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.