Loss Of A Loved One, Life Stress And Longitudinal Cognitive Decline In Adults With Down Syndrome

Alexandra Linker1, Sigan Hartley2, Shahid Zaman3, Benjamin Handen4, Luciana Mascarenhas Fonseca5

1  Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States, 2 School of Human Ecology and Waisman Center, University of Wisconsin-Madison, Madison, WI, United States, 3 Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States. 5 The Krieger Klein Alzheimer’s Research Center, Brain Health Institute, Rutgers University, New Brunswick, NJ, United States

Introduction:

• Individuals with DS are at high risk of developing Alzheimer’s Disease (AD)1

• Exposure to stress has been suggested as a risk factor for cognitive decline in the general population 2,3

• Death of a loved one suggested as a particularly potent stressor4

• Role of life stressors in longitudinal cognitive decline minimally investigated in adults with DS.

Methods:

• Alzheimer’s Biomarkers Consortium - Down Syndrome Data Set5

• participants with no Dementia or Mild Cognitive Impairment at Baseline Visit  (N = 93)

• Data set includes 

• Baseline Informant “Life Stressor Index”: 11 stressors in the past year and their impact (serious illness, hospitalization, a loved one’s hospitalization, a loved one’s death, a move, a friend moving away, a new roommate, losing/quitting a job/retiring, a new job, money problems; none, handled well, bad impact, complex impact)

• Baseline and follow-up cognitive tests 6,7,8

• Separate regressions assessed whether:

• Death of a loved one (complex/negative impact) and Sum of stress events predicted decline in cognitive scores over time. Model 1: bivariate associations; Model 2: adjusted for age, sex, site, level of intellectual disability, and clinical latency; Model 3: adjusted for all covariates in Model 2 plus history of anxiety, depression or obsessive/compulsive disorder

Results:

• Alzheimer’s Biomarkers Consortium - Down Syndrome Data Set5

• participants with no Dementia or Mild Cognitive Impairment at Baseline Visit  (N = 93)

• Data set includes 

• Baseline Informant “Life Stressor Index”: 11 stressors in the past year and their impact (serious illness, hospitalization, a loved one’s hospitalization, a loved one’s death, a move, a friend moving away, a new roommate, losing/quitting a job/retiring, a new job, money problems; none, handled well, bad impact, complex impact)

• Baseline and follow-up cognitive tests 6,7,8

• Separate regressions assessed whether:

• Death of a loved one (complex/negative impact) and Sum of stress events predicted decline in cognitive scores over time. Model 1: bivariate associations; Model 2: adjusted for age, sex, site, level of intellectual disability, and clinical latency; Model 3: adjusted for all covariates in Model 2 plus history of anxiety, depression or obsessive/compulsive disorder

Conclusions:

Life stressors may contribute to subsequent cognitive decline in adults with DS and warrant further investigation.

Bibiolgraphy and Funding

1.Mann (1988) Mech Ageing Dev. 43(2):99-136. 2.Wilson et al. (2011) Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 19(4):327-334. 3. Wilson et al. (2006) Neuroepidemiology. 27(3):143-153 4. Fonseca LM, de Oliveira MC, de Figueiredo Ferreira Guilhoto LM, Cavalheiro EA, Bottino CM.  (2014) Neuropsychiatr Dis Treat. doi:10.2147/NDT.S68831 5. Handen BL et al. (2020) Alzheimers Dement Diagn Assess Dis Monit. 12(1):e12065. doi:10.1002/dad2.12065 6. Haxby JV (1989) J Ment Defic Res.;33 (Pt 3):193-210. 7.  McCarthy DA. (1972) Manual for the McCarthy Scales of Children’s Abilities. https://cir.nii.ac.jp/crid/1971149384766648244 8.Korkman M, Kirk U, Kemp S. NEPSY-II – Second edition.

ABC-DS is funded by the NIH- NIA (U19AG068054).

LMF is supported by the NIH- NIA (K99AG082864).

All authors declare no conflict of interest.

Contact: alexandra.linker@wsu.edu