A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Fall, 2019 | Number 4, Volume 33

Advanced aging, multiple co-occurring conditions seen in middle-aged adults with combined ASD and ID

Middle-aged adults with combined autism spectrum disorder (ASD) and intellectual disability (ID) have a high rate of comorbidities and exhibit signs of premature aging, according to a new study from France. 

The study, conducted by Stéphanie Miot and colleagues, involved 63 participants with both ASD and ID. Participants had a mean age of 42.9 years. Participants with comorbid Down syndrome were excluded from the study, as this syndrome is a known cause of premature aging. 

The researchers screened participants for comorbidities, ASD severity, adaptive functioning, ability to perform activities of daily living, and medication use. They also evaluated the participants’ “comorbidity burden” using the Cumulative Illness Rating Scale (CIRS-G) and two subscores, the severity index (CIRS-SI) and the severe comorbidity subscore (CIRS-SC). 

The researchers report, “We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases.” Unexpectedly, they also found that 25% of the participants had chronic kidney disease. 

The researchers note, “The comorbidity burden, assessed by the CIRS-G total score, of our ASD-ID population, with a mean age of 42.9 years, was comparable with that of an older population (with a mean age of 79 years) from the general hospitalized population in a geriatric department. The CIRS-SI of our sample was also higher than that of a population with a mean age of approximately 80 years, supporting the hypothesis of premature aging in ASD-ID, partially due to a high comorbidity burden.” The comorbidity burden of study participants correlated with increased age, decreased ability to perform activities of daily living, and the use of multiple medications. 

The researchers note that elderly people from the general population often exhibit chronic, low-level inflammation due to an imbalance between proinflammatory and anti-inflammatory cytokines—a phenomenon called inflamm-aging—which is associated with multimorbidity and frailty. Similarly, many studies show an association between ASD and inflammation. In this study, the researchers detected a significant association between the CIRS-G score and elevated CRP—a marker for inflammation—in their ASD group. “This inflamm-aging process,” they say, “could thus partially explain such a comorbidity burden and be an indirect cause of pathological and/or premature aging in ASD.”

The researchers say that because their study focused on a very specific population— individuals with both ASD and ID—their results should be interpreted with caution. “The severe ID observed in our population,” they say, “could be the most important cause of the observed high comorbidity burden.” 

They conclude, “The severity of the comorbidity burden associated with premature aging in adults with ASD and ID highlights their crucial need of personalized medical care.” 

Editor’s note: The Autism Research Institute was instrumental in the online publication of a consensus report on aging in autism. You can view the report at www.ASDSeniorReport.com.

Miot and colleagues found that the comorbidity burden of their middle-aged participants with ASD and ID was comparable to that of 79-year-olds in geriatric hospitals.

Citations

“Comorbidity burden in adults with autism spectrum disorders and intellectual disabilities— a report from the EFAAR (Frailty Assessment in Aging Adults with Autism Spectrum and Intellectual Disabilities) Study,” S. Miot, T. Akbaraly, C. Michelon, S. Couderc, S. Crepiat, J. Loubersac, M. C. Picot, É. Pernon, V. Gonnier, C. Jeandel, H. Blain, and A. Baghdadli, Frontiers in Psychiatry, September 19, 2019 (free online). Address: Stéphanie Miot, [email protected].