Janicki Matthew P, McCallion Philip, Jokinen Nancy, Larsen Frode Kibsgaard, Service Kathyrn P, Mughal Dawna T, Watchman Karen, Gomiero Tiziano, Keller Seth M
University of Illinois Chicago, Chicago, Illinois, USA.
National Task Group on Intellectual Disabilities and Dementia Practices, Rockport, Maine, USA.
Int J Geriatr Psychiatry. 2025 Jun;40(6):e70110. doi: 10.1002/gps.70110.
The second International Summit on Intellectual Disability and Dementia, held in 2023, highlighted the unique challenges of diagnosing dementia in older autistic adults, particularly those with intellectual disabilities, due to the complex interplay of cognitive, communicative, and behavioral factors. This article addresses key diagnostic issues and post-diagnostic considerations for this population.
A consensus report was developed by the Summit's Autism/Dementia Working Group through background reviews, expert discussions at the Summit, and iterative draft revisions, incorporating feedback from internal and external stakeholders. Key issues were extracted from the report and abridged for this manuscript.
Diagnostic challenges stem from overlapping symptoms of co-occurring neurodevelopmental and psychiatric conditions, rendering standard dementia tools insufficient. Comprehensive evaluations tailored to autism-related traits, sensory sensitivities, and alternative communication methods are essential. Building diagnostic capacity among clinicians and fostering multidisciplinary collaboration are critical. Longitudinal assessments, initiated before dementia symptoms appear, facilitate early detection of subtle changes. Emerging biomarkers and neuroimaging techniques show promise and should be incorporated where feasible. Accommodations, such as virtual assessments in familiar settings, can enhance diagnostic accuracy by reducing anxiety. Creating transition processes from diagnostics to post-diagnostic supports will aid in mitigating challenges and enhance life quality when dementia is a factor.
Research and clinician education are urgently needed to improve diagnostic approaches and streamline the transition from diagnosis to tailored post-diagnostic support. An integrated framework of comprehensive efforts is vital for our better understanding of age-associated neuropathological diagnostics and enabling long-term well-being of older autistic adults with dementia.
2023年召开的第二届国际智力残疾与痴呆症峰会强调，由于认知、沟通和行为因素的复杂相互作用，在老年自闭症成年人，尤其是那些有智力残疾的人中诊断痴呆症存在独特挑战。本文探讨了该人群的关键诊断问题及诊断后的注意事项。
峰会的自闭症/痴呆症工作组通过背景审查、峰会上的专家讨论以及反复的草案修订，结合内部和外部利益相关者的反馈，制定了一份共识报告。关键问题从报告中提取并精简用于本文。
诊断挑战源于同时出现的神经发育和精神疾病症状重叠，使标准痴呆症工具不足。针对自闭症相关特征、感官敏感性和替代沟通方式进行全面评估至关重要。提高临床医生的诊断能力并促进多学科合作至关重要。在痴呆症症状出现之前启动纵向评估，有助于早期发现细微变化。新兴的生物标志物和神经成像技术显示出前景，应在可行的情况下加以应用。诸如在熟悉环境中进行虚拟评估等便利措施，可以通过减轻焦虑来提高诊断准确性。建立从诊断到诊断后支持的过渡流程，将有助于在痴呆症成为一个因素时减轻挑战并提高生活质量。
迫切需要开展研究和临床医生教育，以改进诊断方法并简化从诊断到量身定制的诊断后支持的过渡。综合全面努力的框架对于我们更好地理解与年龄相关的神经病理学诊断以及实现患有痴呆症的老年自闭症成年人的长期福祉至关重要。
