INTRODUCTION: Adults with Down syndrome (DS) are at high risk for Alzheimer's disease (AD), the leading cause of death in this population. Survival in DS after AD diagnosis appears shorter than in sporadic AD; however, the factors influencing survival remain poorly understood.
METHODS: We analyzed 157 adults with DS from Spain and Ireland who died of AD between 2012 and 2024. Clinical, genetic, and care predictors were examined using Kaplan-Meier curves and Cox regression.
RESULTS: Mean survival after AD diagnosis was 4.8 years (SD 3.5). Those in specialist intellectual disability dementia care had a longer survival time (mean 9.5 years) than other settings (mean 3.4 to 4.1 years; p < 0.001). Late-onset myoclonic epilepsy in DS (LOMEDS) was linked to a threefold higher risk of death after onset (p < 0.001).
DISCUSSION: Specialist care settings and LOMEDS timing significantly shape survival in DS-associated AD, highlighting the importance of tailored services and proactive epilepsy treatment.
