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Clinical Manifestations.

Gregory L Wallace1, Goldie A McQuaid2, Sean C Duane3

  • 1The George Washington University, Washington D.C., DC, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Autistic adults show increased cognitive decline risk, often linked to high anticholinergic medication use. This study highlights the need for careful medication management in autistic populations to mitigate dementia risk.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Autism Research

Background:

  • Healthcare claims data suggest autistic adults have higher rates of dementia-related diagnoses.
  • Prospective data on cognitive decline risk and dementia screeners are lacking in autistic adults.
  • High polypharmacy in autistic adults may lead to significant anticholinergic burden, a known dementia risk factor.

Purpose of the Study:

  • To assess cognitive decline risk in autistic adults using dementia screeners.
  • To document anticholinergic medication burden in autistic adults.
  • To investigate the association between cognitive decline and anticholinergic burden in autistic adults.

Main Methods:

  • Two samples of autistic adults were recruited via SPARK: 210 "independent" (age 42-81) and 500 "dependent" (age 18-68).
  • Cognitive decline was assessed using the AD8 (self-rated) for independent adults and DSQIID (caregiver-rated) for dependent adults.
  • Anticholinergic medication use was quantified using the CRIDECO Anticholinergic Load Scale (CALS).

Main Results:

  • 30% of independent autistic adults and 10-3% of dependent autistic adults screened positive for cognitive decline.
  • Over 63% of participants in both samples used at least one anticholinergic medication.
  • Higher anticholinergic potency was significantly associated with increased cognitive decline ratings in both samples (p < .01).

Conclusions:

  • Dementia screeners confirm common reports of cognitive decline in autistic adults, aligning with claims data.
  • Autistic adults exhibit high rates of anticholinergic medication use.
  • Increased anticholinergic potency is linked to cognitive decline reports in autistic adults, potentially at younger ages than in the general population.