The behavioural differences between those referred and the comparison group suggest that two factors are involved in the instigation of a referral for a dementia assessment: the nature of the behavioural presentation (excesses rather than deficits) and the effect of that behavioural change upon the care staff.

Background. Informant based assessment of behavioural change and difference in

The authors describe and assess the experience of providing proactive screening for dementia in older adults with intellectual disabilities (ID) through a dedicated clinical psychology service within the National Health Service in England. Subjects were the first 18 participants who were referred to the clinical service or were identified as showing early signs of probable dementia in a proactive screening strategy. The screening process involved combining neuropsychological, behavioral, and health data with information from a clinical assessment of the presenting problem in a case series approach. The process of psychological assessment and formulation is illustrated together with an outline of the psychological interventions employed for early-, mid-, and late-stage dementia. An appraisal of the service strategy showed that a dedicated psychology service for dementia assessment can be effective when offering a defined and workable psychological response to the increasing presentation of dementia-associated behaviors among people with ID. Ancillary services included supporting carers in contributing to the assessment and intervention process so as to ensure appropriately responsive and respectful care management for the person with ID and dementia. The authors recommend that a multimodal stage model of intervention founded on direct performance and informant-based assessments (within a framework of differential diagnosis) be employed in supporting people with ID and dementia.

Results support the hypothesis that, consistent with literature for older adults with dementia in the general population, some behavioral excesses were functional in nature and not randomly occurring events. No relationship was found between appropriate engagement and staff contact. Evidence of the functional nature of target behavioral excesses indicates that behavioral interventions have potential for this client group.

Adults with Down's Syndrome are at risk of developing Alzheimer's disease in later life. This paper gives an overview of the current research in the area and discusses the implications it raises for individuals, carers and service providers. Information on the link between Down's Syndrome and Alzheimer's disease and prevalence rates are given. The clinical symptoms of Alzheimer's disease and a stage model documenting the progression of the disease are presented. Attention is drawn to the problems inherent in assessing and diagnosing Alzheimer's disease in a person with a pre‐existing learning disability. The importance of a thorough assessment procedure and guidelines for assessment methods are highlighted. The paper also discusses the management of Alzheimer's disease and focuses on care management practices and recommendations for service provision. Guidelines for supporting individuals include maintaining skills, adopting a person‐centred approach, implementing psychosocial interventions and multidisciplinary care management. Finally, high prevalence rates of Alzheimer's disease in adults with Down's Syndrome and increasing life spans are highlighted as a particular concern, and recommendations for the future include increasing education and awareness, implementing screening services, improving assessment methods and developing appropriate services.