Chicoine also cautions that whenever a patient declines in function, a thorough evaluation is necessary "to look for reversible causes, or, if no reversible cause is found, to confirm that the decline is consistent with Alzheimer's disease" (Chicoine pp). In other words, just as in the general population, Alzheimer's disease is a diagnosis of exclusion in persons with Down's (Chicoine pp). Because traditional neuropshychological testing, such as used for persons in the general population, is not particularly helpful for assessing individuals with an intellectual disability, thus careful clinical evaluation is important to avoid missing potentially reversible causes of decline (Chicoine pp).
Chicoine cautions that mental health disorders often present differently in persons with Down syndrome due to cognitive and expressive language limitations, which means that mental health disorders may be difficult to distinguish from Alzheimer's dementia (Chicoine pp). For example, loss of adaptive skills, disruption of sleep cycle, appetite changes, apathy, moodiness, irritation, aggressiveness, psychomotor agitation or retardation, memory loss, and the presence of psychotic features, such as extreme withdrawal, delusions and increase in hallucinatory-like self-talk," are all symptoms that are common to both depression and Alzheimer's disease (Chicoine pp). Because there is no definitive test for this disorder, Alzheimer's disease is very difficult to rule out, and to further complicate matters, depression may coexist with Alzheimer's disease, which means that prompt treatment of depression will preserve functioning for some time, although a downhill course may be inevitable (Chicoine pp).
As individuals with Down syndrome take their place in certain areas of society, it should be expected that some of them will assume the sexual roles that the general population takes for granted such as lover, spouse, and parent (Van Dyke pp). The development of a secure sexual identity is difficult even within the general population, so the emergence of sexual behavior in someone with Down syndrome tends to alarm most parents and caretakers who understandably fear their child's cognitive deficit makes him or her especially vulnerable to "unwanted pregnancy, sexual exploitation and abuse, and to sexually transmitted disease" (Van Dyke pp). Masturbation, which is a healthy and normal part of self-discovery, may, in some severely mentally disabled individuals, appear as a form of self-injurious behavior (Van Dyke pp). Studies reveal that the incidence of masturbation in individuals with Down syndrome is roughly 40% in males and 52% in females (Van Dyke pp). Studies have found that 37% of mentally disabled women had prior vaginal penetration, and 50% of mildly disabled subjects had had sexual intercourse, while other studies revealed that rape or incest had occurred in 33% of mildly disabled subjects and 25% of moderately disabled individuals (Van Dyke pp). Experts caution that mentally disabled individuals are vulnerable to sexual maltreatment due to isolation, communication deficits, small peer group, limited mutual support services, and transient caregivers, some of whom may be pedophiles (Van Dyke pp). Studies of marriages among the mentally disabled have shown that individuals with cognitive deficits who married had only mild mental disabilities and that the most troubled marriages were those in which both partners were mentally disabled (Van Dyke pp). In one 1988 study of 38 married individuals with Down syndrome including 35 female subjects, all had spouses without Down syndrome, however the couples lived in an environment that was closely supported and in some cases supervised by other family members or advocates (Van Dyke pp).
As in the general population, the only non-surgical method of contraception available to males is the condom, however because barrier methods require application at the time of each coitus, they may not be practical of individuals with Down syndrome who may need supervision in using such devices (Van Dyke pp). Spermicidal foams and gels, diaphragm, sponges, cervical cap, IUD, oral contraceptives, Norplant, and Depo-Provera are all available for females, however no form of contraception is totally contraindicated for individuals with Down syndrome (Van Dyke pp).
Health care screening in persons with Down syndrome has not been well studied, and most relevant studies have focused on descriptions of the higher prevalence of a condition in persons with Down's as a cause of significant morbidity or on case studies of conditions affecting these patients (Smith pp). Adults with Down syndrome have the same basic health care needs as typically developed people, including health screening and prevention (Smith pp). Immunization schedules are the same, and screening for hypertension and heart disease, and disease surveillance are no different (Smith pp). Although solid tumors are less common in individuals with Down syndrome than the general population, until more data are available, cancer screening should be the same as in the general population (Smith pp). Diabetes has a higher prevalence in adults with Down syndrome than in the general population, however there are no specific recommendations (Smith pp).
An annual testicular examination in men is recommended due to the higher prevalence of testicular cancer in this group (Smith pp). Moreover, females should have a gynecologic examination and pap-smear, however such an exam may be difficult to perform because of poor cooperation, thus a pelvic ultrasound examination should be considered as an option (Smith pp).
Although the risk increases with increasing maternal age, most infants with Down syndrome are born to mothers of typical childbearing age (Smith pp). The average life expectancy of persons with Down syndrome has increased into the middle 50's (Smith pp). Most persons with Down syndrome function within communities, often with minimal support, for many years of adult life (Smith pp).
Appl, Dolores J. "Children with Down Syndrome: implications for adult-child interactions in inclusive settings." Childhood Education. September 22, 1998. Retrieved October 31, 2005 from HighBeam Research Library Web site.
Chicoine, Brian; McGuire, Dennis; Rubin, Stephen. "Adults with Down Syndrome:
Specialty Clinic Perspectives." Dementia, Aging and Intellectual Disabilities: A Handbook. 1999. Retrieved October 31, 2005 at http://www.ds-health.com/adults.htm
Dykens, Elizabeth M. "Behavioral phenotypes and special education: parent report of educational issues for children with Down syndrome, Prader-Willi syndrome, and Williams syndrome." Journal of Special Education. June 22, 2002. Retrieved October 31, 2005 from HighBeam Research Library Web site.
Murphy, Marina. "Down's syndrome: a gene associated with learning and memory loss in Down's syndrome has been identified." Chemistry and Industry. November 03, 2003. Retrieved October 31, 2005 from HighBeam Research Library Web site.
Smith, David S. "Health Care Management of Adults with Down Syndrome."