Increased anticholinergic medication use in middle-aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline.
Common anticholinergic meds predict faster self-reported memory loss in autistic adults 40-83.
01Research in Context
What this study did
McQuaid et al. (2024) followed autistic adults aged 40-83 for two years. They counted how many people took anticholinergic medicines and asked about memory and thinking problems over time.
What they found
Almost half of the adults were on anticholinergic drugs. Those people reported more memory slips and faster cognitive decline than the rest. The link stayed strong after accounting for age and other health issues.
How this fits with other research
Gandhi et al. (2022) already showed autistic adults lose hippocampus volume faster and score worse on short-term memory tests. The new study adds a possible reason: common medicines with anticholinergic load.
Axmon et al. (2017) warned that older autistic adults are often given antipsychotics and benzodiazepines. The 2024 paper narrows the spotlight to anticholinergic burden and links it directly to memory complaints.
Cummings et al. (2024) found half of adults getting their first autism diagnosis already take psychiatric drugs. Together these studies paint a pattern: high medication use starts early and may speed cognitive aging.
Why it matters
If you serve autistic adults 40+, check their med list for anticholinergic load. Drugs for sleep, allergies, bladder, or mood can chip away at memory. A quick pharmacist consult or deprescribing plan could protect thinking skills and quality of life.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Flag any client 40+ on anticholinergics and request a pharmacist or physician review this week.
02At a glance
03Original 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.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1016/j.neubiorev.2021.04.031