Memory-related medications in autism: what this Cochrane review found

In one sentence

Current research does not provide clear evidence that medications like donepezil or galantamine improve core autism-related difficulties in children and teenagers.

What the researchers did

Researchers reviewed studies involving medications called acetylcholinesterase inhibitors — drugs more commonly used for memory-related conditions such as dementia.

These medicines affect a brain system involved in attention, learning, and information processing. Because of this, some researchers have explored whether they could also help autistic people.

The Cochrane team searched medical databases and found only two suitable clinical trials, involving a total of 74 children and teenagers with autism.

One study tested galantamine together with risperidone, while the other compared donepezil with placebo.

What they found

Overall, the review did not find convincing evidence that these medications clearly improve the main characteristics associated with autism.

Researchers did not see reliable improvements in areas such as:

• social communication;
• repetitive behaviors;
• overall autism-related difficulties;
• or day-to-day functioning.

Some small positive findings appeared in certain areas, such as irritability, but the evidence was weak and uncertain.

The review also found that side effects may have been more common when galantamine was combined with another psychiatric medication. However, the studies were small, and no serious adverse effects were clearly reported.

The researchers repeatedly stress that the evidence quality was very low, meaning future studies could potentially lead to different conclusions.

What this means for families and therapists

This review is a reminder that medications used for memory or attention problems in other conditions are not automatically effective for autism.

If a clinician discusses medications such as donepezil, galantamine, or rivastigmine, families may want to ask:

• what specific difficulty the medication is targeting;
• how success will be measured;
• what side effects are possible;
• and how strong the evidence actually is.

For now, the strongest evidence in autism support still comes from approaches focused on communication, daily living skills, emotional support, and adapting environments to the person’s needs.

The review does not completely rule out future benefit from these medications, but at the moment there is not enough evidence to support routine use for core autism features.

Limitations and what we don't know yet

Only two small studies were available, so the findings remain uncertain.

The studies were also short-term and focused mostly on rating scales rather than long-term everyday outcomes that matter most to autistic people and families.

Almost no research was available for autistic adults.

The review authors also note that additional studies were still ongoing, meaning future evidence could change the overall picture.

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This is a simplified summary of Acetylcholinesterase inhibitors for autistic spectrum disorders by Ure A, Cox G.R, Haslam R, Williams K et al., Cochrane Database of Systematic Reviews (2023).

Source license: CC-BY-NC-4.0.

This is not medical advice. Please consult a qualified healthcare professional before making treatment decisions.