May 12, 2020

A senior is struggling with forgetfulness. Is it Alzheimer's—or ADHD?

Daily Briefing

    Attention-deficit hyperactivity disorder (ADHD) is most commonly diagnosed in children, but as awareness around the condition has grown, doctors are seeing a new population of ADHD patients: seniors, Sumathi Reddy reports for the Wall Street Journal.

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    Why ADHD is often easy to miss in seniors

    In children, one of the most common symptoms of ADHD is hyperactivity, but other symptoms include disorganization and inattention—two symptoms that in seniors can often present as cognitive decline, Alzheimer's disease, and other age-related memory conditions. 

    David Goodman, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine who treats ADHD patients over 50 who've previously gone undiagnosed, said the similarities between ADHD in seniors and age-related ailments can make it difficult to diagnose ADHD in that population.

    However, research has found that a sizeable population of older adults likely has ADHD, Reddy reports. One study estimated that around 3% of adults over the age of 50 have ADHD, compared to roughly 8% of children and 4.5% of adults under 45 in the United States.

    Doctors don't believe that ADHD has suddenly become more common among older adults, but rather that many older adults have likely always had ADHD but haven't been diagnosed because the condition was less well known in their youth, Reddy reports.

    How do you diagnose ADHD in seniors

    Kathleen Nadeau, the founder and clinical director of the Chesapeake Center, said she's noticed older ADHD patients often get diagnosed in one of three ways: they were already being treated for another condition and were recommended for ADHD evaluation, they had a relative or friend diagnosed with the ADHD, or they had a significant change in their life that they couldn't cope with that culminated in them learning they had ADHD.

    Nadeau said ADHD symptoms often ebb and flow depending on how stressed a patient is. "If you don't have to work or raise children anymore, it may look like you have less ADHD, but you actually have less demands," she said. "If you're put back in a situation you may have similar difficulties. This doesn't go away and people still need help" at an older age.

    Joan Friess, who's 76 years old, fell into the first category. About five years ago, a neurologist diagnosed her with a precursor to Alzheimer's disease and prescribed medication for her condition. However, both Friess and her son, Steve Friess, doubted the diagnosis.

    When Joan moved to a new area, she saw a new doctor. Steve told the doctor that his mother's behavior wasn't markedly different from when she was younger, and that she'd always lost things and been "a bit forgetful." Joan's brain scans showed no signs of Alzheimer's disease or dementia, and the doctor then diagnosed her with ADHD.

    How ADHD in seniors is treated

    Treating ADHD in older adults also can be difficult, Reddy reports. The most common treatment for younger patients is stimulants, but these drugs can raise heart rates and blood pressure, which means they need to be closely monitored when prescribed to older adults.

    Cognitive behavioral therapy has also been shown to be an effective ADHD treatment among older adults.

    Goodman said he hasn't seen many side effects among the roughly 800 older ADHD patients he's treated. The key, Goodman said, is diagnostic accuracy before prescribing medications. "Dosing is thoughtfully slow while monitoring improving cognitive symptoms, side effects, and blood pressure," he said.

    Sandra Kooij, an associate professor of psychiatry at Amsterdam University Medical Center, said she and other researchers have been analyzing stimulants, along with psychoeducation and cognitive behavioral therapy, as treatments for older ADHD patients.

    Generally, Kooij said the treatment's efficacy in older adults has been much like what researchers have seen in younger adults. Medications have been tolerated well, provided cardiovascular risks are managed properly, she said.

    That said, Kooij said treatment isn't necessarily for everyone with ADHD. "Only people who feel impaired by their symptoms should be treated," she said (Reddy, Wall Street Journal, 2/24).

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