[Dysphagia] Down's and Eisenmenger's Syndrome

[dianesellstrom98 at yahoo.com (diane sellstrom)]

Hello all

i'm going to see this lady next week with a colleague
who works with adults with learning difficulties. she
has seen her once already and suspects something more
than a behavioural component. (i work in adult neuro)

30yo female with Downs syndrome and Eisenmengers
syndrome (progressive congenital heart condition). she
is hypoxic and requires supplementary O2 at all times.
over the last yr she has deteriorated significantly-
less communicative, doesn't speak and all movmts are
generally slowed. the referral queried  depression or
extra pyramidal disorder with possible contribution of
cerebral hypoxia.
Meds: Digoxin 0.125mg daily
      Frusemide 20mg daily
      Thyroxin 0.075mg
      Warfarin adjusted accordingly

mealtimes are extremely prolonged due to what appears
to be difficulty initiating jaw opening, slow and
reduced mastication and likely aspiration of fluids as
indicated by coughing and patient putting her hand on
her chest. her chest status generally is poor.

at this stage i suppose my questions are:
could these meds be contributing in any way? (i've
looked up in our BNF but nothing seems obvious)
i'm wondering if these are signs of dementia - can it
progress this rapidly and at this age in this
population? i'm aware of dementia associated with
down's at a later age.
any thoughts?

i'll no doubt be posting again when i've seen her but
any thoughts beforehand would be useful.

many thanks
diane sellstrom
sunderland royal hospital
UK


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