title: Bereavement and behavioral changes as risk factors for cognitive decline in adults with Down syndrome.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Old Age Research Group, Department of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciana Mascarenhas
authors.initials: LM
authors.lastname: Fonseca
authors.affiliation: Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil.
authors.forename: Melaine Cristina
authors.initials: MC
authors.lastname: de Oliveira
authors.affiliation: Association of Parents and Friends of People with Intellectual Disability of São Paulo, São Paulo, Brazil ; Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Laura Maria
authors.initials: LM
authors.lastname: de Figueiredo Ferreira Guilhoto
authors.affiliation: Association of Parents and Friends of People with Intellectual Disability of São Paulo, São Paulo, Brazil ; Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Esper Abrao
authors.initials: EA
authors.lastname: Cavalheiro
authors.affiliation: Old Age Research Group, Department of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: Cássio Mc
authors.initials: CM
authors.lastname: Bottino
keywords: Cambridge Cognitive Examination; Down syndrome; Informant Questionnaire on Cognitive Decline in the Elderly; behavioral changes; bereavement; cognitive decline