Which statement about brain atrophy with age in Down syndrome is accurate?

• A. Brain atrophy remains exactly the same with age.
• B. Brain atrophy worsens with age.
• C. Brain atrophy never occurs.
• D. Brain atrophy improves with age.

Answer: (B)

Brain aging in Down syndrome involves progressive loss of brain tissue, not stability. This group has a higher risk of early-onset Alzheimer’s disease because of the APP gene on chromosome 21, which drives amyloid deposition and subsequent neurodegeneration. As a result, brain volume tends to decline with age, with imaging showing progressive atrophy especially in the hippocampus, temporal, and frontal regions, and this decline becomes more pronounced in later decades. Thus, saying that brain atrophy worsens with age accurately reflects the typical aging pattern in Down syndrome. The other statements—no change with age, never occurring, or improvement with age—conflict with the well-established progressive neurodegenerative trajectory in this population.