IDD and Dementia. 4.3 Treatment


Changes in behavior, loss of function, and personality and emotional changes in people with intellectual disabilities may be the result of medical or psychiatric conditions other than dementia, such as heart disease, obesity, diabetes, nutritional deficiencies, thyroid abnormalities, hearing or visual impairments, changes in gait or balance, adverse drug reactions, depression, sleep disorders, and pain (Jokinen et al., 2013; O'Caoimh et al., 2013). Individuals with IDD and dementia have more health comorbidities than those without dementia (Strydom, 2010). For example, epilepsy is significantly more common in people with IDD and dementia compared to people with IDD without dementia (McCarron et al., 2014). Sleep apnea is common in adults with Down syndrome, and treating sleep disturbance in an individual with IDD and dementia may involve use of continuous positive airway pressure therapy. Occupational and physical therapists can help treat changes in ADLs as the dementia worsens in an individual with IDD (Moran et al., 2013.).

Nonpharmacologic approaches, such as behavioral strategies, can be effective when working with individuals living with IDD and dementia. A 2007 review of the literature indicates that most families adapt well to a family member with IDD. However, some families of adults with IDD and behavioral challenges are at risk for poor physical and mental health outcomes. (Heller, 2007). Recommendations for families caring for people with intellectual disabilities and dementia are to use stage-based approaches to communication, initiate low-cost environmental adaptations that support independence and avoid conflicts, reduce demand situations, reconnect with previously successful behavioral approaches, and proactively find ways to avoid stresses and to increase enjoyment of valued activities (Jokinen et al., 2013; McCallion et al., 2005; McCarron et al., 2010). The Caregiving Difficulty Scale -- Intellectual Disability (CDS-ID) (McCallion et al., 2005) is also available to help identify caregivers at risk and the areas where they are experiencing challenges.

Research results are mixed regarding the efficacy of pharmaceutical therapies for dementia in persons with IDD. Pharmaceutical concerns include maximum and exact dosage and drug treatment cessation. Delay in diagnosis of AD in the IDD population often results in delayed treatment resulting in a reduced therapeutic window for effective use of medications. Cardiac and respiratory problems and differences in physiology such as metabolism and heart rate require additional consideration when exploring pharmaceutical therapy options for individuals with IDD. If the person is on multiple medications, clinicians must be knowledgeable of known and potential drug interaction implications, as well as poor medications compliance (Mohan, 2009; Moran et al., 2013; Prasher, 2004).

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