility problems, as well as psychosis, was high. We also found, however, a low presence of pathologies like diabetes, hypertension, osteoarthritis and osteoporosis. They also displayed a lower rate of participation in prevention and health promotion programmes, a higher number of hospital admissions and a lower usage of emergency services. CONCLUSIONS: The pattern of health of persons with ID differs from that of the general population, and they use healthcare services differently. It is important to develop programmes of health promotion and professional training that are specifically designed to attend to the needs of persons with ID. Likewise, it is also necessary to implement health surveys that include data about this population.

Envejecimiento saludable en personas con síndrome de Down y demencia: necesidad de promover programas de formación y soporte a los usuarios, familias y entidades / Healthy ageing in people with Down syndrome and dementia: the need to foster education and support programs for individuals, families and organizations

La mayoría de las personas con síndrome de Down (SD) llegan a una edad en que, como ciudadanos seniors, tienen una serie de necesidades que deben ser consideradas y atendidas, obligando a unas intervenciones de anticipación y prevención. Esta realidad ya está generando dificultades en los servicios que tienen la responsabilidad de atenderlos, a sus propias familias y a los propios afectados. Cuando una persona con SD inicia un proceso de deterioro cognitivo o demencia, se hace evidente la inadecuada y escasa planificación de políticas y, al mismo tiempo, la falta de provisión de servicios. La Organización Mundial de la Salud (OMS) en colaboración con la Asociación Internacional para el Estudio Científico de Discapacidades Intelectuales (IASSID)y de Inclusión Internacional ha desarrollado un informe que recoge las necesidades sociales y sanitarias de las personas con discapacidad intelectual en proceso de envejecimiento, entre ellos las personas con SD. En el mismo documento de trabajo se señala como prioritaria la necesidad de que cada país de la Unión Europea desarrolle «Proyectos para el envejecimiento saludable» que conduzcan a la inclusión social de forma natural mejorando el soporte y la formación de los cuidadores formal ese informales. Se presenta a continuación una primera aproximación a la posible creación de programas para personas con SD y deterioro-cognitivo/demencia (AU)

Most individuals with Down syndrome (DS) reachan advanced age which gives rise to specific needs.These must be considered and addressed, through anticipationand prevention. Difficulties are already emergingin services responsible for this population, as wellas for the individuals concerned and their relatives. Theinadequacy and unsuitability of policy planning andlack of adequate services are made apparent whenevera person with DS begins to develop cognitive deteriorationor dementia.The World Health Organization (WHO) has drawnup, in conjunction with the International Associationfor the Scientific Study of Intellectual Disabilities(IASSID) and Inclusion International, a report on thesocial and health care needs of aging persons with intellectualdisabilities, including those with DS. This workingdocument highlights as a priority the need for eachcountry in the European Union to implement «Projectsfor Healthy Aging» that are naturally conducive to socialinclusion while improving support and training forboth formal and informal caregivers. The present articleprovides a rough outline for potential future programstargeting individuals with DS and cognitive deteriorationor dementia (AU)