Increased anticholinergic medication use in middle-aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline.

The study was observational and used self-report, so it cannot show that anticholinergic medications caused memory problems or decline. Follow-up analyses used 197 participants, fewer than the 382 participants in the concurrent memory analysis, and no a priori power analysis was done. Cognitive outcomes were self-reported memory failures and retrospective perceived decline, not performance-based testing or medical record review. Participants were SPARK independent adults without reported intellectual disability, so results may not apply to autistic adults with intellectual disability, who may have higher medication exposure. Medication data were self-reported free text, and people with incomplete or ambiguous medication lists were excluded, so anticholinergic use may be underestimated. The study did not collect dose, frequency, adherence, or duration of each medication, so dose-response or cumulative exposure could not be assessed. The ACB Scale does not include many newer medications, although the CALS does; results differed slightly between scales.

Do not conclude that anticholinergic medications caused memory decline or that reducing them improves memory. The study was observational, used self-report outcomes, and not all follow-up models were significant.