I recently had a couple inquiries about people with Down syndrome in their 50s or 60s who developed increased fatigue and falling asleep easily (these were new symptoms). Questions asked included:
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Is it common for people with DS in their 50s and 60s to become more fatigued?
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Is it common for people with DS in their 50s and 60s to develop episodes of suddenly falling asleep when they have not had this type of symptom in the past?
These are not associated with normal aging in people with Down syndrome. It is important to look for possible medical or psychological causes.
Sleep apnea
Sleep apnea is more common in people with DS. Studies show that observation of symptoms often does not provide a correct assessment. In other words, even people with DS that aren't observed to snore or have pauses in their breathing may have sleep apnea. We recommend considering a sleep study.
Sleep problems in general are more common in people with DS. Observation of sleep may reveal that the person is not sleeping well. There may be a reason for this. For example, GERD (reflux) is more common in people with DS and can cause restless sleep. Consider evaluation for GERD or trial of medication to reduce acid if sleep seems restless.
Often times there is no clear reason for the sleep disturbance other than the fact that one of the impairments of the brain associated with DS appears to be impairment of the sleep center of the brain. However, generally this effect is a life-long pattern and doesn’t suddenly appear in late adulthood.
Hypothyroidism
An underactive thyroid is more common in people with DS. We see hypothyroidism in about 40% of our patients. Fatigue is a symptom. (Blood test: TSH, T4)
Hyperthyroidism
An overactive thyroid may also be associated with fatigue.
Diabetes mellitus
It may be more common in people with DS, and fatigue and malaise may be some of the symptoms. (Blood test: blood sugar)
Other metabolic conditions
Kidney disease, liver disease (Blood test: metabolic panel)
Addison's disease
Adrenal gland insufficiency can cause fatigue. (Blood test: AM cortisol level)
Testosterone deficiency
This may be more common in men with DS but symptoms are not always clearly associated with the deficiency and treatment benefit is not always clear. (Blood test: testosterone level)
Celiac disease
This is more common in people with DS (see our website resources on celiac disease). It may present as fatigue. (Blood test: TTGA- IgA)
Vitamin deficiencies that we have seen that can cause neurological and psychological symptoms
Anemia
A low blood count can cause fatigue. (Blood test: CBC)
Cancer
Cancer can cause fatigue. Fortunately, most cancer is less common in people with DS.
Heart disease
Impaired heart function can cause fatigue. Fortunately, heart attacks (myocardial infarctions) are very uncommon in people with DS. Untreated congenital heart disease, valvular heart disease, slow heart rate, or long-term complications of previously repaired congenital heart disease can all cause fatigue.
Depression
Depression can present with fatigue (assess for other symptoms of depression, consider anti-depressant). Other symptoms may include loss of interest in previously enjoyed activities, sadness, a change in self-talk, change in appetite, irritability, reduced tolerance of others, etc.
Neurological conditions:
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Seizures are more common in people with DS. There are 2 peaks of onset – childhood and older adulthood. They may present with sudden loss of consciousness and may not have the typical shaking movements. However, these episodes are usually brief and would be viewed differently than falling asleep. (An EEG may be helpful).
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We have seen one person that was diagnosed with narcolepsy. Symptoms include excess daytime fatigue and may include sudden episodes of falling asleep. It usually presents in early adulthood (in the general population).
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Brain injury or conditions such as stroke or tumor can also cause sleepiness (imaging of the brain such as CT or MRI can reveal these conditions). However, both strokes and brain tumors appear to be less common in people with DS.
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Alzheimer disease may cause apathy and less interest in activities and a tendency to fall asleep more easily. Generally, we haven't seen increased sleepiness as a first symptom. That is usually a later symptom and other symptoms are seen first – memory impairment, mood changes, decline in function, difficulty swallowing, incontinence, etc.
Additional symptoms associated with fatigue that we were asked about:
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What if the fatigue is associated with weight loss? Several of the above conditions can also cause weight loss and these can often be assessed together.
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There was an additional question about Giardia. Giardia is a protozoan infection that can cause weight loss, diarrhea, and fatigue. These are similar symptoms often seen in people with celiac disease. (Stool test for Giardia).
It is often noted that the person can stay awake for active activities but not passive ones. This may be true for a variety of causes of fatigue. The individual's ability to resist sleep may be adequate as long as he has something that keeps him active. For example, most of our patients fall asleep easily in the car but can stay awake for activities.
I recommend starting with a good history and physical by the person's practitioner. The findings of that evaluation will guide next steps. It may also lead to other testing that I have not listed above.