The authors raise issues related to Down syndrome and the use of Aduhelm, Biogen's new drug for use with early-stage Alzheimer's disease. Issues noted include a lack of data on applicability of drug with adults with Down syndrome, lack of protocols for its use by practitioners, and unknowns as to efficacy of the drug with presence of high amyloid load from early age. Authors recommend (a) including participants with Down syndrome in ongoing and further clinical trials and research, (b) assuring research-informed appropriate oversight over its usage, (c) developing protocols that guide assessment and decision-making for the use of the drug with this group, (d) screening systematically for early symptoms of AD, (e) determining optimal age for prophylactic use of drug, (f) involving families and caregivers in the prescribing and using decision-making process, and (g) providing orientation and education to healthcare providers and ancillary staff involved with use and aftercare.