Characterization of anticholinergic medication use and its associations with everyday memory problems and cognitive decline in autistic adults with higher support needs

Among older adults in the general population, medications with anticholinergic (AC) effects are associated with declines in cognitive functioning and with dementia and Alzheimer’s Disease. Autistic people have high rates of co-occurring medical conditions and polypharmacy across the lifespan; thus, they may be at particularly high risk of exposure to AC medications and their negative impacts on cognitive functioning, including earlier in adulthood. Consistent with this, a single study has shown AC medication use is prevalent among autistic adults without co-occurring intellectual disability and is associated with self-reported concurrent memory problems and declines in cognition. No study has examined AC medications and their associations with cognition among autistic adults with higher support needs. We therefore characterized AC medication use and its associations with caregiver-rated memory problems and changes in cognition and behavior that have been linked with cognitive decline. Caregivers of autistic adults (40–83y; Mean ~31y) recruited via Simons Powering Autism Research's (SPARK) Research Match service reported medication use (N=512), memory complaints (N=467), and changes in behavior and cognition (N=466) that have been associated with cognitive decline among persons with an intellectual disability. The majority (66.41%) of autistic adults were taking at least one AC medication and 31% were taking clinically-meaningful levels of these medications. After controlling for age and birth-sex, greater potency of AC medications was associated with both caregiver-reported memory challenges and behavioral/cognitive changes associated with cognitive decline. Understanding AC medication use and its potential impacts on cognition among autistic adults with higher support needs is crucial.