Use of antipsychotics, benzodiazepine derivatives, and dementia medication among older people with intellectual disability and/or autism spectrum disorder and dementia.

Axmon et al. (2017) compared drug records of older adults who have both intellectual disability or autism and dementia. They looked at how often doctors gave antipsychotics, calming benzodiazepines, and standard dementia medicines. The team matched each adult with ID/ASD to a similar adult without those diagnoses to see the difference in prescriptions.

The adults with ID/ASD plus dementia received antipsychotics and benzodiazepines more often than their matched peers. At the same time, they got dementia-guideline medications less often. The pattern shows heavy use of calming drugs and light use of memory-care drugs in the same group.

Earlier work saw the same drug load. Fahmie et al. (2013) surveyed 4,000 New York adults with ID and found 58% on psychotropics, setting the stage for the 2017 dementia finding. Cerutti et al. (2004) tracked 2,344 community adults with IDD for 17 months and saw over half on psychoactive meds, often three at once. The new data say the habit continues after dementia appears.

Li et al. (2025) seems to tell the opposite story: in Chinese kids with ASD plus ID, antipsychotic use goes up, not down. The gap is about age and goal. The children are in hospital for severe behavior, so doctors reach for antipsychotics. The older adults need memory drugs, yet receive fewer of them. Same drug class, different life stage, different purpose.

McQuaid et al. (2024) adds a warning. They followed autistic adults aged 40-83 and found high anticholinergic load predicted self-reported memory decline. Anna’s group already gets too few dementia meds; adding more anticholinergics could speed cognitive loss.

If you serve older adults with ID or autism, expect their charts to show antipsychotics and benzodiazepines while dementia-guideline drugs are missing. Use this finding to start medication reviews with the prescribing doctor. Ask: Is each antipsychotic still needed? Can we replace benzodiazepines with behavioral supports? Should we add a cholinesterase inhibitor? One good conversation can cut risk and improve quality of life.