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Debate Over Study on Antidementia Drugs for Adults with Down Syndrome and Alzheimer’s Disease

In March 2018, 21 researchers published a study in the British Journal of Psychiatry called “Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study.”

Aims: To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease.The researchers noted that there have been few studies conducted, and therefore little information is available on how to treat adults with Down syndrome and Alzheimer’s disease. They set out to test specific antidementia drugs on people with Down syndrome and Alzheimer’s disease.

In the most recent edition of the same journal doctors David S. Smith, (Director of the Down Syndrome Clinic of Wisconsin at Children’s Hospital in Milwaukee and member of the Down Syndrome Medical Interest Group), and Brian Chicoine, (Medical Director of the Adult Down Syndrome Center of Lutheran General Hospital in Park Ridge, Illinois) published a response to the March study.

Difficulties of diagnosing and managing dementia in people with Down syndrome

“As practicing clinicians who provide care to adults with Down syndrome, we appreciate Eady and colleagues’ attempt to address a real concern in this patient population. However, we have significant concerns about clinicians potentially using in their practice the conclusions drawn by the authors. The study conclusions offer false hope and may result in wasted resources.”

Smith and Chicoine take issue with several aspects of the study:

  1. There are major differences in two groups (those who did/did not receive the medications) involved in the study. Smith and Chicoine argue that the significance of the differences, including age, degree of intellectual disability, and progress of dementia symptoms, could make the results invalid.
  2. The study measured the survival time of the participants. (Those who took the medication survived an average of 2 years longer than those who did not.) Smith and Chicoine suggest that quality of life would be a better measure to investigate.Dementia takes a tremendous toll on the caregivers and families. Even if the medications do extend life, where is the benefit? What kind of life will they have?
  3. Smith and Chicoine point to previous studies that they claim show there is “no benefit of pharmacological interventions for cognitive decline in people with Down syndrome.”

Finally, Smith and Chicoine point out that they fear doctors tend to over-diagnose Alzheimer’s disease in adults with Down syndrome who experience cognitive decline. They remind us that even though people with Down syndrome have plaques and tangles in the brain tissue, not all adults with Down syndrome experience dementia. They stress the importance of ruling out other possible causes of decline before a diagnosis of Alzheimer’s Disease is made.

The original study’s authors reply to Smith and Chicoine in the November journal. In it, they defend their procedures and results. They argue that medications have been shown to slow the rate of cognitive decline in patients without Down syndrome and reiterate the need for more research in this area.

Their final statement: “People with Down syndrome and dementia should not be denied access to antidementia drugs.”

It should be noted that Smith and Chicoine did not argue against the use of antidementia drugs in all cases. They merely took issue with the study’s design and argued for careful evaluation prior to an Alzheimer’s diagnosis in adults with Down syndrome.

 

Studies Mentioned:

David Smith and Brian Chicoine. Difficulties of diagnosing and managing dementia in people with Down syndrome. British Journal of Psychiatry, Volume 213, Issue 5 November 2018 , pp. 668-669. Published online: 19 October 2018

Eady, N, Sheehan, R, Rantell, K, Sinai, A, Bernal, J, Bohnen, I, et al. Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study. Br J Psychiatry 2018; 212: 155–60.

Eady, N, Sheehan, R, Rantell, K, Sinai, A, Bernal, J, Bohnen, I, et al. (2018). Author’s reply to: Difficulties of diagnosing and managing dementia in people with Down syndrome. The British Journal of Psychiatry. 213. 669-669. 10.1192

Further reading: Dementia and People with Intellectual Disabilities

Z is for Zac Efron: “The Road” Scholars April A to Z Blogging Challenge

Zac Efron in Hairspray on The Road Scholars for the A to Z Blogging Challenge

Folks in our community who love the Disney “High School Musical” franchise were no doubt thrilled to see Zac Efron in “Hairspray.”
In week three of our “For The Love of Musicals” course when we look at “Hairspray” we ask students to choose their favorite Zac song from:

  • “Ladies Choice” (Hairspray)
  • “Getcha Head in the Game” (HSM)
  • “Bet on It” (HSM2)
  • “Now or Never” (HSM3)

We use choice and forum activities in the course to encourage students to communicate with others who share their interests.

"The Road" Scholars

 

To see our full line of courses and join in the learning fun visit us at https://theroadscholars.moodlecloud.com

Y is for “Year Without a Santa Claus”: “The Road” Scholars April A to Z Blogging Challenge

In our free course ” ‘Tis The Season” we explore holiday movies and traditions to celebrate the festive season.

 

Topics:

  • A Child Is Born
  • Animated Favorites
  • Inspiring Classics
  • Reinvented Classics
  • Fun For The Family

Find links to holiday classics, games, puzzles, videos, and trivia quizzes to get you in the spirit of Christmas!

"The Road" Scholars

 

To see our full line of courses and join in the learning fun visit us at https://theroadscholars.moodlecloud.com

V is for Valet: “The Road” Scholars April A to Z Blogging Challenge

Let's Get Ready to Rumble

In the last week of our “Let’s Get Ready to Rumble” course we talk about “Managers, Valets, and Tag Teams.”

Being a team player pays off on the WWE. Let’s look at some of the people who support and team up with the superstars.

In the world of professional wrestling, a valet is someone who accompanies a superstar to a match.

Miss Elizabeth was the calming force that accompanied
Photo from WWE

 

“Miss Elizabeth was the calming force that accompanied “Macho Madness.””

"The Road" Scholars

To see our full line of courses and join in the learning fun visit us at https://theroadscholars.moodlecloud.com

U is for Under Wraps: “The Road” Scholars April A to Z Blogging Challenge

"Under Wraps"
Photo: IMDB

We love Halloween here on The Road. (Especially “Black Day: The Monster Rock Band!).

To celebrate Halloween we created the short, 3 week course “Mouse Movies – Halloween.”

  • Week 1 – Halloweentown Series
  • Week 2 – Disney Channel Originals
  • Week 3 – Classic Disney Films

We stocked it full of games and puzzles just for people who love to do Halloween Disney-style!


"The Road" Scholars

To see our full line of courses and join in the learning fun visit us at https://theroadscholars.moodlecloud.com

 

T is for “Then and Now”: “The Road” Scholars April A to Z Blogging Challenge

In week 7 of our “Let’s Get Ready to Rumble” course we look at some of the digital shows created by the WWE.

WWE Digital Shows on The Road Scholars for The A to Z Blogging Challenge

 

 

On “Then and Now” select superstars take a look back in time to show fans how they’ve changed.

"The Road" Scholars

 

To see our full line of courses and join in the learning fun visit us at https://theroadscholars.moodlecloud.com