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Down syndrome, which arises in individuals carrying an extra copy of chromosome 21, is associated with a greatly increased risk of early-onset Alzheimer disease. It is thought that this risk Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts is conferred by the presence of three copies of the gene encoding amyloid precursor protein (APP) -an Alzheimer disease risk factor -although the possession of extra copies of other chromosome 21 genes may also play a part. Further study of the mechanisms underlying the development of Alzheimer disease in people with Down syndrome could provide insights into the mechanisms that cause dementia in the general population.Down syndrome (DS) is a complex, highly variable disorder that arises from trisomy of chromosome 21. It was one of the first chromosomal disorders to be identified 1 and occurs with an incidence of approximately 1 in 800 births 2 . Its prevalence within a given population is influenced by infant mortality rates, access to health care, termination rates, average maternal age 3 and life expectancy. Indeed, despite the increased availability of prenatal diagnosis and access to the option of termination, the global prevalence of DS is rising because of improvements in life expectancy: the number of adults with DS aged over 40 years has doubled in northern Europe since 1990 and, in the United Kingdom, one-third of the estimated 40,000 people with DS are thought to be over 40 years of age 4 .DS is the most common form of intellectual disability. In addition to the features that are found in everyone with the disorder, such as the characteristic facial dysmorphology, there are many DS-associated phenotypes that have variable penetrance and severity. For example, approximately 40% of individuals with DS have heart malformations (usually atrioventricular septal defects) 5 . A key feature of DS is a striking propensity to develop early-onset Alzheimer disease (EOAD). Complete trisomy of chromosome 21 universally causes the development of amyloid plaques and neurofibrillary tangles (NFTs), which are typical characteristics of AD brain pathology, by the age of 40, and approximately twothirds of individuals with DS develop dementia by the age of 60 (REFS 6,7). However, rates of dementia do not reach 100%, even in older individuals, suggesting that some individuals with DS are protected from the onset of AD (FIG. 1).All of the features of DS arise because of aberrant dosages of coding and/or non-coding sequences present on chromosome 21. Among these sequences, the gene encoding amyloid precursor protein (APP) is thought to have a key role in the pathology of AD. The additional copy of APP may drive the development of AD in individuals with DS (AD-DS) by increasing the levels of amyloid-β (Aβ), a cleavage product of APP that misfolds and accumulates in the brain in people with AD. Consistent with this hypothesis, individuals with small internal chromosome 21 duplications that result in three copies of APP -a rare familial trait known as duplic...

Using Developmental Trajectories to Understand Developmental DisordersPurpose: In this article, the authors present a tutorial on the use of developmental trajectories for studying language and cognitive impairments in developmental disorders and compare this method with the use of matching. Method: The authors assess the strengths, limitations, and practical implications of each method. The contrast between the methodologies is highlighted using the example of developmental delay and the criteria used to distinguish delay from atypical development. Results: The authors argue for the utility of the trajectory approach, using illustrations from studies investigating language and cognitive impairments in individuals with Williams syndrome, Down syndrome, and autism spectrum disorder. Conclusion: Two conclusions were reached: (a) An understanding of the underlying mechanism will be furthered by the richer descriptive vocabulary provided by the trajectories approach (e.g., in distinguishing different types of delay) and (b) an optimal design for studying developmental disorders is to combine initial cross-sectional designs with longitudinal follow-up.

Previous work shows that children with autism manifest abnormalities in the use of gaze. They also have difficulties in the comprehension of mental states. The present paper explores whether these two abnormalities might be related. We report four experiments that test whether normal children ‘read’ the eyes, particularly eye‐direction, as conveying information about a person's mental states, and whether subjects with autism are specifically ‘blind’ to such information. The mental states assessed were desire, goal, refer, and think. The results confirm that normal children do use eye‐direction as a cue for reading these mental states, as do subjects with mental handicap (including those with William's Syndrome). In contrast, subjects with autism failed to use eye‐direction to infer the mental states. In addition, whilst normal children and children with mental handicap showed a preference for eye‐direction over an unnatural cue when inferring these mental states, children with autism did not. These findings suggest that part of the explanation for the gaze abnormalities in autism may be a failure to comprehend that the eyes convey information about a person's mental states.