Effect of menopause on cognitive performance in women with Down syndrome.

We compared cognitive function in nondemented pre- and postmenopausal women with Down syndrome, aged 21-57 years, with their age-matched male peers. The Woodcock-Johnson Tests of Cognitive Ability-Revised were used to assess cognitive function at baseline and 2 years later. Premenopausal women performed better than their age-matched male peers, while postmenopausal women performed more poorly than age-matched male peers (p = 0.007). Premenopausal women and young men showed no significant declines in cognition over time. Postmenopausal women, but not their age-matched male peers, showed significant declines in cognitive function. Our results support the hypothesis that cognitive declines in postmenopausal women are associated with estrogen deficiency rather than with age.

A prospective study of menopause in women with Down's syndrome.

The present study prospectively examined the age at menopause of 92 women with Down's syndrome (DS) and the influence of hypothyroidism on the age of menopause. Three methods were used to determine the distribution and median age at onset of menopause: (1) Kaplan-Meier life tables; (2) Cox proportional hazards modelling; and (3) maximum likelihood logistic regression. All three methods provided distributions and similar estimates of the median age at menopause, which was approximately 46 years. The presence of hypothyroidism did not influence age at menopause. The earlier-than-expected age at onset of menopause suggests that women with DS are at an increased risk for post-menopausal health disorders.

Practice guidelines for the clinical assessment and care management of Alzheimer's disease and other dementias among adults with intellectual disability. AAMR-IASSID Workgroup on Practice Guidelines for Care Management of Alzheimer's Disease among Adults with Intellectual Disability.

The AAMR/IASSID practice guidelines, developed by an international workgroup, provide guidance for stage-related care management of Alzheimer's disease, and suggestions for the training and education of carers, peers, clinicians and programme staff. The guidelines suggest a three-step intervention activity process, that includes: (1) recognizing changes; (2) conducting assessments and evaluations; and (3) instituting medical and care management. They also provide guidance for public policies that reflect a commitment for aggressive care of people with Alzheimers's disease and intellectual disability, and avoidance of institutionalization solely because of a diagnosis of dementia.

Acceptance of hospital-based respite care by families and elders.

Health and social service professionals generally view respite services as a preventive health care measure for both caregiver and recipient. However, many families with dependent elders are reluctant to use formal respite care services. Factors associated with family member perceptions of hospital-based respite care as a viable personal option are examined. The findings suggest that families often fail to recognize the preventive health care functions that respite care may offer and that practitioners should propose respite care as part of overall treatment plans.

Use of differential reinforcement of low rates of behavior to decrease repetitive speech in an autistic adolescent.

A differential reinforcement of low rates of behavior (DRL) schedule was successful in reducing repetitive speech in an autistic adolescent. Over a period of 18 months, the rate of repetitions was gradually reduced from a mean of 4.7 to less than 0.3 repetitions per min. Tokens were awarded for maintaining rates of repetitive speech below each of nine successive criterion levels. A reversal phase in which the token economy was no longer in effect resulted in a return to baseline repetition rates. Subsequent reintroduction of the contingencies saw a return to previous low levels of responding which were maintained at a 6-month and 14-month follow-up.

Functional assessment: bridge between family and rehabilitation medicine within an ambulatory practice.

This study describes development of a functional assessment instrument used to screen ambulatory care patients who have difficulty performing daily activities. Sample selection occurred in 2 stages. In the first stage, an interdisciplinary team used clinical selection criteria in order to screen patients into 2 groups: group 1, those likely to have functional limitations; and group 2, those not likely to have functional limitations. Using clinical selection criteria for a 3-week period in an ambulatory primary care setting, it was found that 20% of the outpatients seen fell into group 1. In the second stage, a randomly selected subsample of 194 persons was used, with 97 in group 1, and 97 in group 2. The Functional Assessment Screening Questionnaire (FASQ) was tested using this second sample. The FASQ was found to discriminate between the 2 groups, with those in group 1 having a significantly greater number of functional difficulties than those in group 2. An analysis was conducted to investigate which diagnostic problems were more likely to be associated with patients reporting functional limitations. Fourteen diagnostic patient problems found to be significantly more limiting than for the total sample were identified. The factor structure of the FASQ was examined and a format for clinically integrating the FASQ factors was offered.

Comparison of community adjustment of older vs. younger mentally retarded adults.

The relationship between age and community adjustment was studied in a sample of 153 deinstitutionalized mentally retarded adults. Those aged 18 to 54 were compared with those aged 55 and older with respect to IQ, rate of recidivism, community adjustment, and residential environment. Results showed that although the two groups were comparable in IQ and recidivism rate, the older subjects lived in less autonomous residences in the community and functioned at a lower level. Alternative explanations for these results were offered, and policy implications were presented.

Community residential adjustment: the relationship among environment, performance, and satisfaction.

A cohort of 153 persons released from a state school for mentally retarded persons was studied with regard to two outcome measures of community residential adjustment: (a) adaptive behavior as measured by the percentage of mastered skills that a subject performed regularly and independently and (b) subjects' satisfaction with aspects of their residential environments. Five environmental dimensions of six residential program types were examined, and significant differences among the program types on these environmental dimensions were reported. A multiple regression analysis was performed to explain the relationship between the measures of adaptive behavior and individual and environmental characteristics. Benefits of this study's measurement of community adjustment were discussed in terms of their potential use for future research and for use by planners and providers of services.