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There is little evidence to guide pharmacological treatment in adults with Down syndrome and Alzheimer's disease.
Aims
To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease.
Method
This was a naturalistic longitudinal follow-up of a clinical cohort of 310 people with Down syndrome diagnosed with Alzheimer's disease collected from specialist community services in England.
Results
Median survival time (5.59 years, 95% CI 4.67–6.67) for those on medication (n = 145, mainly cholinesterase inhibitors) was significantly greater than for those not prescribed medication (n = 165) (3.45 years, 95% CI 2.91–4.13, log-rank test P<0.001). Sequential assessments demonstrated an early effect in maintaining cognitive function.
Conclusions
Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated.
Declaration of interest
A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.
Methods of evaluating training courses in behaviour modification for staff working in mental handicap are briefly reviewed. Insufficient attention seems to have been paid to changes in staff behaviour following training. A widely used training package—the E.D.Y. Course—was investigated using a non-equivalent control group design. Four special school teachers were given E.D.Y. training and compared with four control teachers pretraining, post-training and at a fourteen month follow-up. Results indicated that experimental teachers changed their behaviour following training in the expected direction and maintained this change at follow-up. Control group teachers showed no behavioural change from occasion to occasion and scored significantly lower than the experimental group on the dependent variable on each occasion. The results are discussed in terms of the effectiveness of the package and the maintenance and generalization of skills.
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