Alzheimer's disease is more common in people with Down syndrome.
Presently, we do not know how to prevent or cure Alzheimer's disease.
We may lower the risk of developing Alzheimer's disease by maintaining a healthy diet, being physically active, getting good sleep, promoting mental health, challenging our brain, and staying engaged socially.
Alzheimer’s disease is significantly more common in individuals with Down syndrome compared to individuals without Down syndrome. Sadly, we do not know definitively how to prevent or cure the disease. However, there are steps that individuals with Down syndrome can take to promote overall health that also may lower the risk of developing Alzheimer’s disease or delay its onset.
Risk factors for developing Alzheimer’s disease continue to be studied. A 2022 study by Nianogo et al. identified eight risk factors associated with Alzheimer’s disease. Several of the risk factors are more common in people with Down syndrome – midlife obesity, physical inactivity, depression, and hearing loss. The strategies below address these risk factors.
Maintain a healthy diet
There has been much interest in whether certain diets may reduce the risk of Alzheimer’s disease. While they have not been studied in people with Down syndrome, some diets have shown benefit in studies in people without Down syndrome . However, it should be noted that some studies did not show benefit of these diets. Three of the diets include:
The Mediterranean diet emphasizes vegetables, fruits, whole grains, nuts, seeds, fish and shellfish, and healthy fats like nuts and olive oil. It suggests eating poultry, eggs, cheese, and yogurt in moderation and limiting red meat, added sugars, and refined grains.
Dietary Approaches to Stop Hypertension (DASH) diet
The DASH diet emphasizes vegetables, fruits, fat-free or low-fat dairy products, whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils. It limits red meat, added sugars, and sodium.
Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet
The MIND diet combines features of the Mediterranean and DASH diets. It suggests eating green leafy vegetables, non-starchy vegetables, berries, nuts, olive oil, whole grains, fish, beans, and poultry, and avoiding butter and margarine, cheese, red meat, fried food, pastries, and sweets.
There are many approaches to healthy eating. Changing one’s diet may seem overwhelming. We encourage individuals with Down syndrome to make small changes over time. Small changes add up and tend to be more sustainable. Here are some general tips:
Another dietary consideration is vitamin D. Some research has suggested that vitamin D deficiency may increase the risk of developing Alzheimer’s disease. Vitamin D is found in some foods and is made from cholesterol when the skin is exposed to sunlight. Vitamin D deficiency can be a common deficiency in places further from the equator, especially during the winter when there is less direct sun exposure.
A blood test can be done to check a person’s vitamin D level. Some individuals with Down syndrome may want to consider a vitamin D supplement if their levels are low. However, vitamin D supplements can interact with some medications, so we recommend that people with Down syndrome speak with their health care provider before taking a supplement.
Other vitamins and supplements
Vitamin B12 deficiency is a known cause of dementia but it has not been associated with Alzheimer's disease specifically. Many other vitamins and supplements are being investigated but there are no definitive data as of now.
A 2023 study found that orthostatic hypotension is associated with onset of dementia at a younger age (in people without Down syndrome). Orthostatic hypotension most commonly occurs when we go from lying or sitting to standing and we become dizzy because the blood pressure lowers in our brain. Dehydration (inadequate fluid intake) is a common cause of orthostatic hypotension. In our experience, many individuals with DS do not drink enough fluids. We encourage drinking adequate fluids. Our Tips for Staying Hydrated article shares several resources about drinking enough fluids.
Be physically active
Being physically active can benefit our health in many ways, including improving cognition and reducing the risk of dementia (including Alzheimer’s disease). According to the Physical Activity Guidelines for Americans, 2nd edition , adults should do at least 150 minutes to 300 minutes of moderate-intensity aerobic activity each week or 75 minutes to 150 minutes of vigorous-intensity aerobic activity each week. One way to achieve the recommendation is to be active for 30 minutes, 5 days per week. Adults should also do muscle-strengthening activities of moderate or greater intensity on 2 or more days a week.
These guidelines may seem daunting if an individual does not participate in regular physical activity. Any amount of physical activity is better than no physical activity. Moving more and sitting less is the overall goal. Here are some general tips we share with individuals with Down syndrome:
See the Exercise and Physical Activity section of our library for more resources.
Get good sleep
Getting good sleep and enough sleep is important for daily function. Inadequate or poor sleep can have a negative impact on physical and mental health, behavior, and cognition. A review article on sleep disorders in adults with Down syndrome reported that sleep disorders such as obstructive sleep apnea (OSA) and sleep disturbances are more common in adults with Down syndrome compared to those without Down syndrome. A study published in 2022 found that adults with Down syndrome and OSA had more amyloid in the brain. Amyloid is a type of protein that builds up in the brains of people with Alzheimer's disease (AD). The authors concluded, "OSA may be a modifiable risk factor that can be targeted for intervention in this population at risk for AD."
The healthcare guidelines for children and adolescents with Down syndrome developed by the American Academy of Pediatrics recommends a sleep study for all children between the ages of 3 and 4 to assess for sleep apnea. There is not a comparable guideline for adults, although sleep apnea is being reviewed as part of an ongoing effort to develop guidelines for adults with Down syndrome. Particularly since sleep apnea is common in people with Down syndrome and can cause a variety of symptoms, we recommend considering a sleep study when an individual has sleep disturbance, mood or behavioral change, or a number of other symptoms.
For individuals with Down syndrome who have trouble falling or staying asleep, we recommend the following:
Practice good sleep hygiene.
Do relaxing activities or use sensory strategies before bed.
Review your medications with your health care provider.
Work with your health care provider to address medical and psychological issues that may be contributing to sleep disturbances.
Consider trying natural products.
Consider asking your health care provider about prescription medications.
Additional information about these strategies is available in our article called Addressing Challenges with Falling or Staying Asleep.
Promote mental health
Several mental health conditions, including mood disorders such as depression, are more common in people with Down syndrome. Our study on prevalence of mental health conditions found that people with Down syndrome were over 3 times as likely to have a mood disorder as people without Down syndrome.
Maintaining a healthy diet, being physically active, and getting good sleep are important aspects of mental health promotion. Another aspect is managing stress. We recommend working with individuals with Down syndrome to identify situations that cause them stress. I like to say, “Stress is in the eye of the beholder.” What causes me to stress, may not be what causes you to stress, or something that causes me a lot of stress may not cause as much stress for you. After identifying stressors, discuss ways to avoid those situations or strategies that can be used to cope with them (such as taking deep breaths, going for a walk, talking to a family member, etc.).
Abby Rowley, LCSW, the licensed clinical social worker at the Adult Down Syndrome Center, shares more information about managing stress in her article How to Cope with Stress. Our library also has several visuals and videos on healthy ways to manage stress. Our library also has a Mental Health section with more resources.
Challenge your brain
Doing activities that challenge our brains may prevent or delay cognitive decline. It is included on a list of 10 Ways to Love Your Brain from the Alzheimer’s Association. Doing puzzles, playing games, and learning a new skill are just a few suggestions. We share many other activity ideas in Activities You Can Do at Home and Fun Activities for Promoting Health.
Stay engaged socially
Staying engaged socially benefits mental health, stimulates the brain, and may reduce the risk of cognitive decline. In addition to having meaningful relationships with family and friends, other social opportunities include participating in recreational activities, working a paid or volunteer job, getting involved in clubs or groups, and going on outings in the community. Local Down syndrome organizations, libraries, and park districts may offer programs.
Get hearing checked regularly
Our ability to hear impacts our ability to participate in social settings. Hearing loss is more common in people with Down syndrome. Losing hearing can lead to isolation which can contribute to decline in skills and cognition. We recommend that adults with Down syndrome have their hearing checked every one to two years.
The health promotion steps listed above may have the added benefit of lowering the risk of developing Alzheimer’s disease or delaying its onset. We encourage individuals with Down syndrome and their families to incorporate these activities in their daily routines.