Virtually all individuals with Down's syndrome over the age of 35 years have neuropathological changes characteristic of Alzheimer's disease. It has become increasingly recognized that people with Down's syndrome and dementia have very special needs, and those who care for them require specialist knowledge and skills. This paper aims to explore some important issues in caring for persons with this dual disability. It commences with a brief outline on the prevalence of dementia in this population. Diagnostic issues and the clinical presentation of dementia in persons with Down's syndrome are reviewed. In an attempt to help staff respond to the opportunities and challenges they encounter, issues discussed include: promoting well-being, developing a shared vision on which to build practice, mealtimes – a therapeutic event, reality orientation and validation therapy, communication, activity and entertainment.
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