Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

Abstract

Many commonly used prescription and over‐the‐counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co‐occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40–83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self‐reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self‐reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%–62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically‐relevant levels of AC medication (potency ≥3). After controlling for birth‐sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self‐reported cognitive decline at follow‐up 2 years later. Understanding AC medications—including potentially earlier AC polypharmacy—and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.

Cognitive and brain morphological deviations in middle-to-old aged autistic adults: A systematic review and meta-analysis

“…These confounds may, to a greater extent, explain increased study heterogeneity in the meta-analysis of global cognitive function, executive control, and episodic memory. Very recent studies have made progress in evaluating the impact of confounding variables on cognitive aging in autistic adults ( Pagni et al, 2022 ; McQuaid et al, 2023 ; Harker et al, 2023 ; Torenvliet et al, 2024 ). However, there is not a sufficient number of studies available for meta-regression analysis ( Higgins et al, 2020 ) to identify factors that could either slow down or accelerate pathological aging in ASD.…”

Aging Well and Autism: A Narrative Review and Recommendations for Future Research

“…Together, these samples and research studies complement each other to describe an increased risk for dementia and cognitive decline in autistic adults across cognitive abilities, and that autistic traits may be related to cognitive decline across autistic and non-autistic middle-aged and older adults. Other outcomes in autistic older adults, including low education levels [ 88 ], unemployment or underemployment (described in Social Participation and Engagement), depression (described in Positive Affect and Control), risks associated with medications (e.g., anticholinergic cognitive burden), and low levels of physical activity [ 89 ] may be contributing to increased risk of experiencing cognitive decline in autistic adults [ 79 , 81 , 90 ], although more longitudinal research is needed to examine predictors and modifiable indicators of cognitive decline and cognitive reserve in autistic adults from mid to older adulthood.…”