Aging in autism: A systematic review of cognitive, neural, and physical health findings

BACKGROUND: Autism is a lifelong neurodevelopmental condition, yet aging trajectories in autistic adults remain poorly understood. We conducted a systematic review of studies examining age-related cognitive, neural, and physical health outcomes in autistic adults to clarify emerging patterns and identify priority areas for future research. METHODS: A systematic search of PubMed, PsycINFO, and Web of Science identified 56 eligible studies that included autistic adults and provided either longitudinal data or explicit age-by-diagnosis comparisons. Findings were synthesized separately by domain. RESULTS: Current evidence does not support globally accelerated or attenuated aging in autism. Most objective cognitive measures showed comparable age-related patterns across autistic and non-autistic adults, although subjective cognitive complaints were consistently elevated. Neuroimaging findings were similarly mixed. Most studies reported no structural or functional differences, though some found evidence of vulnerability in white matter microstructure. Physical health studies more consistently identified elevated rates of neurodegenerative diseases, sensory impairments, and musculoskeletal conditions, but comparable or lower rates for cancer. Cardiovascular findings were complex, with lower hypertension rates but higher rates of severe outcomes such as heart failure and stroke, suggesting gaps in early detection and preventive care. CONCLUSION: Rather than generalized accelerated aging, findings point toward targeted vulnerabilities in autism. Subjective cognitive complaints, white matter integrity, and elevated neurodegeneration rates represent the clearest targets for future surveillance. Critically, existing research almost exclusively involves autistic adults without intellectual disability, limiting generalizability. Advancing the field requires longitudinal designs, more inclusive samples, and a shift from group-level comparisons toward understanding within-group heterogeneity and individual risk profiles.