Krinsky-McHale Sharon J, Silverman Wayne
Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York 10314-6399, USA.
Dev Disabil Res Rev. 2013;18(1):31-42. doi: 10.1002/ddrr.1126.
Individuals with intellectual disability (ID) are now living longer with the majority of individuals reaching middle and even "old age." As a consequence of this extended longevity they are vulnerable to the same age-associated health problems as elderly adults in the general population without ID. This includes dementia, a general term referring to a variety of diseases and conditions causing substantial loss of cognitive ability and functional declines; adults with Down syndrome are at especially high risk. A great deal of recent effort has focused on the very earliest detectable indicators of decline (and even prodromal stages of dementia-causing diseases). A condition called mild cognitive impairment (MCI) has been conceptually defined as a decline in functioning that is more severe than expected with typical brain aging but not severe enough to meet criteria for a diagnosis of dementia. Consensus criteria for both dementia and MCI have been developed for typically developing adults but are of limited applicability for adults with ID, given their pre-existing cognitive impairments. Early diagnosis will continue to be of growing importance, both to support symptomatic treatment and to prevent irreversible neuropathology when interventions are developed to slow or halt the progression of underlying disease. While the intellectual and developmental disabilities field has for some time recognized the need to develop best-practices for the diagnosis of MCI and dementia, there remains a pressing need for empirically based assessment methods and classification criteria.
智力残疾（ID）患者如今的寿命更长了，大多数人已步入中年甚至“老年”。由于寿命延长，他们易患与普通人群中老年人相同的与年龄相关的健康问题，这其中包括痴呆症，这是一个统称，指的是导致认知能力大幅丧失和功能衰退的各种疾病和病症；唐氏综合征成年人的患病风险尤其高。最近大量的努力都集中在最早可检测到的衰退指标（甚至是导致痴呆症的疾病的前驱阶段）上。一种名为轻度认知障碍（MCI）的病症在概念上被定义为一种功能衰退，其程度比典型的大脑衰老预期更为严重，但又不足以达到痴呆症的诊断标准。针对发育正常的成年人已经制定了痴呆症和MCI的共识标准，但鉴于ID成年人已有的认知障碍，这些标准对他们的适用性有限。早期诊断将继续变得越来越重要，这既能支持对症治疗，又能在开发干预措施以减缓或阻止潜在疾病进展时预防不可逆转的神经病理学变化。虽然智力和发育障碍领域在一段时间以来已经认识到需要制定MCI和痴呆症诊断的最佳实践，但仍然迫切需要基于实证的评估方法和分类标准。
