In the September issue 2013 of Attention Magazine, published by the national organization CHADD (Children and Adults with ADHD), my article was published on ADHD in people age 50 and older. There is remarkably little research looking at this population of patients. Clinical medication trials that seek the FDA approval for the treatment of ADHD include subjects up to 65 years old. However, the number of subjects over 50 in these studies is relatively small and often the mean age is 34.
Unfortunately, ADHD may not be a diagnostic consideration when older people complain of cognitive difficulties. A study looking at memory clinics in the U.S. found only 1 in 5 centers screen for ADHD. Therefore, it is possible that ADHD symptoms may be misdiagnosed as something else (Fischer BL 2012). Given that ADHD is a cognitive impairment, people wonder if ADHD is a risk factor for developing dementia. A recently published study looking at the question concluded that ADHD is not a risk factor for dementia (Ivanchak N, 2011). We’ll await further research.
Myths about ADHD over age 50:
Can’t diagnose ADHD in the presence of older age.
Can’t diagnose ADHD in the presence of medical disorders and medications.
Why bother treating it, they lived their whole life this way.
The ADHD medications aren’t safe in older adults.
Diagnosing ADHD in a person this age presents unique challenges because there are specific medical and psychiatric considerations in someone over age 50. If we just focus on the cognitive symptoms, the first issue is how much of the cognitive symptoms are age related. As we age we will notice some forgetfulness, difficulty in recalling information quickly, losing a train of thought, and getting distracted. What distinguishes this from ADHD is the fact that the symptoms started much later in life and not in childhood. Second possibility is a new diagnostic category in the DSM-5 called Mild Cognitive Impairment. This is a degree of cognitive change accompanied by impairment but not rising to the level of Alzheimer’s disease. Third are the effects of medication on cognition. As we age we will develop medical illnesses treated with medication that may have subtle effects on cognition (i.e. statins, antidepressants, chemotherapy). The more medications we are on, the more likely they will affect our thinking ability. Fourth, medical illnesses themselves may affect our thinking ability (i.e. hypothyroidism, post cardiac surgery). Fifth, women in peri- or post-menopause often notice clear changes in memory and cognition. Sixth, a long history of alcohol and/or substance abuse may cause lasting cognitive symptoms. Seventh, head trauma/concussion/neurological disorders may leave persistent changes on memory and processing speed for information (i.e. multiple concussions from sports injury). What distinguishes all of the above diagnostic consideration is the age of onset of these symptoms. Except for the possibility of head trauma in childhood, all the other diagnostic considerations occur later in life. The hallmark of ADHD is the presence of symptoms in childhood.
I will continue my blog on this subject in the future. Thank you for your interest. Hope it is helpful to you.