APPD is a relatively stable diagnosis and argues for a distinct diagnostic entity.

Objective-Virtually all adults with Down syndrome (DS) have neuropathological manifestations of Alzheimer's disease (AD) but not all develop the condition. The effect of allelic variants of Apolipoprotein (APOE) gene in the development and progression of AD and mortality in people with DS is examined.Methods-Participants with DS recruited through local clinical services and voluntary organizations underwent 2 to 14 sequential assessments over a follow up period of 5 years on average. Blood samples were collected for determination of the APOE genotype. Dementia status of each participant was confirmed as recommended by the Working Group for the Establishment of Criteria for the Diagnosis of Dementia in Individuals with Intellectual Disability.Results-At the end of the study APOE genotype results were available for 252 individuals and thus included in the analysis. Participants with APOE ε4 allele had a significantly higher risk of developing AD (Hazard ratio = 1.8, 95% CI: 1.12-2.79), had an earlier onset of AD (55.0 vs. 57.0 years; p = .0027) and a more rapid progression to death compared with participants with ε3 allele. In those who did not have AD, presence of ε4 allele was associated with early mortality (Hazard ratio = 5.9, 95% CI: 1.7-21.3).Conclusions-This study highlights the relationship of APOE genotype to morbidity and mortality in people with DS which may have important clinical implications in terms of early identification of individuals at risk. We recommend screening for APOE genotype for individuals with DS early in their life.

Melatonin appears to be an effective sleep-initiator for children and adolescents with ID and probably has a similar effect for adults. There may be heterogeneity of response depending on the nature of the sleep problem and cause of the ID or associated disabilities. Further studies are necessary before firm conclusions can be drawn and guidelines for the use of melatonin for people with ID formulated.

Objective To investigate the relation of plasma levels of Aβ peptides (Aβ1-40 and Aβ1-42) and Apolipoprotein E (APOE) genotype to dementia status and duration of Alzheimer’s disease in adults with Down syndrome (DS). Methods Adults with DS were recruited from community settings and followed up for a mean period of 6.7 years. Plasma levels Aβ1-40 and Aβ1-42 and APOE genotype were determined at the last visit. Results There were 83 nondemented participants and 44 participants with prevalent AD. Overall, plasma levels of Aβ1-42, Aβ1-40 and the ratio Aβ1-42/Aβ1-40 did not differ significantly between the adults with DS. Among demented participants the mean level of Aβ1-40 was significantly lower (157.0 vs. 195.3) and the ratio of Aβ1-42/Aβ1-40 was significantly higher (0.28 vs. 0.16) in those with more than 4 years duration of dementia than in those with 4 or fewer years duration of dementia. This pattern was generally similar in those with and without an APOE ε4 allele. Conclusions There is an association between plasma Aβ peptide levels and duration of AD in older persons with DS. The predictive and diagnostic roles of Aβ1-42 and Aβ1-40 measurements for AD, however, remain controversial. Change in Aβ peptide levels with onset of AD and with duration of dementia may account for lack of difference between prevalent cases and nondemented individuals and for variation in the predictive power of Aβ peptide levels.e

The quality of evidence base for the use of pharmacological agents in the treatment of ISBs is inadequate to justify their use in routine clinical practice. If used, they should only be a part of a comprehensive treatment programme and closely monitored. In addition, there are several clinical, ethical and legal issues to be addressed before considering pharmacological treatment of ISBs in people with ID.

Persons with intellectual disabilities may present with multiple and complex needs including communication difficulties which may contribute to their challenging behaviors. Having a holistic account of each individual in terms of his or her needs, likes, and dislikes and behavioral issues may help to prevent communication breakdown between the persons with intellectual disabilities and caregivers which may in turn improve their quality of life and reduce their challenging behaviors. Communication passport is a practical and person-centered document providing a special and efficient way of sorting and presenting important and complex information about the person into an accessible manner. We describe the development and introduction of communication passports in an acute inpatient unit for adults with intellectual disabilities at the Institute of Mental Health, a tertiary psychiatric hospital in Singapore. The study team developed a communication passport through literature review, focus group discussions and liaison with caregivers and patients with intellectual disabilities. After an initial pilot for 6 months, improvements were made in the content and presentation. It was designed in such a way that useful information about the patient's personal and communication needs as well as behavioral problems and interventions were easily passed on to the community caregivers at the point of patient's discharge from the hospital. The final format of the communication passport consisted of a 12-page document encompassing multiple aspects including communication and behavioral profile. Our work may provide the necessary framework and directions in developing communication passports for services providers caring for people with intellectual disabilities. bs_bs_banner ConclusionsCommunication passports can play a significant role in improving care, communication, and addressing challenging behaviors of individuals with intellectual disabilities, particularly, in the community. We hope that sharing of our experience may provide the necessary framework and directions in developing communication passports in other services caring for people with intellectual disabilities.

Objective Tools generally used in measuring patient safety incidents in general healthcare settings are not considered suitable for mental health settings. The aim of this study was to develop and evaluate a specialized trigger tool for mental health settings that could detect both traditionally defined adverse events (AEs) and other mental health–related patient safety incidents (MHPSIs). Methods We first defined and categorized AEs and MHPSIs based on existing literature and then developed a trigger list, initially consisting of 50 items, which was subsequently reduced to 25 items after a pilot study. We then explored the properties of this final 25-item trigger tool, the Mental Health Trigger Tool (MHTT), through a retrospective review of 515 patient records with a two-stage review process similar to Global Trigger Tool methodology. We used findings of an alternative method of review which consisted of page-to-page reviews of patient records in the analysis of properties of MHTT. Results Using the MHTT, at least one AE was identified in 98 patient records (19%) and at least one MHPSI was identified in 58 patient records (11%). The MHTT had a sensitivity of 98.6% and its specificity was 100%. The probability of finding an AE/MHPSI when any trigger was detected in a patient record with MHTT was 33.8% and that of individual triggers ranged from 0% to 100%. Conclusions The MHTT may offer an effective, practical, and easy-to-use method in identifying and measuring safety incidents in mental health settings.

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