Cholinergic therapy for autistic spectrum disorders: Review and case report

The causes of autism are heterogeneous and still largely unknown. Currently available treatments especially for the behavioural problems frequently reported in children and adults with autistic spectrum disorder (ASD) are largely symptomatic. The cholinergic abnormalities are rather consistently reported in various molecular pathological studies, both in children and adults with ASD, and they may underlie the numerous cognitive and behavioural changes seen in ASD, e.g. cognitive changes, memory problems, attentional dysfunction etc. This raises the prospect of the use of cholinesterase inhibitors and other cholinomimetics (chemicals that can act by either directly stimulating the nicotinic or muscarinic receptors, or promote acetylcholine release) in ASD for treatment of both cognitive and behavioural changes, as well as activities of daily living and improving the overall global functioning in these subjects, similar to the effect these treatments have in various neurodegenerative and neurodevelopmental conditions (e.g. dementia and schizophrenia). We provide an overview of the current use of cholinesterase inhibitors (donepezil, galantamine and rivastigmine) and cholinomimetics (e.g. nicotine) in the treatment of some of the cognitive and behavioral symptoms in ASD. In greater detail, we discuss the potential use of cholinomimetics in these subjects, and review the experience of Mr. A, a now twenty-eight year-old non-smoking male with a history of severe behavioral dysfunction who has been wearing a nicotine patch since July, 2005.