Anticholinergic Medications and Health in Adults with Autism or Intellectual Disability

  1. Goldie A. McQuaid
  2. Sha Tao
  3. Lindsay L. Shea
  4. Gregory L. Wallace
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Abstract

Objective

Contributors to autistic adults’ elevated risk for negative aging-related outcomes, including Alzheimer’s disease and related dementias (ADRD), falls, and mortality remain underexplored. One candidate factor is exposure to medications with anticholinergic (AC) effects. Thus, this study assessed prevalence of medications with AC effects, and their associations with ADRD, falls, and mortality across four groups: autism-only, autism+intellectual disability (ID), ID-only, and controls.

Methods

We conducted a retrospective cohort study of 2017-2019 US linked Medicare and Medicaid claims data for 40+ year-olds. Autism, ID, ADRD, and falls were identified using validated algorithms, and mortality was based on Medicare/Medicaid death indicators. Medications were coded using a comprehensive AC potency scale. AC medication exposure effects and interactions between AC potency and group were examined using modified Poisson regressions. Sensitivity analyses to address indication bias excluded persons prescribed antidepressant and/or antipsychotic medication(s).

Results

All three clinical groups experienced significantly greater AC medication exposure (autism+ID: 92.5%>ID-only: 88.6%>autism-only: 80.0%) than non-autistic/non-ID controls (61.3%). Additionally, AC medications were more frequently associated with ADRD, falls, and mortality in all of these groups. Stepwise associations between AC potency levels and ADRD, falls, and mortality were found, and these effects were more prominent for persons with autism and/or ID relative to the control sample.

Interpretation

This study provides a foundational examination of exposure to AC medication effects and their associations with aging-related outcomes in middle-age and older autistic adults and adults with ID. AC medication exposure represents one potential modifiable risk factor for negative aging-related outcomes in these groups.

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  1. Mentioned by @prepub-neurodegen.bsky.social on Bluesky

    Anticholinergic Medications and Health in Adults with Autism or Intellectual Disability #NeuroDegeneration 🧪🧠 https://www.medrxiv.org/content/10.64898/2026.10.26.26366518v1

  2. Version published to 10.64898/2026.10.26.26366518v1 on medRxiv