Age-related differences in behavioral and brain predictors of parkinsonism in autistic adults.

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Autistic adults experience lifelong motor differences and may have increased vulnerability to parkinsonism, yet behavioral and neuroanatomical correlates of motor challenges across adulthood remain poorly understood. We examined cross-sectional behavioral and motor-related brain region morphology in autistic (n = 123) and non-autistic (n = 102) adults aged 18-71 years using the Parkinsonism Screening Questionnaire (PSQ), Adult Repetitive Behavior Questionnaire-2 (RBQ-2A), finger tapping, and MRI-derived cortical thickness and subcortical volumes of motor-related brain regions. Replication of the questionnaire analyses was conducted in an independent cohort of middle- and older-aged autistic adults from the Simons Powering Autism Research (SPARK; n = 210; ages 42-80 years), whereas structural MRI and finger tapping analyses were limited to the Arizona cohort. Autistic adults reported significantly higher PSQ scores than non-autistic adults. A significant group-by-age interaction was observed for RBQ-2A Factor 1, with autistic adults showing a steeper age-related reduction in repetitive motor and sensory behaviors. RBQ-2A scores were positively correlated with PSQ scores across both cohorts. Finger tapping performance did not differ between groups. Caudate volumes were larger in autistic adults and showed a modestly stronger negative association with age that did not survive multiple comparison correction. These findings suggest that self-reported restricted, repetitive motor behaviors and interests may serve as an indicator of self-reported parkinsonism-like symptoms in autism and highlight the need for longitudinal studies to clarify mechanisms of parkinsonism risk across the lifespan.

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