Chicoine also cautions that whenever a patient declines in function, a thorough evaluation is necessary "to look for reversible causes, or, if no reversible cause is found, to confirm that the decline is consistent with Alzheimer's disease" (Chicoine pp). In other words, just as in the general population, Alzheimer's disease is a diagnosis of exclusion in persons with Down's (Chicoine pp). Because traditional neuropshychological testing, such as used for persons in the general population, is not particularly helpful for assessing individuals with an intellectual disability, thus careful clinical evaluation is important to avoid missing potentially reversible causes of decline (Chicoine pp).

Chicoine cautions that mental health disorders often present differently in persons with Down syndrome due to cognitive and expressive language limitations, which means that mental health disorders may be difficult to distinguish from Alzheimer's dementia (Chicoine pp). For example, loss of adaptive skills, disruption of sleep cycle, appetite changes,...
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