“…As in several previous studies (Coppus et al, 2008;Temple et al, 2001;Zigman & Lott, 2007), we can postulate that environmental factors play a key role in aging and were responsible for the some of the interindividual differences reported here. A number of studies have highlighted the importance of education and medical care in the development of people with DS (Buckley, Bird, Sacks, & Archer, 2006;Couzens, Haynes, & Cuskelly, 2012;Hanson, 2003). Although comprehensive health assessment programs have improved health outcomes among people with intellectual disability (Cooper et al, 2006), many adults with DS still do not have access to regular health care, despite the high frequency of medical complications (Henderson, Lynch, Wilkinson, & Hunter, 2007;Määttä et al, 2011).…”