**Author details**

et al. 2006). This is also needed in the elderly with established Alzheimer's disease because of common co-morbidities. In the case of a rapid deterioration of function, the underlying reasons should be assessed even when Alzheimer's disease has been diagnosed and treatment started. Visual acuity and hearing should be regularly monitored in all adults with Down syndrome because of high prevalence's of visual impairment and hearing loss. Alzheimer's disease does not protect from any other disease or disability. Other treatable conditions, including hypo‐

The decline of the ABS total scores associated strongly to Alzheimer's disease; therefore the described declines in the ABS subscale scores probably reflect changes attributable to Alz‐ heimer's disease. The relative rates of change among of the subscales of ABS differed. The scores of the domains Domestic Activity, Responsibility, Self-Direction and Vocational Activity declined more, as compared to other domains including Independent Functioning and Physical Activities. This may reflect the early impairment of frontal lobe functions among people with Down syndrome (Holland *et al.* 2000), including executive dysfunction in the

Individual differences of the functional skills assessed by ABS scores were considerable. Decline of skills with ageing started at very different ages among participants in this study. The improvements of adaptive behaviour seen in several participants highlight the need for careful assessment of treatable medical conditions and possibilities for supporting the maintenance of functional independence. Stabilization of ABS scores was seen during medi‐ cation for Alzheimer's disease in one participant for up to five years. Studies using population based representative larger samples would be needed to further analyse factors that represent

A considerable proportion of people with Down syndrome do not develop clinical dementia at all (Coppus et al. 2006). People with Down syndrome differ in their individual biological and genetic risk of dementia (Zigman & Lott 2007; Prasher et al. 2008; Patel et al. 2008). Better understanding of genetic and environmental influences and medical conditions contributing

Repeated prospective assessments overcome memory errors compared to retrospective evaluations. Short questionnaires of adaptive behaviour change may be sufficient for screening purposes (Prasher *et al.* 2004). However, repeated assessments are needed for the confirmation of dementia and evaluation of interventions. The possibility of performing an assessment in

The informant-based assessments of coping skills for daily living may prove practical and useful for the follow up of ageing and dementia from the early non-symptomatic phase to the advanced stages at various levels of abilities. The authors suggest repeated assessments of adaptive behaviour and careful clinical evaluations to detect treatable medical conditions in

various settings without special professional expertise is a benefit of this approach.

thyroidism, visual impairment and hearing loss, may be found.

322 Pharmacology and Nutritional Intervention in the Treatment of Disease

development of Alzheimer's disease (Ball *et al.*2008).

to these differences is needed.

adults with Down syndrome.

potential confounders affecting adaptive behaviour more vigorously.

