The Correlation Between Cognitive Function and Motoric Function With Quality of Life in Chidren Suspected of Down Syndrome

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Rifki Mauludin, Irman Permana, Tiar Masykuroh Pratamawati, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9119273/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21, commonly referred to as trisomy 21. In 2020, its prevalence was estimated at approximately 1 in 10.000 live births. The presence of an additional chromosome 21 can lead to various anomalies, including distinctive facial features, intellectual disabilities, and hypotonia. Cognitive and motor function impairment frequently pose challenges in the daily lives of children with Down syndrome and may affect their quality of life. This study aims to investigate the correlation between cognitive and motor functions with quality of life in children suspected of Down syndrome. The three variables were assessed using validated questionnaires: the Cognitive Scale for Down Syndrome (CSDS), the Gross Motor Function Measure (GMFM), and The TNO-AZL Questionnaire for Children’s Health-Related Quality of Life (TACQOL). Pearson correlation analysis revealed a significant positive correlation between cognitive function and quality of life. However, no statistically significant correlation was observed between motor function and quality of life. Health sciences/Diseases Biological sciences/Genetics Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience Down syndrome cognitive motor function quality of life Figures Figure 1 Introduction Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21, commonly referred to as trisomy 21. This chromosomal anomaly may result in a variety of abnormalities, including intellectual disability, which manifests as impairments in communication and language, learning difficulties, memory deficit, and attention disorder. Common craniofacial features include low-set ears, flat nasal bridge, flat occiput, small mouth, and epicanthic folds, all of which form a recognizable phenotype. [ 1 ]. Additionally, hypotonia, short stature, and atlantoaxial instability are frequenly observed. [ 2 ] The global prevalence of Down syndrome is approximately 1 in 700 live births.[ 3 ] However, the World Health Organization, the estimated prevalence in 2020 was around 1 in 10.000 live births.[ 4 ] Data from Survei Kesehatan Indonesia 2023 reported that 0,26% of children aged 0–59 month were diagnosed with Down syndrome, [ 5 ] showing an increase from data of Riset Kesehatan Dasar (Riskesdas) 2018, which recorded a prevalence of 0,24% among children aged 24–59 month. Intellectual disability is one of the most prominent features in children with Down syndrome. Intelligence Quotient (IQ) scores can provide an estimate of the severity of intellectual impairment. Children with Down syndrome typically exhibit IQ scores ranging from 30 to 70, with average of around 50. Most fall into the category of moderate (IQ 35–50) to severe (IQ 20–35) intellectual disability, while a smaller proportion are classified as having mild intellectual disability (IQ 50–70). [ 1 , 7 , 8 ] Hypotonia is commonly observed in children with Down syndrome, varying in severity from mild to severe. Hypotonia can impair both gross and fine motor functions. Gross motor deficits are often evident in postural abnormalities and compensatory mechanisms. For example, abdominal muscle weakness may cause difficulty in maintaining balance while standing, prompting children to compensate by leaning for support. Fine motor function is often more severely affected than gross motor skills due to the complex integration required for fine motor movements, including eye-hand coordination, balance control, visiomotor activity, and response processing time. [ 9 , 10 ] Quality of life is a multidimensional concept encompassing individual well-being in terms of physical, mental, and spiritual health, socioeconomic status, education, decision-making autonomy, and a sense of safety and protection. The WHO define quality of life as an individual’s perception of their position in life in context of culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. This global construct includes various dimensions such as physical well-being, functional well-being, emotional well-being, and social well-being. [ 11 – 14 ] Children with Down syndrome often experience challenges in communication, motor abilities, and social functioning, which in turn affect their ability to perform daily activities. Moreover, they consistently utilize problems. [ 15 ] In general, children with intellectual disabilities, including those with Down syndrome, are perceived to have a lower quality of life compared to their peers. Until now, assessments of cognitive and motor function in a children suspected Down syndrome have often been based solely on visible characteristics perceived by laypersons. Similarly, assumptions regarding a decline in quality of life among these children tend to be speculative. [ 16 ] Therefore, scientific evidence is needed to describe the levels of cognitive, motor function, and quality of life in children suspected Down syndrome, as well as to analyze the possible correlation among these three variables. Methods A total of 70 participants were recruited for this study, consisting of 27 students from SLB Pancaran Kasih and 43 students from SLB Budi Utama, both located in Cirebon, Indonesia. All participants’ parents provided written informed consent prior to participation. This study was approved by Komisi Etik Penelitian Kesehatan Fakultas Kedokteran, Universitas Swadaya Gunung Jati (Ethical Clearance No. 15/EC/FKUGJ/II/2025). The first step of the study involved screening all participants based on the following inclusion criteria: (i) parents willing to serve as respondents, and (ii) children presenting with phenotypic features consistent with Down syndrome based on clinical history and physical examination. The physical examination included both anthropometric measurements and dysmorphology assessment. Anthropometric measurements were categorized into three regions: Cranial measurements: head circumference, intercanthal distance, interpupillary distance, outer canthal distance, nose length and width, ear length, and philtrum length. Truncal measurement: chest circumference, internipples distance Extremity measurement: upper arm circumference, upper arm length, forearm length, palmar length, foot length, plantar length. Dysmorphology assessment was conducted to identify typical features of Down syndrome, including microcephaly, flat occiput, epichantal folds, brushfield spots, depressed nasal bridge, macroglossia, micrognathia, microdontia, simian crease, sandal gap, clinodactyly, and brachydactyly. Following screening, 17 participants were identified as suspected of Down syndrome and included in the main study. The second step involved assessment of cognitive function using the Cognitive Scale for Down Syndrome (CSDS) questionnaire, and evaluation of quality of life using the TNO-AZL Questionnaire for Children’s Health-Related Quality of Life (TACQOL), both completed by the participants’ parents. The third step involved assessment of motor function, specifically gross motor abilities (lying, sitting, standing, walking, and jumping), using the Gross Motor Function Measure (GMFM). After all data were collected, coding and processing were carried out. To determine whether the data were normally distributed, the Shapiro-Wilk test was applied. If normally distributed, the data were analyzed using Person correlation. If not, Spearman correlation test was applied. Results The participants in this study had a mean age of 13.17 years with a standard deviation of ±3.14 years. The sample was predominantly male, comprising 11 participants (64.7%), while female participants accounted for 6 individuals (35.3%). With respect to paternal age at the time of pregnancy, the majority of fathers (10 participants, 58.8%) were aged ≤40 years, while 7 participants (41.2%) had fathers aged >40 years. As for maternal age during pregnancy, 9 participants (52.9%) were born to mothers aged ≤35 years, and 8 participants (47.1%) to mother aged >35 years. Table 1. Participant Characteristics Characteristics Mean ±Deviation Frequency Percentage Age 13.17 3.14 Sex Male 11 64.7% Female 6 35.3% paternal age at the time of the pregnancy ≤40 10 58.8% >40 7 41.2% maternal age during pregnancy ≤35 9 52.9% >35 8 47.1% Among the 17 participants, 10 children (58.8%) exhibited cognitive impairment, while 7 children (41.2%) had normal cognitive function. In terms of motor function, all 17 participants (100%) were capable of performing gross motor movements and demonstrated good motor function. Concerning quality of life, the mean score was 127.18 with a standard deviation ±22.51. Table 2. Frequency Distribution of Cognitive, Motor Function, and Quality of Life Score Frequency Percentage Mean Median (Min-Max) ±Deviation Cognitive Function Cognitive impairment <78 10 58.8% Normal ≥78 7 41.2% 74.76 73 (57-99) Motor Function Not able to perform <50 0 0% Able to perform ≥50 17 100% 91.49 92.2 (84.4-97.6) Quality of Life 127.18 132 (82-166) 22.51 In the normality test, each of the three variables were found to be normally distributed, as indicated by p-values greater than 0.05. Subsequently, a Pearson correlation test was conducted between cognitive function and quality of life, with a correlation coefficient of r = 0.57 and p-value of 0.02. Meanwhile, the Pearson correlation test between motor function and quality of life showed a correlation of r = 0.18 with a p-value 0.48. Table 3. The Pearson Correlation Between Cognitive Function And Quality of Life Variable Shapiro-Wilk Test Cognitive Function 0.89 Motor Function 0.46 Quality of Life 0.95 The Person correlation between cognitive function and quality of life yielded a result of r= 0.57 with p= 0.002, indicating a moderate positive correlation. Meanwhile, the Pearson correlation between motor function and quality of life showed r= 0.18 with p= 0.48, indicating no statistically significant correlation. Table 4. The Pearson Correlation Between Cognitive Function And Quality of Life Quality of life Cognitive Function N R P 17 0,57 0,02 N = Total sample, R = Pearson correlation , P = Significancy Table 5. The Pearson Correlation Between Motor Function And Quality of Life Quality of Life Motor Function N R P 17 0,18 0,48 N = Total samplel, R = Pearson correlation , P = Significancy Discussion The correlation analysis between cognitive function and quality of life demonstrated a statistically significant relationship (p < 0.05). This suggests a tendency that higher cognitive function scores in children suspected of Down syndrome are associated with higher quality of life scores. This finding can be explained by the role of cognitive functions such as memory, language, attention, and executive function in supporting daily activities. Executive function and memory impairment in Down syndrome are attributed to altered brain development in the prefrontal cortex and hippocampus. Neuroimaging studies have shown reduced volume in these structures due to slower neural development. The result are consistent with the findings of El-Hady et al., who reported a significant association between cognitive function and health-related quality of life (HRQOL) in children with Down syndrome, particulary in the domains of attention and concentration. [ 17 ] Additionally, Rithman et al. found a correlation between IQ scores and adaptive behavior includes communication skill, daily living skills, socialization, and motor skills. [ 18 ] The correlation analysis demonstrated a moderate positive correlation (r = 0.57), indicating that cognitive function is an important factor supporting the quality of life in children suspected of Down syndrome. Nacinovich et al. explained that most children with Down syndrome have mild to severe cognitive impairment. However, regarding adaptive function, children with Down syndrome showed high scores, especially in daily living skills. Additionally, socialization function scores were high, likely because children frequently engage in social activities such as meeting and playing with peers at school, participating in sports, and recreating activities. [ 19 ] In contrast, the correlation test between motor function and quality of life showed no statistically significant relationship (p = 0.48). This is attributed to hypotonia in Down syndrome typically occurring only in early childhood and gradually diminishing with age. Furthermore, hypotonia in Down syndrome is classified as delayed motor development rather than a persistent condition. This mean children with Down syndrome do not always experience hypotonia, particularly after six years old. Consequently, motor function does not significantly influence quality of life in children with Down syndrome. The weak correlation found between motor function with quality of life (r = 0.18). This, finding aligns with the study by El-Hady et al. which reported weak correlation between motor function and HRQOL in both 8–10 and 10–12 year age groups. [ 17 ] Several factors could contribute to this weak association, including communication abilities, socialization, family environment, and the quality of mother-child interactions, all of which can motor function. [ 20 ] Other studies have highlighted motor delays in children with Dwon syndrome, attributing these to brain structural differences such as reduced grey and white matter volumes in the frontal and parietal lobes, decreased corpus callosum and hippocampus volumes, and delayed central and peripheral myelination. These factors contribute to delays in gross motor skill such as sitting, crawling, and walking, often accompanied by hypotonia in early development. However, motor tone typically improves with age, making hypotonia less common in adolescence and adulthood. For example, children with Down syndrome aged four years have an 18–25% probability of completing Gross Motor Function Measure (GMFM) domain D (standing), and E (Walking, Running, and Jumping), increasing to 65–85 by six years of age. [ 21 – 23 ] This study’s limitation is its exclusive focus on assessing cognitive function, motor function, and quality of life without considering socio-economic status, parental education, the child’s health status, or history of medical treatment and therapies that may affect the condition of children suspected of Down syndrome. In conclusion, this study demonstrates a significant association between cognitive function and quality of live in children suspected of Down syndrome. Cognitive function appears to influence the quality of live level in these children. Conversely, there was no significant correlation between motor function and quality of life. this is likely because hypotonia diminishes with age and children actively participate in physical activities at school that indirectly train their motor skills. Cognitive function has a greater impact than motor function because various cognitive domains such as attention, language, memory, and executive functions, contribute significantly to supporting children’s daily lives. All participant gave written informed consent. The study was approved by the local Ethics Committee at the “Komisi Etik Penelitian Kesehatan Fakultas Kedokteran, Universitas Swadaya Gunung Jati” (Ethical Clearance No. 15/EC/FKUGJ/II/2025) and conducted in accordance with the Helsinki Declaration. Declarations Data The datasets used and/or analysed during the current study are available from the corresponding author on the reasonable request Funding No Funding Author Contribution All authors contributed to the study conceptualization and methodological design. DN served as the corresponding author. IP contributed to conceptual guidance, manuscript revision, and data curation. TM and and MI contributed to data collection and manuscript revision. MR was responsible for data collection and drafting the manuscript. All authors read and approved the final version of the manuscript. References Irwanto, H. W., Ariefa, A. & Samosir, S. M. A-Z Sindrome Down. 1st ed. Irwanto, Wicaksono H, editors. Airlanga University Press. Surabaya: Airlangga University Press; (2019). Antonarakis, S. E. et al. Down syndrome. Nat. Rev. Dis. Prim. 6 (1), 1–43 (2020). Vazquez-Hernández, P. I. et al. Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course? Case Rep. Pediatr. 2021 , 1–4 (2021). Asim, A., Kumar, A., Muthuswamy, S., Jain, S. & Agarwal, S. Down syndrome: An insight of the disease. J. Biomed. Sci. 22 (1), 1–25 (2015). Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia 2023 (Badan Kebijakan Pembangunan Kesehatan, 2023). Kementerian Kesehatan Republik Indonesia. Laporan Riskesdas Nasional 2018. Lembaga Penerbit Balitbangkes ; (2018). Dhakal, A. & Bobrin, B. D. Cognitive Deficits. [Updated 2023 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559052/ Harvey, P. D. Domains of cognition and their assessment. Dialogues Clin. Neurosci. 21 (3), 227–237 (2019). Khan, I., Leventhal, B. L. & Developmental Delay [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562231/ Faizi, M. & Irwanto. Pediatric Clinical Update 2018. Pediatr Clin Updat 2018;43–4. (2018). Fucà, E., Galassi, P., Costanzo, F. & Vicari, S. Parental perspectives on the quality of life of children with Down syndrome. Front. Psychiatry ; 13 (1). (2022). Teoli, D. & Bhardwaj, A. Quality Of Life. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536962/ Cella, D. F. Quality of life: Concept and definition. J. Pain Symptom Manage. 9 (3), 186–192 (1994). Murti, D. H. R. Kualitas Hidup Anak Dengan Down Syndrome Di Sekolah Luar Biasa (Slb) Kabupaten Trenggalek. Skripsi ;1–168. (2015). Mediani, H. S., Hendrawati, S. & Fatimah, S. Kualitas Hidup Anak dengan Retardasi Mental. J. Obs J. Pendidik Anak Usia Dini . 6 (4), 2626–2641 (2022). Hisanah, L. N., Mailani, R., Faradillah, K. R. & Oktarina, M. Korelasi Kualitas Hidup dan Fungsi Kognitif Anak Down Syndrome di YPLB Depok. Indones J. Physiother . 3 (2), 59–62 (2023). Abd El-Hady, S. S., Abd El-Azim, F. H. & El-Talawy, H. A. E. A. M. Correlation between cognitive function, gross motor skills and health – Related quality of life in children with Down syndrome. Egypt J Med Hum Genet [Internet]. ;19(2):97–101. (2018). Available from: https://doi.org/10.1016/j.ejmhg.2017.07.006 Rihtman, T. et al. Are the cognitive functions of children with Down syndrome related to their participation? Dev. Med. Child. Neurol. 52 (1), 72–78 (2010). Nacinovich, R. et al. Cognitive development and adaptive functions in children with down syndrome at different developmental stages. J. Psychopathol. 27 (2), 84–89 (2021). Volman, M. J. M., Visser, J. J. W. & Lensvelt-Mulders, G. J. L. M. Functional status in 5 to 7-year-old children with Down syndrome in relation to motor ability and performance mental ability. Disabil. Rehabil . 29 (1), 25–31 (2007). Jain, P. D., Nayak, A., Karnad, S. D. & Doctor, K. N. Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review. Clin. Exp. Pediatr. 65 (3), 142–149 (2022). Malak, R., Kostiukow, A., Krawczyk-Wasielewska, A., Mojs, E. & Samborski, W. Delays in motor development in children with down syndrome. Med. Sci. Monit. 21 , 1904–1910 (2015). Kim, H. I., Kim, S. W., Kim, J., Jeon, H. R. & Jung, D. W. Motor and cognitive developmental profiles in children with down syndrome. Ann. Rehabil Med. 41 (1), 97–103 (2017). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 01 May, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor assigned by journal 22 Apr, 2026 Editor invited by journal 24 Mar, 2026 Submission checks completed at journal 22 Mar, 2026 First submitted to journal 22 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9119273","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":631545414,"identity":"0c2d9fbb-1c40-422c-8d95-a113838ea577","order_by":0,"name":"M. 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This chromosomal anomaly may result in a variety of abnormalities, including intellectual disability, which manifests as impairments in communication and language, learning difficulties, memory deficit, and attention disorder. Common craniofacial features include low-set ears, flat nasal bridge, flat occiput, small mouth, and epicanthic folds, all of which form a recognizable phenotype. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, hypotonia, short stature, and atlantoaxial instability are frequenly observed. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe global prevalence of Down syndrome is approximately 1 in 700 live births.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] However, the World Health Organization, the estimated prevalence in 2020 was around 1 in 10.000 live births.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Data from Survei Kesehatan Indonesia 2023 reported that 0,26% of children aged 0\u0026ndash;59 month were diagnosed with Down syndrome, [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] showing an increase from data of Riset Kesehatan Dasar (Riskesdas) 2018, which recorded a prevalence of 0,24% among children aged 24\u0026ndash;59 month.\u003c/p\u003e \u003cp\u003eIntellectual disability is one of the most prominent features in children with Down syndrome. Intelligence Quotient (IQ) scores can provide an estimate of the severity of intellectual impairment. Children with Down syndrome typically exhibit IQ scores ranging from 30 to 70, with average of around 50. Most fall into the category of moderate (IQ 35\u0026ndash;50) to severe (IQ 20\u0026ndash;35) intellectual disability, while a smaller proportion are classified as having mild intellectual disability (IQ 50\u0026ndash;70). [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHypotonia is commonly observed in children with Down syndrome, varying in severity from mild to severe. Hypotonia can impair both gross and fine motor functions. Gross motor deficits are often evident in postural abnormalities and compensatory mechanisms. For example, abdominal muscle weakness may cause difficulty in maintaining balance while standing, prompting children to compensate by leaning for support. Fine motor function is often more severely affected than gross motor skills due to the complex integration required for fine motor movements, including eye-hand coordination, balance control, visiomotor activity, and response processing time. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eQuality of life is a multidimensional concept encompassing individual well-being in terms of physical, mental, and spiritual health, socioeconomic status, education, decision-making autonomy, and a sense of safety and protection. The WHO define quality of life as an individual\u0026rsquo;s perception of their position in life in context of culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. This global construct includes various dimensions such as physical well-being, functional well-being, emotional well-being, and social well-being. [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eChildren with Down syndrome often experience challenges in communication, motor abilities, and social functioning, which in turn affect their ability to perform daily activities. Moreover, they consistently utilize problems. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] In general, children with intellectual disabilities, including those with Down syndrome, are perceived to have a lower quality of life compared to their peers. Until now, assessments of cognitive and motor function in a children suspected Down syndrome have often been based solely on visible characteristics perceived by laypersons. Similarly, assumptions regarding a decline in quality of life among these children tend to be speculative. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Therefore, scientific evidence is needed to describe the levels of cognitive, motor function, and quality of life in children suspected Down syndrome, as well as to analyze the possible correlation among these three variables.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA total of 70 participants were recruited for this study, consisting of 27 students from SLB Pancaran Kasih and 43 students from SLB Budi Utama, both located in Cirebon, Indonesia. All participants\u0026rsquo; parents provided written informed consent prior to participation. This study was approved by Komisi Etik Penelitian Kesehatan Fakultas Kedokteran, Universitas Swadaya Gunung Jati (Ethical Clearance No. 15/EC/FKUGJ/II/2025).\u003c/p\u003e \u003cp\u003eThe first step of the study involved screening all participants based on the following inclusion criteria: (i) parents willing to serve as respondents, and (ii) children presenting with phenotypic features consistent with Down syndrome based on clinical history and physical examination. The physical examination included both anthropometric measurements and dysmorphology assessment.\u003c/p\u003e \u003cp\u003eAnthropometric measurements were categorized into three regions:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCranial measurements: head circumference, intercanthal distance, interpupillary distance, outer canthal distance, nose length and width, ear length, and philtrum length.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTruncal measurement: chest circumference, internipples distance\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eExtremity measurement: upper arm circumference, upper arm length, forearm length, palmar length, foot length, plantar length.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDysmorphology assessment was conducted to identify typical features of Down syndrome, including microcephaly, flat occiput, epichantal folds, brushfield spots, depressed nasal bridge, macroglossia, micrognathia, microdontia, simian crease, sandal gap, clinodactyly, and brachydactyly.\u003c/p\u003e \u003cp\u003eFollowing screening, 17 participants were identified as suspected of Down syndrome and included in the main study.\u003c/p\u003e \u003cp\u003eThe second step involved assessment of cognitive function using the Cognitive Scale for Down Syndrome (CSDS) questionnaire, and evaluation of quality of life using the TNO-AZL Questionnaire for Children\u0026rsquo;s Health-Related Quality of Life (TACQOL), both completed by the participants\u0026rsquo; parents.\u003c/p\u003e \u003cp\u003eThe third step involved assessment of motor function, specifically gross motor abilities (lying, sitting, standing, walking, and jumping), using the Gross Motor Function Measure (GMFM).\u003c/p\u003e \u003cp\u003eAfter all data were collected, coding and processing were carried out. To determine whether the data were normally distributed, the Shapiro-Wilk test was applied. If normally distributed, the data were analyzed using Person correlation. If not, Spearman correlation test was applied.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eThe participants in this study had a mean age of 13.17 years with a standard deviation of \u0026plusmn;3.14 years. The sample was predominantly male, comprising 11 participants (64.7%), while female participants accounted for 6 individuals (35.3%). With respect to paternal age at the time of pregnancy, the majority of fathers (10 participants, 58.8%) were aged \u0026le;40 years, while 7 participants (41.2%) had fathers aged \u0026gt;40 years. As for maternal age during pregnancy, 9 participants (52.9%) were born to mothers aged \u0026le;35 years, and 8 participants (47.1%) to mother aged \u0026gt;35 years.\u003c/p\u003e\n\u003cp\u003eTable 1. Participant Characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026plusmn;Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e64.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e35.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003epaternal age at the time of the pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026le;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e58.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e41.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003ematernal age during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026le;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e52.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e47.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the 17 participants, 10 children (58.8%) exhibited cognitive impairment, while 7 children (41.2%) had normal cognitive function. In terms of motor function, all 17 participants (100%) were capable of performing gross motor movements and demonstrated good motor function. Concerning quality of life, the mean score was 127.18 with a standard deviation \u0026plusmn;22.51.\u003c/p\u003e\n\u003cp\u003eTable 2. Frequency Distribution of Cognitive, Motor Function, and Quality of Life\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"656\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMedian (Min-Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026plusmn;Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCognitive Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eCognitive impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e58.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026ge;78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e41.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e74.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e73 (57-99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eMotor Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNot able to perform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eAble to perform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e91.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e92.2 (84.4-97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eQuality of Life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e127.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e132 (82-166)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e22.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the normality test, each of the three variables were found to be normally distributed, as indicated by p-values greater than 0.05. Subsequently, a Pearson correlation test was conducted between cognitive function and quality of life, with a correlation coefficient of r = 0.57 and p-value of 0.02. Meanwhile, the Pearson correlation test between motor function and quality of life showed a correlation of r = 0.18 with a p-value 0.48.\u003c/p\u003e\n\u003cp\u003eTable 3. The Pearson Correlation Between Cognitive Function And Quality of Life\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eShapiro-Wilk Test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eCognitive Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eMotor Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eQuality of Life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Person correlation between cognitive function and quality of life yielded a result of r= 0.57 with p= 0.002, indicating a moderate positive correlation. Meanwhile, the Pearson correlation between motor function and quality of life showed r= 0.18 with p= 0.48, indicating no statistically significant correlation.\u003c/p\u003e\n\u003cp\u003eTable 4. The Pearson Correlation Between Cognitive Function And Quality of Life\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eQuality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eCognitive Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0,57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0,02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eN = Total sample, R = \u003cem\u003ePearson correlation\u003c/em\u003e, P = \u003cem\u003eSignificancy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5. The Pearson Correlation Between Motor Function And Quality of Life\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eQuality of Life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eMotor Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0,18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eN = Total samplel, R = \u003cem\u003ePearson correlation\u003c/em\u003e, P = \u003cem\u003eSignificancy\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe correlation analysis between cognitive function and quality of life demonstrated a statistically significant relationship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests a tendency that higher cognitive function scores in children suspected of Down syndrome are associated with higher quality of life scores. This finding can be explained by the role of cognitive functions such as memory, language, attention, and executive function in supporting daily activities. Executive function and memory impairment in Down syndrome are attributed to altered brain development in the prefrontal cortex and hippocampus. Neuroimaging studies have shown reduced volume in these structures due to slower neural development.\u003c/p\u003e \u003cp\u003eThe result are consistent with the findings of El-Hady et al., who reported a significant association between cognitive function and health-related quality of life (HRQOL) in children with Down syndrome, particulary in the domains of attention and concentration. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Additionally, Rithman et al. found a correlation between IQ scores and adaptive behavior includes communication skill, daily living skills, socialization, and motor skills. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe correlation analysis demonstrated a moderate positive correlation (r\u0026thinsp;=\u0026thinsp;0.57), indicating that cognitive function is an important factor supporting the quality of life in children suspected of Down syndrome. Nacinovich et al. explained that most children with Down syndrome have mild to severe cognitive impairment. However, regarding adaptive function, children with Down syndrome showed high scores, especially in daily living skills. Additionally, socialization function scores were high, likely because children frequently engage in social activities such as meeting and playing with peers at school, participating in sports, and recreating activities. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn contrast, the correlation test between motor function and quality of life showed no statistically significant relationship (p\u0026thinsp;=\u0026thinsp;0.48). This is attributed to hypotonia in Down syndrome typically occurring only in early childhood and gradually diminishing with age. Furthermore, hypotonia in Down syndrome is classified as delayed motor development rather than a persistent condition. This mean children with Down syndrome do not always experience hypotonia, particularly after six years old. Consequently, motor function does not significantly influence quality of life in children with Down syndrome.\u003c/p\u003e \u003cp\u003eThe weak correlation found between motor function with quality of life (r\u0026thinsp;=\u0026thinsp;0.18). This, finding aligns with the study by El-Hady et al. which reported weak correlation between motor function and HRQOL in both 8\u0026ndash;10 and 10\u0026ndash;12 year age groups. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Several factors could contribute to this weak association, including communication abilities, socialization, family environment, and the quality of mother-child interactions, all of which can motor function. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOther studies have highlighted motor delays in children with Dwon syndrome, attributing these to brain structural differences such as reduced grey and white matter volumes in the frontal and parietal lobes, decreased corpus callosum and hippocampus volumes, and delayed central and peripheral myelination. These factors contribute to delays in gross motor skill such as sitting, crawling, and walking, often accompanied by hypotonia in early development. However, motor tone typically improves with age, making hypotonia less common in adolescence and adulthood. For example, children with Down syndrome aged four years have an 18\u0026ndash;25% probability of completing Gross Motor Function Measure (GMFM) domain D (standing), and E (Walking, Running, and Jumping), increasing to 65\u0026ndash;85 by six years of age. [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study\u0026rsquo;s limitation is its exclusive focus on assessing cognitive function, motor function, and quality of life without considering socio-economic status, parental education, the child\u0026rsquo;s health status, or history of medical treatment and therapies that may affect the condition of children suspected of Down syndrome.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrates a significant association between cognitive function and quality of live in children suspected of Down syndrome. Cognitive function appears to influence the quality of live level in these children. Conversely, there was no significant correlation between motor function and quality of life. this is likely because hypotonia diminishes with age and children actively participate in physical activities at school that indirectly train their motor skills. Cognitive function has a greater impact than motor function because various cognitive domains such as attention, language, memory, and executive functions, contribute significantly to supporting children\u0026rsquo;s daily lives.\u003c/p\u003e \u003cp\u003e All participant gave written informed consent. The study was approved by the local Ethics Committee at the \u0026ldquo;Komisi Etik Penelitian Kesehatan Fakultas Kedokteran, Universitas Swadaya Gunung Jati\u0026rdquo; (Ethical Clearance No. 15/EC/FKUGJ/II/2025) and conducted in accordance with the Helsinki Declaration.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on the reasonable request\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding \u003c/h2\u003e \u003cp\u003eNo Funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conceptualization and methodological design. DN served as the corresponding author. IP contributed to conceptual guidance, manuscript revision, and data curation. TM and and MI contributed to data collection and manuscript revision. MR was responsible for data collection and drafting the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIrwanto, H. W., Ariefa, A. \u0026amp; Samosir, S. M. A-Z Sindrome Down. 1st ed. Irwanto, Wicaksono H, editors. Airlanga University Press. Surabaya: Airlangga University Press; (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntonarakis, S. E. et al. Down syndrome. \u003cem\u003eNat. Rev. Dis. Prim.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e (1), 1\u0026ndash;43 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVazquez-Hern\u0026aacute;ndez, P. I. et al. Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course? \u003cem\u003eCase Rep. 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L. M. Functional status in 5 to 7-year-old children with Down syndrome in relation to motor ability and performance mental ability. \u003cem\u003eDisabil. Rehabil\u003c/em\u003e. \u003cb\u003e29\u003c/b\u003e (1), 25\u0026ndash;31 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain, P. D., Nayak, A., Karnad, S. D. \u0026amp; Doctor, K. N. Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review. \u003cem\u003eClin. Exp. Pediatr.\u003c/em\u003e \u003cb\u003e65\u003c/b\u003e (3), 142\u0026ndash;149 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalak, R., Kostiukow, A., Krawczyk-Wasielewska, A., Mojs, E. \u0026amp; Samborski, W. Delays in motor development in children with down syndrome. \u003cem\u003eMed. Sci. Monit.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 1904\u0026ndash;1910 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, H. I., Kim, S. W., Kim, J., Jeon, H. R. \u0026amp; Jung, D. W. Motor and cognitive developmental profiles in children with down syndrome. \u003cem\u003eAnn. Rehabil Med.\u003c/em\u003e \u003cb\u003e41\u003c/b\u003e (1), 97\u0026ndash;103 (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Down syndrome, cognitive, motor function, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-9119273/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9119273/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDown syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21, commonly referred to as trisomy 21. In 2020, its prevalence was estimated at approximately 1 in 10.000 live births. The presence of an additional chromosome 21 can lead to various anomalies, including distinctive facial features, intellectual disabilities, and hypotonia. Cognitive and motor function impairment frequently pose challenges in the daily lives of children with Down syndrome and may affect their quality of life. This study aims to investigate the correlation between cognitive and motor functions with quality of life in children suspected of Down syndrome. The three variables were assessed using validated questionnaires: the Cognitive Scale for Down Syndrome (CSDS), the Gross Motor Function Measure (GMFM), and The TNO-AZL Questionnaire for Children\u0026rsquo;s Health-Related Quality of Life (TACQOL). Pearson correlation analysis revealed a significant positive correlation between cognitive function and quality of life. However, no statistically significant correlation was observed between motor function and quality of life.\u003c/p\u003e","manuscriptTitle":"The Correlation Between Cognitive Function and Motoric Function With Quality of Life in Chidren Suspected of Down Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:43:12","doi":"10.21203/rs.3.rs-9119273/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-01T12:54:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116430184669445077776609948171549557861","date":"2026-04-23T18:21:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T11:03:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-22T11:01:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-24T14:45:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-22T17:46:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-22T08:11:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"485ece80-017a-432d-a3f3-ae53e5c3aaee","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-01T12:54:06+00:00","index":100,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":67339115,"name":"Health sciences/Diseases"},{"id":67339116,"name":"Biological sciences/Genetics"},{"id":67339117,"name":"Health sciences/Medical research"},{"id":67339118,"name":"Health sciences/Neurology"},{"id":67339119,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-05-04T09:43:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:43:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9119273","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9119273","identity":"rs-9119273","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}