Screening for osteoporosis in community-dwelling adults with mental retardation.

Osteoporosis screening of adults ages 40 to 60 who attended community-based adult training centers was conducted utilizing dual-energy X-ray absorptiometry (DEXA) measurements of the calcaneus. Valid measurements were obtained on 107 individuals, a response rate of 94%. One fifth of the sample (21%) had osteoporosis and 34% had osteopenia. On multiple regression analysis, the most significant predictors of BMD were Down syndrome, mobility status, and race. Future studies involving larger samples of middle-age adults with mental retardation/developmental disabilities will clarify the need and optimum age for osteoporosis screening.

Caring for adults with mental retardation: survey of family practice residency program directors.

In their core curriculum guidelines, the Society of Teachers of Family Medicine has recognized the importance of training family physicians in caring for persons with mental retardation. We mailed surveys to all family practice residency directors in the United States, questioning them about experiences and methods used to teach residents about health care needs of adults with mental retardation and the importance of this education. We found that 84% of programs provide residents with one or more experiences, and 60% instruct residents in this area. Most directors ranked this education as very important or important. There was no relationship between type or age of residency program and likelihood that residents were educated about mental retardation. The importance of this education is discussed.

Genetic diagnosis in adulthood. A case report.

While family physicians may readily entertain genetic diagnoses in their pediatric patients, they may fail to consider such diagnoses in their adult patients. We present the case of a man with recurrent leg ulcers who was recognized as hypogonadal and was ultimately given the diagnosis of Klinefelter's syndrome (XXY) at age 47. Although there is no primary treatment for XXY, significant associated conditions, including osteoporosis and testosterone deficiency, can be ameliorated. We review the clinical condition of XXY at various ages and summarize age-specific interventions. We discuss the importance of genetic diagnosis throughout the life span.

Primary care of adults with mental retardation.

BACKGROUND: There is a national trend to deinstitutionalize mentally retarded adults, placing them in community residential settings. As a result, community-based primary care physicians will assume responsibility for their medical care. Primary care physicians may have uncertainties regarding the medical care of this population. The purpose of this case series is to describe the medical care of a group of adults with mental retardation during their first year of community residence following deinstitutionalization, and to provide practical advice to family physicians who care for these adults. METHODS: Medical diagnoses and medications at the time of deinstitutionalization of a series of 21 adults were abstracted from institutional records and transfer forms. Follow-up data were obtained from office medical records. RESULTS: In the first year following deinstitutionalization, each patient averaged 6.6 office visits to a family physician. Newly identified major health impairments were: chronic persistent hepatitis due to hepatitis B, acid peptic disease, gastroesophageal reflux disease, dysphagia, primary degenerative dementia, absence seizures, bronchiectasis, and idiopathic iridocyclitis. Significant changes in pharmacotherapy included consolidation of multidrug anticonvulsant regimens and discontinuance of psychotropics and laxatives. Health maintenance practices included hepatitis B immunizations, cholesterol determinations, smoking cessation counseling, and calcium supplementation. CONCLUSIONS: Newly deinstitutionalized patients require careful diagnostic and therapeutic reassessment. Family physicians assuming their care need to look for conditions common in this population, including dysphagia, seizure disorders, chronic hepatitis B, and sensory impairments. Previously neglected health maintenance practices need to be instituted. Pharmacotherapies, particularly anticonvulsants, psychotropics, and laxatives, may be amenable to dosage reduction or discontinuance.

Dementia and Down syndrome.

Through deinstitutionalization, more adults with mental retardation are living in the community under the care of family physicians. Patients with Down syndrome are at high risk for early Alzheimer's disease. This case report describes a 43-year-old woman with Down syndrome whose progressive functional decline over 3 years was attributed to dementia of the Alzheimer type.

Glucocorticoid modification of spinal dopamine receptor activation by apomorphine.

The effects of an intensive short-term glucocorticoid (e.g. triamcinolone) regimen in cats have been studied on the actions of the dopamine (DA) receptor agonist apomorphine (APO) on spinal lumbar primary afferent excitability (dorsal root reflex or DRR) and monosynaptic reflex (MSR) transmission. Glucocorticoid dosing significantly decreased the APO-induced depression of the spinal DRR, but not the similar action of APO on the MSR. This complex effect of triamcinolone on spinal dopaminergic activation by APO may represent a differential action of glucocorticoid on two types of spinal DA receptors with one type, but not the other, undergoing partial desensitization.