BackgroundAdults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population.AimTo probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure.MethodsThe 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed.ResultsOverall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08–19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32–43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08–80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32–12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003).ConclusionsPsychotropic drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.

Dementia appears at a higher rate among some adults with intellectual disabilities (ID) and this potentially poses a greater risk of nursing home admission. Yet, to date, there is no evidence on the efficacy of general dementia-derived environment-, personnel-, and patient-oriented intervention strategies in delaying onset of dementia or in slowing down its rate of progression in this population. To investigate the feasibility and efficacy of a multicomponent nonpharmacological approach, the authors studied a sample of 14 adults with worsening cognition and everyday functioning who were no longer manageable by their family or staff in day centers or group homes, and who were relocated in a model special care unit (SCU) designed to proactively accommodate the needs of people with ID and dementia. Baseline level and rate of decline across a 3-year period were assessed by means of the Dementia Questionnaire for Persons with Intellectual Disabilities and compared to two control groups not in dementia-capable programs matched for age, sex, and severity of ID. After 3 years, the authors found some improvement in cognition and stabilization in everyday functioning and behaviors in the SCU residents and a worsening in the control groups. The authors noted that enrollment in a dementia-capable program facilitated daily practice of residents' residual skills and abilities, enhancing their memory and verbal communication, that the prosthetic environment contributed to activity maintenance and appropriate intellectual challenges, and that the greater participation on an individual level added to the skill maintenance. Although the interpretation of these positive findings is not straightforward, they confirm the validity of this "in-place progression" model and provide a platform for continuing progress in person-centered services and care for aging persons with ID.

These results confirm the reliability and validity of AFAST-I and emphasise the complexity of the relationship among functional status, cognitive functioning and behaviour also in adults/seniors with ID.

The present study confirms the cross-cultural value of DSQIID which was proved to be a psychometrically valid and user-friendly observer-rated scale for dementia screening in adults with both DS and non-DS ID.

These results confirm the reliability and validity of the Italian version of AADS.