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Prevalence of dementia in intellectual disability using different diagnostic criteria
- Authors:
- STRYDOM A., et al
- Journal article citation:
- British Journal of Psychiatry, 191(8), August 2007, pp.150-157.
- Publisher:
- Cambridge University Press
Diagnosis of dementia is complex in adults with intellectual disability owing to their pre-existing deficits and different presentation. The aim was to describe the clinical features and prevalence of dementia and its subtypes, and to compare the concurrent validity of dementia criteria in older adults with intellectual disability. The Becoming Older with Learning Disability (BOLD) memory study is a two-stage epidemiological survey of adults with intellectual disability without Down syndrome aged 60 years and older, with comprehensive assessment of people who screen positive. Dementia was diagnosed according to ICD–10, DSM–IV and DC–LD criteria. The DSM–IV dementia criteria were more inclusive. Diagnosis using ICD–10 excluded people with even moderate dementia. Clinical subtypes of dementia can be recognised in adults with intellectual disability. Alzheimer’s dementia was the most common, with a prevalence of 8.6% (95% CI 5.2–13.0), almost three times greater than expected. Dementia is common in older adults with intellectual disability, but prevalence differs according to the diagnostic criteria used. This has implications for clinical practice.
Relationship between diagnostic criteria, depressive equivalents and diagnosis of depression among older adults with intellectual disability
- Authors:
- LANGLOIS L., MARTIN L.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(11), November 2008, pp.896-904.
- Publisher:
- Wiley
This study uses the interRAI ID assessment instrument to investigate the relationship between standard diagnostic criteria for depression, depressive equivalents and a diagnosis of depression among older and younger adults with ID in community and institutional settings in Ontario, Canada. Items in the interRAI ID assessment instrument that were representative of The Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria and depressive equivalents were examined among persons with ID in institutional (census-level data) and in community-based (sample) residential settings. Bivariate logistic regression was used to examine the relationship between depressive symptoms and a diagnosis of depression. Descriptive statistics were used to examine the prevalence of depressive symptoms among those who did not have a diagnosis of depression. The results indicate that DSM-IV diagnostic criteria and depressive equivalents were significantly related to a diagnosis of depression among older and younger adults with ID, and that both types of symptoms were exhibited by a non-trivial proportion of individuals without a diagnosis of depression. The depression rating scale embedded in the interRAI ID is helpful in identifying older adults at risk of depression. Contrary to other studies, few significant differences were found in depressive symptoms by age.
The psychiatry of elderly people with mental handicaps
- Author:
- COOPER Sally-Ann
- Journal article citation:
- International Journal of Geriatric Psychiatry, 7(12), December 1992, pp.865-874.
- Publisher:
- Wiley
Argues that postmortem studies and attempts to link neuropathological findings with clinical findings, and presumptive diagnoses of Alzheimer's Disease following a decline in skills of the elderly with mental handicaps, have shed little light on the true extent of dementia in the elderly mentally handicapped.
Case report: an unusual case of post-stroke psychosis in a 71-year-old lady with a learning disability
- Authors:
- LEEDS Lesley, SRINIVASAN Janaki
- Journal article citation:
- British Journal of Learning Disabilities, 39(4), December 2011, pp.292-294.
- Publisher:
- Wiley
Stroke is a major health concern, and can lead to psychiatric problems, and people with a learning disability are just as likely as people in the general population to be at risk of cerebrovascular disease, due to the presence of undetected or undertreated vascular risk factors. However, it is often difficult to tell whether someone with a learning disability has had a stroke, especially if they seem well. When people with a learning disability are presenting with additional cognitive impairment, it is important to consider a range of conditions that may account for this. Stroke is a major cause of cognitive impairment in older people, affecting at least one-third of stroke survivors. However, post-stroke psychosis is rare following stroke, and, as can be seen from the case of ‘May’, a 71 year-old lady with a learning disability, individuals can make a good recovery with appropriate assessment and intervention. The article concludes that it is important that a diagnosis of dementia is given only after all other potentially treatable conditions have been excluded, and there is deterioration in condition that defies other explanations.
The needs of people with learning disabilities who develop dementia: a literature review
- Author:
- LLEWELLYN Penny
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 10(2), May 2011, pp.235-247.
- Publisher:
- Sage
The longevity of people with learning disabilities is rising, and they are increasingly developing age related conditions including dementia. When this occurs, their medical and social needs pose many challenges for services. A literature review was undertaken of articles published between 1996 and 2006. Data were collected relating to the needs of people with learning disabilities and dementia, their carers and their peers. Findings revealed that the primary medical need was for timely and accurate diagnosis. There were a multitude of diagnostic tools, and advice was available as to which are most suitable for different client groups. The needs of carers are intertwined with those of people with learning disabilities and dementia and meeting their needs for education, training and increased staff numbers, has proved beneficial. Although multiple services were responsible for the needs of this client group, there was an agreement that learning disability services should be central to social care service provision.
Dementia in older adults with intellectual disabilities: epidemiology, presentation and diagnosis
- Authors:
- STRYDOM Andre, et al
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 7(2), June 2010, pp.96-110.
- Publisher:
- Wiley
The authors conducted a literature review on the epidemiology, presentation and diagnosis of dementia in older adults with intellectual or learning disabilities (ID) and specific genetic syndromes, such as Downs syndrome (DS) using Medline, EMBASE and PsycINFO for original papers in English, German or Dutch, between 1997 and 2008. Articles from the United Kingdom, Canada, Australia, United States, Netherlands, Ireland; Japan, South Africa, Scandinavia and Italy had varied methodologies and differences in diagnoses resulting in a wide range of prevalence rates of dementia. Rates of dementia in those with ID, not because of DS, were comparable or higher than those in the general population. The onset of Alzheimers disease in DS appears earlier and the prevalence increases from less than 10% in the 40’s, to more than 30% in the 50’s with varying prevalence reported in those over 60 years. Incidence rates increased with age. Presentation differs in the ID population compared with the general population, with those with DS presenting with behavioural changes believed to be due to frontal lobe deficits. Few studies of dementia in other genetic syndromes such as Rett syndrome, an autistic spectrum disorder, and Sanfilippo syndrome were located in the literature, but these are discussed and tabulated along with others found.
Psychiatric diagnoses in relation to severity of intellectual disability and challenging behaviors: a register study among older people
- Authors:
- AXMON A., et al
- Journal article citation:
- Aging and Mental Health, 22(10), 2018, pp.1344-1350.
- Publisher:
- Taylor and Francis
Objective: To investigate the possible association between severity of intellectual disability (ID) and presence of challenging behaviour, respectively, on diagnoses of psychiatric disorders among older people with ID. Methods: People with a diagnosis of ID in inpatient or specialist outpatient care in 2002–2012 were identified (n = 2147; 611 with mild ID, 285 with moderate ID, 255 with severe or profound ID, and 996 with other/unspecified ID). Moreover, using impairment of behaviour as a proxy for challenging behaviour, 627 people with, and 1514 without such behaviour were identified. Results: Severe/profound ID was associated with lower odds of diagnoses of psychotic, affective, and anxiety disorders than was mild/moderate ID. People with moderate ID had higher odds than those with mild ID of having diagnoses of affective disorders. Diagnoses of psychotic, affective, and anxiety disorders, and dementia were more common among people with challenging behaviour than among those without. Conclusions: People with severe/profound ID had lower odds of receiving psychiatric diagnoses than those with mild and moderate ID. Whether this is a result of differences in prevalence of disorders or diagnostic difficulties is unknown. Further, challenging behaviours were associated with diagnoses of psychiatric disorders. However, the nature of this association remains unclear. (Edited publisher abstract)
Dementia in older adults with intellectual disabilities: a report on the state of science on dementia in older adults with intellectual disabilities by the IASSID Special Interest Research Group on Ageing and Intellectual Disabilities
- Authors:
- STRYDOM Andre, et al
- Publisher:
- International Association for the Scientific Study of Intellectual Disabilities
- Publication year:
- 2009
- Pagination:
- 49p., bibliog.
- Place of publication:
- Canterbury
This systematic review summarises current knowledge on dementia in older people with learning disabilities. The review included papers published from 1997 to 2008. Findings are discussed in the areas of: epidemiology; presentation and symptoms; screening, assessment and diagnosis; non-pharmacological and pharmacological interventions and issues for carers.
Associations between behaviour disorders and health status among older adults with intellectual disability
- Authors:
- DAVIDSON P. W., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.424-430.
- Publisher:
- Taylor and Francis
Few studies have examined the relationship of behaviour and health status among aging persons with intellectual and developmental disabilities (I/DD). Behavioural disorders, which often are coincident with functional decline in older persons with I/DD, may be more related to medical morbidity than previously reported. This cross-sectional study examined the association between health status and behaviour disorders with increasing age in a cohort of 60,752 adults with I/DD clustered into four adult-age groupings (21-44, 45-59, 60-74, and >74). Age grouping data suggested an association between morbidity and increased likelihood of behaviour symptoms in all but the oldest age grouping. The magnitude of the association and trend varied by specific disease across age groupings compared to that found in healthy cohorts. About 25% of the adults with I/DD had psychiatric diagnoses and the frequency of such diagnoses did not decrease with age grouping. These results suggest that adverse health status may increase the likelihood of persistent behavioural disturbances in older persons with I/DD. Moreover, behavioural disorders may be sentinels for occult medical morbidity, which in turn may be responsive to intervention.
Diagnostic instruments for dementia in older people with intellectual disability in clinical practice
- Authors:
- STRYDOM A., HASSIOTIS A.
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.431-437.
- Publisher:
- Taylor and Francis
There is a need for simple and reliable screening instruments for dementia in the intellectual disability (ID) population that can also be used to follow their progress, particularly if they are being treated with anti-dementia drugs. Commonly used tests for the general population such as the Mini Mental State Examination (MMSE) are not appropriate for many people with ID. This paper is a literature review of alternative instruments that have been used in research or recommended by experts since 1991 and have the potential to be used as screening instruments. Two types of tests have been identified: those administered to informants, and those that rely on direct assessment of the individual. The most promising informant rated screening tool in most adults with ID including Down syndrome (DS) diagnosis is the Dementia Questionnaire for Persons with Mental Retardation (DMR). However, sensitivity in single assessments is variable and cut-off scores need further optimisation. In those with DS, the Dementia Scale for Down Syndrome (DSDS) has good specificity but mediocre sensitivity. The Test for Severe Impairment and Severe Impairment Battery are two direct assessment tools that show promise as screening instruments, but need further evaluation.