Behavioral and psychological symptoms of Alzheimer’s disease and other
dementias may create a considerable burden of care in the general population, yet
relatively little research has been carried out in this area. Although problem behaviors
may be relatively less frequent in people with Down syndrome who develop
Alzheimer’s dementia, nevertheless they cause additional caregiver burden. Both
pharmacological and non-pharmacological interventions are used for the management
of problem behaviors in people with intellectual disability in general. Similarly, both
pharmacological and non-pharmacological interventions are used to manage symptoms
of dementia including behavioral symptoms in the general population. Treatment
approaches used in both these groups could equally be used to manage problem
behaviors in people with Down syndrome who develop dementia. Extrapolated
evidence from studies on children with autism spectrum disorder and intellectual
disability possibly supports use of risperidone for management of problem behavior in
adults with Down syndrome and dementia. RCT-based evidence exists to support use of
antipsychotics, mood stabilizers, and cholinesterase inhibitors for the management of
behavioral and psychological symptoms of dementia in the general population but no
specific evidence for Down syndrome exists. Clinicians have to be mindful of potential
serious central nervous system adverse effects of antipsychotics in people with
dementia. Similarly, evidence for efficacy of non-pharmacological interventions for
problem behaviors both in the general population with dementia and people with
intellectual disability in general is too equivocal to make any definitive
recommendation at this stage for people with Down syndrome and dementia. Recently
there has been an emphasis on providing person-centered service specifically designed
for people with dementia. Another important aspect of management is training and
support for caregivers and care staff to help people with dementia to live a better quality
of life and reduce behavioral and psychological problems.
Keywords: Alzheimer’s disease, dementia, Down syndrome, management, nonpharmacological,
pharmacological, problem behavior.