Habilitative and rehabilitative educational interventions as protective factors against cognitive decline in adults with Down syndrome: A retrospective study.

BACKGROUND AND OBJECTIVES Adults with Down syndrome (DS) face a markedly elevated risk of Alzheimer's disease (AD), yet modifiable environmental factors that modulate cognitive decline remain under-explored. We aimed to determine whether formal education and lifelong habilitative/rehabilitative educational interventions (HREI) preserve neuropsychological functioning in DS.

METHODS We retrospectively reviewed records of 50 adults with DS (median=41 years). Global cognition and seven Test for Severe Impairment (TSI) domains were compared between individuals with dementia (n=25) and matched controls without dementia (n=25). Participants were further stratified by schooling (0-5 vs. 8-13years) and HREI exposure/duration.

RESULTS The dementia group performed significantly worse in praxis, language comprehension, immediate memory, general knowledge, conceptualisation and total TSI score (P<0.01). Within this group,≥8years of schooling and HREI exposure were each associated with higher global cognition and superior performance across up to five domains; no benefit was evident when interventions ceased after age 18. Schooling and HREI did not differentiate participants without dementia.

CONCLUSION Formal education and sustained HREI appear to confer cognitive reserve in DS, attenuating AD-related decline. These findings support policies that guarantee educational inclusion and lifelong, structured cognitive-motor enrichment for individuals with DS. Prospective larger-scale studies are warranted to delineate optimal dosage and timing of enrichment programmes in DS.