Hilde Geurts, Ph.D., discusses the impact of aging on health, quality of life, and cognition in autistic adults. She discusses aging in the general population and how it relates to autistic experiences. The speaker considers differences in aging experiences across groups and how they inform autism care and research. Geurts dives into cognition and aging, highlighting potential cognitive aging profiles for autism and what evidence there is to support them. The presenter discusses avenues and caveats for future research before the Q&A.

In this webinar: 

0:00 – 4:55 – Organization introductions
4:56 – Speaker and affiliate introduction
7:20 – Outline
8:50 – Aging in the general population
13:15 – Autism and aging
15:30 – Health and quality of life across groups
24:10 – Similarities in differences across groups
30:00 – Aging and cognition
36:00 – Cognition profiles
41:45 – What’s next?
44:50 – Q&A

Aging in the general population

Geurts outlines presentation goals and highlights the overlap of mental health, cognition, and quality of life (QoL) (7:20). She briefly describes a ten-year study on autism heterogeneity from which much of the data discussed is drawn (8:30). The speaker outlines the three pillars of a successful aging process, as described by Rowe & Kahn in 1997: 

  1. Minimize risk of disease and disability
  2. Maintain physical and cognitive function
  3. Continue engagement with life

She explains that our bodies undergo physical and cognitive changes as we age, like brain shrinkage, decreased flexibility, and increased forgetfulness. Conversely, happiness and quality of life (QoL) increase with age in the general population (9:55). Geurts lists risk factors for aging, including genetics, poverty, stress, physical and mental health, and a lack of social support. She underscores that many of these are more prevalent in autistic adults and considers whether or not this means that autistic people are at risk for aging faster with a lower QoL (11:30).

Autism and aging

The presenter describes patterns of co-occurring conditions in autism. She cites studies showing that those who receive a late autism diagnosis have a higher chance of mental health disorders and that people assigned female at birth have a higher chance of general health problems (13:15). Therefore, Geurts considers whether late-diagnosed female-presenting autistic adults are at higher risk for mental health difficulties (14:45). 

Health and quality of life across groups

Geurts details a recent study showing that autistic adults have more mental health conditions compared to controls, with a peak in prevalence between 40 and 54 years old (15:30). She describes research that revealed autistic women experience more menopausal problems and depressive symptoms than their non-autistic peers. Therefore, the speaker posits that the observed peak in middle-aged mental health conditions could be in part attributed to the menopausal experiences of female-presenting autistic adults (17:00). 

The speaker presents data showing a decline in social anxiety with age in autism, where participants reported caring less about what other people think of them and feeling more comfortable in their own skin (20:15). She notes the impact of camouflaging on mental health and considers the intersection of age, camouflaging, and mental health in autism (22:35). Geurts summarizes that research to date shows both mental and physical health problems are more common in autistic adults, though causes differ across groups (i.e., menopause, camouflaging). She asserts that these differences are essential for understanding autism subgroups (23:38). 

The similarities and differences between autistic profiles are crucial for identifying subgroups of autism and finetuning research and care. Geurts describes a study that revealed autistic adults feel more vulnerable and like they have less control and emotional support compared to non-autistic adults (24:10). Feelings of control and emotional support were stable at two and five-year follow-ups and predicted mental health and QoL (27:50). The speaker notes that between 14% and 17% of participants switched profiles across time, underscoring the need to study those changes and how they affect QoL and mental health (28:30). 

Aging and cognition

Cognition is a predictor of Neurocognitive Disorders (NCD), like dementia, which are diagnosed five times as often in autistic adults compared to the general population (30:00). NCD diagnoses generally include:

  • Cognitive challenges.
  • A significant decline in daily life.
  • Low performance in at least one cognitive domain (i.e., memory, flexibility, social cognition).

The speaker cites research revealing more self-reported cognitive challenges and lower performance in social and quick response (flexibility) tests for autistic adults compared to controls (32:18). She asserts that although autistic people are more likely to meet phenotypic NCD criteria, the underlying mechanisms may not align. 

For example, research shows that depressive symptoms may drive self-reported cognitive challenges in autism, meaning that mood, not memory, is the issue (34:00). Geurts notes that cognitive differences were observed across autism independent of age, meaning that there is no significant evidence that autistic individuals experience faster cognitive decline compared to the general population (35:24). 

Cognitive aging profiles

Geurts outlines three cognitive aging profiles comparing autism and controls: Faster, Parallel 1, and Parallel 2, where Parallel 1 has no cognitive difference by age and Parallel 2 does. No conclusive or replicable evidence supports the Faster cognitive aging profile for autism, though comparatively early decline has been found in individual cognitive domains (36:00). The speaker describes recent research suggesting parallel cognitive aging patterns between autism and the general population (37:00). For example, an autistic middle-aged person may have the same cognitive profile as someone who is older and not autistic. Geurts asserts that this could be why some autistic adults feel older or that they are declining faster, though this may not be the case (38:41). The presenter urges viewers to be careful in diagnosing NCD, especially in autistic adults, where NCD presentations could result from a different, less-understood cognitive profile (39:53). She reiterates that little to no evidence exists for accelerated (faster) cognitive aging in autism, though some adults with autism have old-age profiles (40:30). 

What’s next?

Future research on the intersection of cognition, aging, and autism must consider how the age of diagnosis and assigned sex seem to play a role. Geurts also underscores the need for research that includes people with intellectual disabilities and early diagnosis (41:45). 

The presenter asserts that current avenues of research should focus on the interplay of mental and physical health problems in autistic adults, drivers of seemingly age-related health changes, and subgroups that may be at risk for faster aging. She notes two studies currently under review for publication (42:30). Geurts provides thanks and acknowledgments before the Q&A (44:50). 

Originally published April 9, 2024

The speaker:

Hilde Geurts, Ph.D., is currently a professor in clinical neuropsychology and head of the section Brain & Cogntion at the Department of Psychology of the University of Amsterdam. Dr. Geurts studies autism and ADHD. Her starting point is the neurodiversity perspective, and she focuses on cognition (especially cognitive control/executive functioning), inter & intra individual variability, quality of life as well as interventions across the life span.

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