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Older adults with type 1 diabetes (T1D) may have an elevated risk of developing Alzheimer disease and related dementia. Higher intraindividual cognitive variability (IICV) has been proposed as a novel risk factor of Alzheimer disease and related dementia. Here, we examined the association between cross-domain IICV measured using the Montreal Cognitive Assessment (MoCA) and cognitive impairment measured using traditional neuropsychological tests in older individuals with T1D. Participants with T1D (N=201) completed both the MoCA and a battery of traditional neuropsychological tests. Participants with cognitive impairment, determined using traditional tests, had significantly higher IICV scores and significantly lower total MoCA scores (P0.001). However, the effect of the total score was greater than that of the IICV score on the likelihood of cognitive impairment (total odds ratio=3.50, IICV odds ratio=2.03, P0.001). The MoCA total score performed better than the MoCA IICV score in identifying T1D individuals classified with cognitive impairment.

The presence of age-related neuropathology characteristic of Alzheimer's disease (AD) in people with Down syndrome (DS) is well-established. However, the early symptoms of dementia may be atypical and appear related to dysfunction of prefrontal circuitry. OBJECTIVE To characterize the initial informant reported age-related neuropsychiatric symptoms of dementia in people with DS, and their relationship to AD and frontal lobe function. METHODS Non-amnestic informant reported symptoms (disinhibition, apathy, and executive dysfunction) and amnestic symptoms from the CAMDEX-DS informant interview were analyzed in a cross-sectional cohort of 162 participants with DS over 30 years of age, divided into three groups: stable cognition, prodromal dementia, and AD. To investigate age-related symptoms prior to evidence of prodromal dementia we stratified the stable cognition group by age. RESULTS Amnestic and non-amnestic symptoms were present before evidence of informant-reported cognitive decline. In those who received the diagnosis of AD, symptoms tended to be more marked. Memory impairments were more marked in the prodromal dementia than the stable cognition group (OR = 35.07; P

Objective Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) frequently co-occur and are associated with neurocognitive intra-individual variability (IIV) and difficulty with prospective memory (PM). The current study aimed to examine associations between IIV and PM in this comorbid group. Method Fifty veterans with a history of blast mTBI and current comorbid PTSD completed a standardized neurocognitive battery to measure IIV, and the Memory for Intentions Screening Test measuring PM. Results Adjusting for age, education, and race, higher IIV was associated with poorer time-based PM (p Conclusions Cognitive variability on a standardized neuropsychological battery was associated with strategically demanding PM, which is an ecologically relevant ability and highlights the possible connection between subtle cognitive difficulties in-clinic and those experienced in daily life.

Background: Neuropsychiatric symptoms (NPS) are non-cognitive manifestations common to dementia and other medical conditions, with important consequences for the patient, caregivers, and society. Studies investigating NPS in individuals with Down syndrome (DS) and dementia are scarce. Objective: Characterize NPS and caregiver distress among adults with DS using the Neuropsychiatric Inventory (NPI). Methods: We evaluated 92 individuals with DS (≥30 years of age), divided by clinical diagnosis: stable cognition, prodromal dementia, and AD. Diagnosis was determined by a psychiatrist using the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX-DS). NPS and caregiver distress were evaluated by an independent psychiatrist using the NPI, and participants underwent a neuropsychological assessment with Cambridge Cognitive Examination (CAMCOG-DS). Results: Symptom severity differed between-groups for delusion, agitation, apathy, aberrant motor behavior, nighttime behavior disturbance, and total NPI scores, with NPS total score being found to be a predictor of AD in comparison to stable cognition (OR for one-point increase in the NPI = 1.342, p = 0.012). Agitation, apathy, nighttime behavior disturbances, and total NPI were associated with CAMCOG-DS, and 62% of caregivers of individuals with AD reported severe distress related to NPS. Caregiver distress was most impacted by symptoms of apathy followed by nighttime behavior, appetite/eating abnormalities, anxiety, irritability, disinhibition, and depression (R2 = 0.627, F(15,76) = 8.510, p

INTRODUÇÃO. Embora esteja bem estabelecida a relação neuropatológica da síndrome de Down (SD) com a doença de Alzheimer (DA), os primeiros sintomas de demência na população com SD são considerados atípicos. Estudos indicam que os sintomas iniciais estão relacionados à disfunção comportamental que envolvem circuitos cerebrais fronto-subcorticais, como mudança de comportamento e disfunção executiva. O presente estudo teve como objetivo investigar fatores associados ao funcionamento do lobo frontal (disfunção executiva, desinibição e apatia) durante o declínio cognitivo e a DA em adultos com SD. MÉTODOS. 92 indivíduos com SD com idade acima de 30 anos foram alocados em três diferentes grupos diagnósticos (cognição estável, demência prodrômica e DA) por meio da avaliação com o instrumento Exame Cambridge para Transtornos Mentais em Adultos com Síndrome de Down e Deficiência Intelectual (CAMDEX-DS), previamente validado como parte da metodologia de trabalho. Os participantes foram avaliados com um protocolo de funções executivas desenvolvido para pessoas com deficiência intelectual por pesquisadores da Universidade de Cambridge e classificados para a presença de disfunção executiva, desinibição e apatia através da entrevista com um informante utilizando a Escala de Personalidade Frontal. Além disso, dados sobre características de comportamentos resultantes de disfunções frontais, memória e orientação foram analisados por meio do CAMDEX-DS em conjunto com uma amostra inglesa totalizando amostra combinada de 162 participantes com SD com mais de 30 anos e divididos em quatro grupos: cognição estável abaixo de 45 anos, cognição estável acima de 45 anos, demência prodrômica e DA. RESULTADOS. Os relatos de disfunção executiva, desinibição e apatia através da Escala de Personalidade Frontal foram correlacionados com o desempenho cognitivo dos participantes: quanto maior a disfunção comportamental nestas áreas, pior o desempenho cognitivo nas tarefas executivas. A desinibição e a disfunção executiva foram associadas aos diferentes diagnósticos. A probabilidade de ter DA aumentou com elevações nos escores da Escala de Personalidade Frontal (p

Background: There is a proven link between Down syndrome and the early development of the neuropathological features of Alzheimer's disease (AD). Changes in the personality and behavior of adults with Down syndrome might indicate the early stages of dementia or of frontotemporal lobar degeneration. The objective of this study was to investigate the executive functions and changes in behavior associated with frontal lobe degeneration in individuals with Down syndrome who develop AD. We conducted a systematic review selecting studies employing cognitive assessments. Summary: We identified few studies using objective measurements to determine whether cognitive aspects associated with the frontal lobe correlate with dementia in this population. We observed a tendency toward such correlations. Key Messages: There is a need for further studies in which objective measures of cognitive and behavioral factors are evaluated together with data related to brain function and morphology.

There is evidence that frontal-subcortical circuits play an important role in the initial presentation of dementia in Down syndrome (DS), including changes in behavior, a decline in working memory and executive dysfunction. We evaluated 92 individuals with DS (≥30 years of age), divided into 3 groups by diagnosis—stable cognition, prodromal dementia, and Alzheimer's disease. Each individual was evaluated with an executive protocol developed for people with intellectual disabilities and was rated for behaviors related to frontal lobe dysfunction (disinhibition, executive dysfunction, and apathy) by an informant using the Frontal Systems Behavior Scale. Informant-reported behaviors related to frontal lobe dysfunction were found to correlate negatively with executive function performance. Disinhibition and executive dysfunction were associated with the clinical stage of dementia. The odds of having Alzheimer's disease increased in parallel with increases in the domain and total Frontal Systems Behavior Scale scores (p ≤ 0.5). Disinhibition, executive dysfunction and apathy should be taken into consideration during the clinical evaluation of adults with DS, and future studies should consider the intersection of neuropathology, brain connectivity, and behavior.

Background: There is a close genetic relationship between Alzheimer's disease (AD) and Down syndrome (DS), AD being the most severe mental disorder affecting ageing individuals with DS. The objective of the present study was to evaluate the efficacy of cognitive rehabilitation interventions in DS patients with AD by means of a critical literature review. Summary: Because AD is progressive and irreversible, treatment is aimed at delaying and reducing the cognitive and functional decline in order to preserve or improve quality of life. The effects that pharmacological treatments and cognitive interventions have on elderly individuals with AD are well documented. Recent clinical trials have investigated the use of pharmacological treatment in DS patients with AD, generating preliminary results that have been unfavourable. Key Messages: There is a clear lack of studies addressing the efficacy of cognitive rehabilitation interventions in DS patients with AD, and there is an urgent need for studies providing evidence to inform decisions regarding the appropriate choice of treatment strategies.

Luciana Mascarenhas Fonseca,1 Melaine Cristina de Oliveira,2 Laura Maria de Figueiredo Ferreira Guilhoto,3,4 Esper Abrao Cavalheiro,3,4 Cássio MC Bottino1 1Old Age Research Group, Department of Psychiatry, 2Institute of Mathematics and Statistics, University of São Paulo, 3Association of Parents and Friends of People with Intellectual Disability of São Paulo, 4Federal University of São Paulo, São Paulo, Brazil Background: Cognitive decline and Alzheimer’s disease often affect older adults with Down syndrome (DS) much earlier than those in the general population. There is also growing evidence of the effects of negative life events on the mental health and behavior of individuals with intellectual disability. However, to our knowledge, this is the first study investigating objective cognitive decline following bereavement in aging individuals with DS.Objective: The objective of this study was to determine whether cognitive decline correlates with bereavement following the recent loss of a caregiver or with behavioral changes in a sample of adult individuals with DS who do not meet the criteria for dementia or depression, using the longitudinal assessment of the Cambridge Cognitive Examination (CAMCOG), together with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).Methods: We evaluated 18 subjects at baseline and over a follow-up period of 14–22 months, attempting to determine whether cognitive decline correlates with bereavement following the recent loss of the main caregiver or with behavioral changes (as assessed with the Neuropsychiatric Inventory).Results: The mean rate of change in CAMCOG was -1.83 (standard deviation 4.51). Behavioral changes had a significant direct influence on cognitive decline. When bereavement was accompanied by behavioral changes, the probability of cognitive decline was 87% (odds ratio 3.82). Conclusion: The occurrence of behavioral changes attributed to bereavement following the loss of the primary caregiver significantly increases the probability of cognitive decline in individuals with DS. Longitudinal comparison of the CAMCOG and use of the IQCODE appear to enrich the analysis of cognitive decline in individuals with DS. Further studies involving larger samples are needed in order to corroborate and expand upon our findings, which can have implications for the clinical management of older adults with DS. Keywords: cognitive decline, Down syndrome, bereavement, behavioral changes, Cambridge Cognitive Examination, Informant Questionnaire on Cognitive Decline in the Elderly

Thanatology is a recent field that contemplates death studies and employs an interdisciplinary approach to practice. This science emerged in a historical context marked by intense social, economic, and political changes that contributed to the concept of death being excluded from social life. This literature review aims to outline the history and evolution of thanatology in Western society, delineating the contextual circumstances that led to its origin and drawing special attention to current works on death education. In our post-modern society, the call for studies in the field of thanatology appears to be increasing. However, although there have been significant contributions and promising research is underway, there are still many questions to be answered.

Implicacoes sobre Deficiencia Intelectual e Longevidade: Projeto Piloto de Intervencao nos casos de Senilidade Resumo O aumento da expectativa de vida da pessoa com deficiencia intelectual e um tema instigante e que merece atencao dos profissionais voltados a esta area. Ainda que seja notorio que os beneficios trazidos pela atencao ao ciclo vital e os avancos da biomedicina tenham aumentado a sua longevidade, nos ultimos anos de vida com frequencia estes passam por comorbidades e aceleracao do processo de envelhecimento. Buscar qualidade de vida para esta populacao durante o seu envelhecimento ainda e um desafio para as areas da Gerontologia e da Deficiencia Intelectual. O presente trabalho e resultado de um projeto piloto de intervencao em casos de pessoas com deficiencia intelectual em processo de envelhecimento senil atraves da adaptacao temporaria de um Servico por meio de uma proposta voltada as demandas desta populacao. E evidente a necessidade de adaptacao social e dos Servicos a estas novas demandas, sendo importante a qualificacao e a especializacao dos profissionais envolvidos na area, bem como a divulgacao de informacoes para as familias e a comunidade. Palavras-chave: Deficiencia intelectual; Envelhecimento; Gerontologia; Demencia; Senilidade Implications of Intellectual Disabilities and Longevity: A Pilot Project of Cross-cared intervention on Senility Abstract The increasing life expectancy for people with intellectual disability is a intriguing theme that deserves attention of professionals related to this area. Although it is well known that the benefits brought by modern interventions and advances in biomedicine have increased life’s longevity, it also means that during the later years of life these people often have comorbidities and a pathological aging processes. Enhancing the quality of life for this population is a unique challenge in the field of Gerontology and Intellectual Disabilities. The present work is the result of a pilot study carried out by a Service for intellectual disability and aging. The intervention focused on the participants who undergo some form of senile process through a proposal of management and temporary service adaptation which was developed based on patients´ demands. The need for social and service’s adjustments for the new demands of this population is evident, and it is of special significance professional qualification and expertise in this area, as well as, the rise of information for the families and the community. Key words: Intellectual disability; Aging; Gerontology; Dementia; Senility