Mental retardation is progressive in Down syndrome: individuals are born wi
th normal intelligence which starts to decline linearly within the first ye
ar. This phenomenon can be observed with phenylalanine in patients with phe
nylketonuria, therefore it is compatible with metabolic intoxication. The t
oxic compound could be hydrogen sulfide. The amount of the compound is prob
ably increased in Down syndrome by increasing active cystathionine beta syn
thase. This heuristic hypothesis requires further investigation. (C) 2001 H
arcourt Publishers Ltd.