Dementia symptoms in persons with severe/profound intellectual disability: Expertise of practice

Aim Life expectancy of people with severe or profound intellectual disability (SPID) increases, which contributes to the risk of developing dementia. However, early detection and diagnosing dementia is complex, because of their low-level baseline functioning. Therefore, the aim is to identify observable dementia symptoms in adults with SPID in available literature. Method A systematic literature search, in line with PRISMA guidelines, was conducted in PubMed, PsycINFO and Web of Science using a combination of search terms for SPID, dementia/aging and aged population. Results In total, fifteen studies met inclusion criteria. Cognitive, behavioral and psychological symptoms (BPSD) and a decline in the ability to perform activities of daily living as well as neurological and physical changes were found. This presentation gives an overview of reported symptoms of (possible) dementia-related symptoms in SPID. Conclusions Despite growing attention for dementia in people with ID in literature, only very few studies have studied dementia symptoms in SPID. Given the complexity of signaling and diagnosing dementia in SPID, dedicated studies are required to unravel the natural history of dementia in SPID, specifically focusing on observable symptoms for caregivers of (early) dementia in this population

Dementia in People with Severe/Profound Intellectual (and Multiple) Disabilities::practice-Based Observations of Symptoms

Introduction Observable dementia symptoms are hardly studied in people with severe/profound intellectual (and multiple) disabilities (SPI(M)D). Insight in symptomatology is needed for timely signaling/diagnosis. This study aimed to identify practice-based observations of dementia symptoms in this population. Methods Care professionals and family members were invited to complete a survey about symptoms. Quantitatively analyzed survey data were further deepened through semi-structured interviews with care professionals having vast experience in signaling/diagnosing dementia in this population. Symptoms were categorized using a symptom matrix. Results Survey respondents and interviewees frequently observed a decline in activities of daily living (ADL) functioning and behavioral and psychological changes, like increased irritability, anxiety, apathy and decreased eating/drinking behavior. Cognitive symptoms were particularly recognized in persons with verbal communication and/or walking skills. To lesser extent motor changes and medical comorbidities were reported. Conclusion Increased insight in dementia symptoms contributes to developing a dedicated screening instrument for dementia in people with SPI(M)D

Dementia in People with Severe/Profound Intellectual (and Multiple) Disabilities:Practice-Based Observations of Symptoms

Introduction Observable dementia symptoms are hardly studied in people with severe/profound intellectual (and multiple) disabilities (SPI(M)D). Insight in symptomatology is needed for timely signaling/diagnosis. This study aimed to identify practice-based observations of dementia symptoms in this population. Methods Care professionals and family members were invited to complete a survey about symptoms. Quantitatively analyzed survey data were further deepened through semi-structured interviews with care professionals having vast experience in signaling/diagnosing dementia in this population. Symptoms were categorized using a symptom matrix. Results Survey respondents and interviewees frequently observed a decline in activities of daily living (ADL) functioning and behavioral and psychological changes, like increased irritability, anxiety, apathy and decreased eating/drinking behavior. Cognitive symptoms were particularly recognized in persons with verbal communication and/or walking skills. To lesser extent motor changes and medical comorbidities were reported. Conclusion Increased insight in dementia symptoms contributes to developing a dedicated screening instrument for dementia in people with SPI(M)D

Diagnostisch hulpmiddel dementie bij mensen met (Z)EV(M)B voor gedragskundigen en psychodiagnostisch medewerkers

Mensen met (zeer) ernstige verstandelijke (en meervoudige) beperkingen ((Z)EV(M)B) worden steeds ouder. Aangezien leeftijd de belangrijkste risicofactor is voor dementie, komt dementie vaker voor bij deze doelgroep. Daarbij komt ook dat mensen met downsyndroom (trisomie 21) een hoog genetisch bepaald risico hebben op dementie door de ziekte van Alzheimer (Ballard et al., 2016). 20-30% van alle mensen met het downsyndroom heeft een ernstige of zeer ernstige verstandelijke beperking.Het signaleren en diagnosticeren van dementie bij mensen met (Z)EV(M)B is complex. Om dementie te diagnosticeren, moet er sprake zijn van cognitieve achteruitgang ten opzichte van een eerder, hoger niveau van functioneren die impact heeft op het dagelijks functioneren. Bij mensen met (Z)EV(M)B is het ingewikkeld om achteruitgang door dementie te onderscheiden van de al aanwezige (zeer) ernstige beperkingen in het functioneren.Bij mensen zonder verstandelijke beperking worden neuropsychologische testen gebruikt voor het vaststellen van dementiegerelateerde cognitieve achteruitgang. Deze testen zijn echter niet geschikt voor mensen met (Z)EV(M)B door hun beperkte begrip van de testinstructie en beperkingen in verbale vaardigheden. Ook eerder ontwikkelde dementie-screeningsinstrumenten voor mensen met verstandelijke beperkingen (VB) zijn niet als geheel bruikbaar voor mensen met (Z)EV(M)B (Wissing, Dijkstra, et al., 2022).Dit diagnostisch hulpmiddel is ontwikkeld om dementiegerelateerde veranderingen bij mensen met (Z)EV(M)B in kaart te brengen ter ondersteuning van het diagnostisch traject bij (een vermoeden van) dementie.Inclusief handleidin

Dementia in People with Severe/Profound Intellectual (and Multiple) Disabilities:Applicability of Items in Dementia Screening Instruments for People with Intellectual Disabilities

Introduction: Diagnosing dementia in people with severe/profound intellectual (and multiple) disabilities (SPI(M)D) is complex. Whereas existing dementia screening instruments as a whole are unsuitable for this population, a number of individual items may apply. Therefore, this study aimed to identify applicable items in existing dementia screening instruments. Methods: Informant interviews about 40 people with SPI(M)D were conducted to identify applicable items in the Dementia Scale for Down Syndrome, Behavioral and Psychological Symptoms of Dementia in Down Syndrome II scale, Dementia Questionnaire for persons with Mental Retardation and Social competence Rating scale for people with Intellectual Disabilities. Results: Among 193 items, 101 items were found applicable, categorized in 5 domains: behavioral and psychological functioning (60 items), cognitive functioning (25), motor functioning (6), activities of daily living (5) and medical comorbidities (5). Conclusion: Identifying applicable items for people with SPI(M)D is an essential step in developing a dedicated dementia screening instrument for this population

Derivation and testing of a model to predict selection for fungicide resistance

A mathematical model was derived to predict selection for fungicide resistance in foliar pathogens of cereal crops. The model was tested against independent data from four field experiments quantifying selection for the G143A mutation conferring resistance to a quinone outside inhibitor (QoI) fungicide in powdery mildew (Blumeria graminis f.sp. hordei) on spring barley (Hordeum vulgare). Fungicide treatments with azoxystrobin differed in the total applied dose and spray number. For each treatment, we calculated the observed selection ratio as the ratio of the frequency of the resistant strain after the last and before the first spray. The model accurately predicted the variation in observed selection ratios with total applied fungicide dose and number of sprays for three of the four experiments. Underprediction of selection ratios in one experiment was attributed to the particularly late epidemic onset in that experiment. When the equation representing epidemic development was modified to account for the late epidemic, predicted and observed selection ratios at that site were in close agreement. On a scatter plot of observed selection ratios on predicted selection ratios, for all four experiments, the 1:1 line explained 89-92% of the variance in the mean of observed selection ratios. To our knowledge, this is the first fungicide resistance model for plant pathogens to be rigorously tested against field data. The model can be used with some degree of confidence, to identify anti-resistance treatment strategies which are likely to be effective and would justify the resources required for experimental testing

Validation of the Dutch version of the quick mild cognitive impairment screen (Qmci-D)

Background: Differentiating mild cognitive impairment (MCI) from dementia is important, as treatment options differ. There are few short ( Method: The Qmci was translated into Dutch with a combined qualitative and quantitative approach. In all, 90 participants were recruited from a hospital geriatric clinic (25 with dementia, 30 with MCI, 35 with NC). The Qmci-D and SMMSE-D were administered sequentially but randomly by the same trained rater, blind to the diagnosis. Results: The Qmci-D was more sensitive than the SMMSE-D in discriminating MCI from dementia, with a significant difference in the area under the curve (AUC), 0.73 compared to 0.60 (p = 0.024), respectively, and in discriminating dementia from NC, with an AUC of 0.95 compared to 0.89 (p = 0.006). Both screening instruments discriminated MCI from NC with an AUC of 0.86 (Qmci-D) and 0.84 (SMMSE-D). Conclusion: The Qmci-D shows similar,(good) accuracy as the SMMSE-D in separating NC from MCI; greater,(albeit fair), accuracy differentiating MCI from dementia, and significantly greater accuracy in separating dementia from NC. Given its brevity and ease of administration, the Qmci-D seems a useful cognitive screen in a Dutch population. Further study with a suitably powered sample against more sensitive screens is now required