The prevalence and incidence of early‐onset dementia among adults with autism spectrum disorder

Abstract

The prevalence and incidence of early-onset dementia among adults with autism spectrum disorder (ASD) is currently unknown. In this case-control study, the prevalence and incidence of early-onset dementia in individuals with ASD was examined during 2008-2012 using Medicaid Analytic eXtract files. Participants were 30-64 year-old adults who were Medicaid beneficiaries and had either a diagnosis of ASD only (n = 12,648), a diagnosis of ASD with co-occurring intellectual disability (ID) (n = 26,168), a diagnosis of ID without ASD (n = 406,570), or no ASD nor ID diagnoses (n = 798,828). The 5-year prevalence of dementia was 4.04% among adults with ASD only, and 5.22% for those with ASD and cooccurring ID. This prevalence was higher compared to the prevalence of dementia in individuals with no ASD and no ID (0.97%), but lower compared to individuals with ID only (7.10%). Risk factors associated with the increased prevalence in the general population were similarly associated with the increased risk of dementia in individuals with ASD. Even after adjusting for these risk factors, compared to the general population, dementia was found to occur more frequently in individuals with ASD only (adjusted hazard ratio, 1.96; 95% CI, 1.69-2.28), as well as individuals with ASD and co-occurring ID (adjusted hazard ratio, 2.89; 95% CI, 2.62-3.17). In conclusion, adults with ASD under the age of 65 were approximately 2.6 times more likely to be diagnosed with dementia compared to the general population in our study. Lay SummaryIt is unclear whether adults diagnosed with autism spectrum disorder (ASD) are at higher risk of being diagnosed with early-onset dementia compared to those who are not on the autism spectrum. In this study we examined for the first time the nationwide prevalence and incidence of Alzheimer's Disease and other types of dementia in ASD in a sample of adults with ASD aged 30-64 years who were enrolled in Medicaid, the largest insurer of behavioral health services in the US. Medicaid claims data, which include information on the diagnoses that beneficiaries receive, suggested that the adults with ASD were approximately 2.6 times more likely to be diagnosed with early-onset Alzheimer's disease and related dementias compared to the general population.

Effects of age on the hippocampus and verbal memory in adults with autism spectrum disorder: Longitudinal versus cross‐sectional findings

“…Research on aging in adults with autism spectrum disorder (ASD)/autistic adults 1 is growing, but longitudinal work in middle-age and older adults has yet to emerge. Importantly, recent evidence suggests that older adults with ASD may be at increased risk of cognitive disorders (Hand et al, 2020) and neurodegenerative disease, including early-onset dementia (Starkstein et al, 2015;Vivanti et al, 2021). These findings raise concern that aging outcomes may be worse for autistic adults.…”

Genomic architecture of Autism Spectrum Disorder from comprehensive whole-genome sequence annotation

“…Although highly distinct both phenotypically and genetically, ASD and neurodegenerative diseases have common clinical features, including impairments of language, executive function, and motor skills (Khan et al, 2016); they also share aspects of their molecular pathomechanism (e.g., synaptic deregulation), with several genes having been proposed to contribute to both (Jęśko et al, 2020). Further evidence for genetic links includes early suggestions of an increased likelihood that individuals with ASD will later be diagnosed with AD-like disorders (Plana-Ripoll et al, 2019) and increased incidence of dementia (Vivanti et al, 2021). However, a major challenge in evaluating these associations is the paucity of longitudinal studies in adults with autism (Lord et al, 2022).…”

The use of everyday and assistive technology in the lives of older autistic adults

“…Currently, little is known about autism and cognitive decline in older age (see review by Sonido et al, 2020). However, there is some recent research to indicate the autistic adults may experience higher rates of early onset dementia diagnoses (Vivanti et al, 2021). If we assume that older autistic adults experience at least the same (if not greater) cognitive and functional declines as the general population, it is important to ensure appropriate supports to manage these challenges.…”