5 Things About ADHD in Older Adults You May Not Know

Attention-deficit/hyperactivity disorder (ADHD) is a recognized disorder in adults and children, affecting about 8% of children and 4.4% of adults. However, what is known about ADHD when it affects older adults, especially those nearing retirement age or those who are already retired?

Kathleen G. Nadeau, PhD, has particular interest in the topic, since she herself has ADHD, and she is surveying this special population for research for an upcoming book. Nadeau, a psychologist in Maryland, spoke about this issue at the 2018 annual meeting of the American Professional Society of ADHD and Related Disorders in a talk called Still Distracted After All These Years: Exploring ADHD After Age 60.

Here are 5 takeaways from her talk:

1. It’s difficult to diagnose older adults. There is no specific screen tool developed for older adults, Nadeau said. The best measure is how people function in daily life, which is why she likes screening tools developed by other psychologists, such as the Brown ADD Scales for Adolescents and Adults, created by psychologist Thomas Brown, or the Barkley Adult ADHD Rating Scale—IV (BAARS-IV), created by psychologist Russell Barkley. There’s no training for professionals for diagnosing and treating what she calls “senior ADHD,” despite the fact that she said memory clinics are reporting more older patients are coming in asking to be tested for dementia or mild cognitive impairment, when what they really have is undiagnosed ADHD. Part of that issue may stem from the fact that 40% of primary care doctors have said they have never seen a patient with adult ADHD.¹

2. The relationship of ADHD to dementia, mild cognitive impairment is unclear. Some of the same cognitive symptoms of ADHD resemble symptoms of mild cognitive impairment (MCI), and the relationship between the 2 remains unclear. ADHD may increase the risk of MCI years later because of lifestyle issues related to ADHD that affect brain health. Nadeau said the jury is still out on whether it raises the risk of Alzheimer disease (AD). However, 1 retrospective study of individuals with dementia with Lewy bodies (DLB) suggests that those with ADHD are at greater risk of developing the disease. The 2011 study said 47.8% of those with DLB had retrospectively diagnosed ADHD, compared with AD (15.2%) and a control group (15.1%).²

3. There are interesting parallels between older adults with ADHD and younger adults with ADHD. Just as young adults with ADHD lose oversight of their parents when they go away to school or move out, retirees may find themselves in new living situations and may have lost the structure of a job or a routine. Both groups are at risk for developing poor sleep patterns and poor nutritional habits and benefit from finding or restoring structure to their lives.

4. ADHD affects older women differently. Women with ADHD can start to see changes in mid 40s in perimenopause and bigger changes around age 50. Many women report that they’ve “become dumb” at this age when hormone levels decline, Nadeau said. She said stimulant medication can feel ineffective if estrogen levels are low. She suggested that female patients with ADHD should consult with a physician who specializes in integrative medicine about hormone levels and hormone replacement.

5. People with ADHD report different outcomes in retirement. Some people are happier because they have less stress on their executive functions now that they are no longer working. They are free to pursue their passions and are free from structure and demands. But some people fare worse because they are socially isolated and have trouble managing paperwork, their homes, or clutter. “I think the overall message I want to convey in the book I plan to write titled ‘Still Distracted After All These Years’ is that some older adults with ADHD seem to be thriving while others are still struggling,” said Nadeau in an e-mail exchange with The American Journal of Managed Care.^® “I want to examine the differences between these two groups to learn more about what older adults can do to lead more satisfying lives in their later years.”

Dr Nadeau is currently interviewing senior adults for this book and is especially seeking male subjects.

References

1. Callhan BL, Bierstone D, Stuss DT, Black SE. Adult ADHD: risk factor for dementia or phenotypic mimic? Front Aging Neurosci. 2017(9):260. doi: 10.3389/fnagi.2017.00260.

2. Golimstok A, Rojas JI, Romano M, et al. Previous adult attention-deficit and hyperactivity disorder symptoms and risk of dementia with Lewy bodies: a case—control study. Eur J of Neurol. 2011(18)78-84. doi:10.1111/j.1468-1331.2010.03064.x.