The neurological evaluation plays an essential role in the consensus diagnosis for dementia in people with Down syndrome. The evaluation must take into account the level of predementia functioning and provide a construct for longitudinal observations. This chapter explores selected features of the history and examination relevant to the neurological clinical impression. These features include hearing and visual acuities, wherein problems may be confused with dementia. Unrecognized partial seizures can confound a mental status examination. Hypotension and syncope must be distinguished from an epileptic event. Psychiatric symptoms in Down syndrome may precede dementia and are often characterized by disinhibition, apathy, and other frontal lobe manifestations. Situational depression-anxiety is very common. A structured neurological examination can provide salient observations about gait, muscle tone, reflexes, and office-based mental status findings. Throughout it is important to note those neurological findings that represent normal aging as opposed to dementia.
The Neurobiology of Aging and Alzheimer Disease in Down Syndrome, 2022, Pages 251-272,