Health comorbidities and cognitive abilities across the lifespan in Down syndrome

Abstract

Background: Down syndrome (DS) is associated with variable intellectual disability and multiple health and psychiatric comorbidities. The impact of such comorbidities on cognitive outcomes is unknown. We aimed to describe patterns of physical health and psychiatric comorbidity prevalence, and receptive language ability, in DS across the lifespan, and determine relationships with cognitive outcomes.

Methods: Detailed medical histories were collected and cognitive abilities measured using standardised tests for 602 individuals with DS from England and Wales (age range 3 months to 73 years). Differences in prevalence rates between age groups and between males and females were determined using chi-squared or Fisher's exact tests. In adults, rates for psychiatric comorbidities were compared to expected population rates using standardised morbidity ratios (SMRs). Adapted ANCOVA functions were constructed to explore age and sex associations with receptive language ability across the lifespan, and regression analyses were performed to determine whether the presence of health comorbidities or physical phenotypes predicted cognitive abilities.

Results: Multiple comorbidities showed prevalence differences across the lifespan, though there were few sex differences. In adults, SMRs were increased in males and decreased in females with DS for schizophrenia, bipolar disorder, and anxiety. Further, SMRs were increased in both males and females with DS for dementia, autism, ADHD, and depression, with differences more pronounced in females for dementia and autism, and in males for depression. Across the lifespan, receptive language abilities increasingly deviated from age-typical levels, and males scored poorer than females. Only autism and epilepsy were associated with poorer cognitive ability in those aged 16-35 years, with no relationships for physical health comorbidities, including congenital heart defects.

Conclusions: Our results indicate the prevalence of multiple comorbidities varies across the lifespan in DS, and in adults, rates for psychiatric comorbidities show different patterns for males and females relative to expected population rates. Further, most health comorbidities are not associated with poorer cognitive outcomes in DS, apart from autism and epilepsy. It is essential for clinicians to consider such differences to provide appropriate care and treatment for those with DS and to provide prognostic information relating to cognitive outcomes in those with comorbidities.

Keywords: Cognitive outcomes; Down syndrome; Health comorbidities; Intellectual disability; Psychiatric comorbidities; Receptive language ability.

Fig. 1

Changes in receptive language ability across the lifespan in DS. Lines show performance for males (blue) and females (red), with age-typical performance (black). The top graph (a) represents receptive language z-scores across the lifespan (males n = 271, females n = 252), with a value of 0 corresponding to age-typical performance. The bottom graphs (b-e) represent raw scores coresponding to the z-scores in the top graph, split into scores for younger children (b; males n = 59, females n = 45), older children (c; males n = 10, females n = 15), younger adults (d; males n = 80, females n = 77), and older adults (e; males n = 122, females n = 115). Children with DS develop abilities (b and c) but do so at a slower pace than typically developing children, as reflected by a decrease in z-scores over childhood (a). Young adults with DS show a plateau in abilities (d), while in older adults with DS there is a decrease in raw scores (e) likely associated with the development of dementia which results in a further decrease in z-scores (a)