Bereavement and behavioral changes as risk factors for cognitive decline in adults with Down syndrome

Figures & data

Table 1 Informant Questionnaire on Cognitive Decline in the Elderly items and its relationship to cognitive decline

IQCODE item	Combined frequency of response (worsened)	Chi-square for IQCODE score ≥3.16
		% of positive responses		Relative risk	P-value
		<3.16	≥3.16
4. Remembering things that have happened recently	22.2%	7.1%	75%	10.5	0.019
6. Forgetting what he/she wanted to say in the middle of a conversation	27.8%	14.3%	75%	5.2	0.044
11. Adjusting to any change in his/her day-to-day routine	27.8%	14.3%	75%	5.2	0.044
14. Learning new things in general	27.8%	14.3%	75%	5.2	0.044
22. Making decisions on everyday matters	33.3%	14.3%	100%	6.9	0.005

Note: We have listed only the IQCODE items for which there was a statistically significant correlation with cognitive decline.

Abbreviation: IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly.

Figure 1 Differences in subscale scores and total score on the CAMCOG, as well as the MMSE score, between bereaved and not bereaved groups after 2 years of follow-up in 18 individuals with Down syndrome.

Notes: Data shown are mean ± standard deviation. ✰Area of greatest difference on cognition by Wilcoxon test.
Abbreviations: CAMCOG, Cambridge Cognitive Examination; MMSE, Mini-Mental State Examination; n, number of subjects.

Table 2 Differences between groups: bereaved and not bereaved

	Not bereaved (n=12)		Bereaved (n=6)		Differences between groups
	Mean	SD	Mean	SD	P-value (by Mann–Whitney test)
Age at baseline, years	43.75	6.76	39.83	3.82	0.397
Age at follow-up, years	44.83	6.78	41.33	4.03	0.452
Follow-up period (months)	18.33	3.06	18.33	3.39	0.850
Baseline scores
Orientation	7.33	2.10	7.17	1.84	0.811
Language total	16.00	4.13	16.33	3.93	0.887
Comprehension	4.42	1.62	4.17	0.98	0.885
Expression	11.58	2.81	12.33	2.81	0.887
Memory total	11.50	4.36	12.67	5.13	0.573
Long-term memory	1.08	0.79	1.33	0.82	0.514
Short-term memory	2.50	1.17	1.50	0.84	0.078
Learning	7.92	3.68	10.00	4.34	0.202
Attention	0.17	0.58	0.00	0.00	0.480
Praxis	7.92	1.38	8.00	1.10	0.810
Calculation	0.17	0.39	0.17	0.41	1.000
Abstract thought	2.25	1.36	2.67	2.66	0.809
Perception	7.25	1.14	8.00	1.55	0.337
CAMCOG total	52.58	11.63	54.17	11.62	0.850
MMSE	15.17	3.86	13.67	4.41	0.451
Follow-up scores
Follow-up period (months)	18.33	3.06	18.33	3.39	0.850
Orientation	7.00	2.00	5.83	3.37	0.538
Language total	14.92	3.32	14.50	4.14	0.814
Comprehension	3.50	1.24	3.00	1.79	0.382
Expression	11.42	2.61	11.67	2.66	0.962
Memory total	12.17	4.69	10.83	6.08	0.572
Long-term memory	1.08	0.79	1.17	0.98	0.955
Short-term memory	2.92	1.00	1.50	1.38	0.034
Learning	8.58	3.63	8.17	4.75	0.963
Attention	0.08	0.29	0.00	0.00	0.480
Praxis	8.08	1.00	8.33	0.82	0.652
Calculation	0.17	0.39	0.00	0.00	0.303
Abstract thought	1.83	1.75	1.17	1.33	0.408
Perception	7.58	1.51	9.17	1.47	0.054
CAMCOG total	51.92	11.87	50.00	14.31	0.639
MMSE	14.83	4.24	13.67	4.93	0.638
IQCODE	3.05 (n=9)†	0.11 (n=9)†	3.23	0.22	0.027
	n	%	n	%	P-value (by Fisher’s exact test)
Sex (male)	7	58.3	5	83.3	0.600
Literacy (illiterate)	8	66.7	6	100.0	0.245
Comorbidity (without)	6	50.0	4	66.7	0.638
IQCODE >3.16	1	8.3	3	50.0	0.083
Any change in behavior	5	41.7	6	100.0	0.038
Kind of behavior change
Agitation/aggression	1	8.3	2	33.3	0.245
Euphoria	0	0	1	16.7	0.333
Anxiety	0	0	1	16.7	0.333
Apathy	0	0	2	33.3	0.098
Dysphoria	0	0	2	33.3	0.098
Disinhibition	3	25.0	1	16.7	1
Irritability/lability	3	25.0	2	33.3	1

Note:

† Excluded three outliers (identified by box-plot analysis).

Abbreviations: MMSE, Mini-Mental State Examination; CAMCOG, Cambridge Cognitive Examination; IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly; SD, standard deviation; n, number of subjects.