With a growing number of adults with autism spectrum disorder (ASD), more and more research has been conducted on majority male cohorts with ASD from young, adolescence, and some older age. Currently, males make up the majority of individuals diagnosed with ASD, however, recent research states that the gender gap is closing due to more advanced screening and a better understanding of how females with ASD present their symptoms. Little research has been published on the neurocognitive differences that exist between older adults with ASD compared to neurotypical (NT) counterparts, and nothing has specifically addressed older women with ASD. This study utilized neuroimaging and neuropsychological tests to examine differences between diagnosis and sex of four distinct groups: older men with ASD, older women with ASD, older NT men, and older NT women. In each group, hippocampal size (via FreeSurfer) was analyzed for differences as well as correlations with neuropsychological tests. Participants (ASD Female, n = 12; NT Female, n = 14; ASD Male, n = 30; NT Male = 22), were similar according to age, IQ, and education. The results of the study indicated that the ASD Group as a whole performed worse on executive functioning tasks (Wisconsin Card Sorting Test, Trails Making Test) and memory-related tasks (Rey Auditory Verbal Learning Test, Weschler Memory Scale: Visual Reproduction) compared to the NT Group. Interactions of sex by diagnosis approached significance only within the WCST non-perseverative errors, with the women with ASD performing worse than NT women, but no group differences between men. Effect sizes between the female groups (ASD female vs. NT female) showed more than double that of the male groups (ASD male vs. NT male) for all WCST and AVLT measures. Participants with ASD had significantly smaller right hippocampal volumes than NT participants. In addition, all older women showed larger hippocampal volumes when corrected for total intracranial volume (TIV) compared to all older men. Overall, NT Females had significant correlations across all neuropsychological tests and their hippocampal volumes whereas no other group had significant correlations. These results suggest a tighter coupling between hippocampal size and cognition in NT Females than NT Males and both sexes with ASD. This study promotes further understanding of the neuropsychological differences between older men and women, both with and without ASD. Further research is needed on a larger sample of older women with and without ASD.