In an evidence-based clinical guideline, published online Oct. 20 in the Journal of the American Medical Association, recommendations are presented for the medical care of adults with Down syndrome.
Amy Y. Tsou, M.D., from the ECRI Center for Clinical Excellence and Guidelines in Plymouth Meeting, Pennsylvania, and colleagues developed evidence-based clinical practice guidelines for adults with Down syndrome. Ten population/intervention/comparison/outcome questions were developed addressing multiple clinical areas. Data from 22 studies (three systematic reviews and 19 primary studies) were reviewed and synthesized.
Based on the evidence, the researchers developed 14 recommendations and four statements of good practice. The evidence base was limited overall. Screening for Alzheimer-type dementia starting at 40 years was formulated as the one strong recommendation. Four recommendations were in accordance with current guidance for individuals without Down syndrome: managing risk factors for cardiovascular disease and stroke prevention, obesity screening, and evaluation for secondary causes of osteoporosis. Given the high prevalence and earlier onset of diabetes in adults with Down syndrome, two recommendations for diabetes screening suggest earlier initiation of screening and at shorter intervals.
“This clinical guideline identifies many areas in which additional research is needed, including prevalence, screening, diagnostic testing, biomarkers, comorbidities, and treatment,” write the authors of an accompanying editorial.