Miot Stéphanie, Akbaraly Tasnime, Michelon Cecile, Couderc Sylvie, Crepiat Sophie, Loubersac Julie, Picot Marie-Christine, Pernon Éric, Gonnier Véronique, Jeandel Claude, Blain Hubert, Baghdadli Amaria
CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.
Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.
Front Psychiatry. 2019 Sep 19;10:617. doi: 10.3389/fpsyt.2019.00617. eCollection 2019.
Autism spectrum disorder (ASD) is an early-onset and lifelong neurodevelopmental condition frequently associated with intellectual disability (ID). Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. To determine the comorbidity burden and its association with distinct clinical presentation in terms of ASD severity, adaptive skills, level of autonomy, and drug exposure in a well-phenotyped sample of individuals with ASD-ID-the EFAAR (Frailty Assessment in Ageing Adults with Autism Spectrum and Intellectual Disabilities) cohort. A total of 63 adults with ASD-ID, with a mean age of 42.9 ± 15.1 years, were recruited from 2015 to 2017 from nine specialized institutions. They underwent detailed clinical examinations, including screening for comorbidities, ASD severity [Childhood Autism Rating Scale (CARS)], adaptive functioning [Vineland Adaptive Behavior Scale II (VABS-II)], autonomy [activities of daily living (ADLs)], and drug use [polypharmacy and the Drug Burden Index (DBI)]. The comorbidity burden was evaluated using the Cumulative Illness Rating Scale (CIRS-G) and its sub-scores [the severity index (CIRS-SI) and severe comorbidity (CIRS-SC)]. We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy. The severity of the comorbidity burden associated with premature ageing in adults with ASD and ID highlight their crucial need of personalized medical care.
自闭症谱系障碍（ASD）是一种早发性且终身的神经发育疾病，常与智力残疾（ID）相关。尽管新兴研究表明，ASD与过早衰老及各种医学合并症有关，如同ID的情况一样，但相关数据稀缺。为了确定合并症负担及其与ASD严重程度、适应技能、自主水平和药物暴露等不同临床表现之间的关联，我们对一个具有良好表型的ASD-ID个体样本——EFAAR（自闭症谱系和智力残疾老年人衰弱评估）队列进行了研究。2015年至2017年期间，从9家专业机构招募了总共63名ASD-ID成年人，他们的平均年龄为42.9±15.1岁。他们接受了详细的临床检查，包括合并症筛查、ASD严重程度[儿童自闭症评定量表（CARS）]、适应功能[文兰适应行为量表第二版（VABS-II）]、自主能力[日常生活活动（ADL）]以及药物使用情况[多重用药和药物负担指数（DBI）]。使用累积疾病评定量表（CIRS-G）及其子分数[严重程度指数（CIRS-SI）和严重合并症（CIRS-SC）]来评估合并症负担。我们发现了大量的合并症，包括胃肠道疾病以及精神和神经疾病。总体而言，我们的ASD-ID样本中有25%患有慢性肾病，并伴有心血管危险因素增加。合并症负担较高（CIRS-G总分平均为10.6±4.8），与老年科住院患者中比我们研究人群年龄更大的患者所观察到的情况相当。此外，合并症负担与年龄、自主能力下降和多重用药呈正相关。ASD和ID成年人中与过早衰老相关的合并症负担严重程度凸显了他们对个性化医疗护理的迫切需求。
