A group of international scientists have found that people with attention-deficit/hyperactivity disorder (ADHD) could be at higher risk of developing cognitive impairment—one of the signs of dementia. They also found that those with ADHD who developed cognitive impairment experienced worse health outcomes as a result of the disease as well. The findings build on previous studies discovering an association between adult ADHD and a higher risk of developing dementia, and experts say this highlights the need for more research to understand the connection, as well as greater and more targeted monitoring and care for those with ADHD as they get older.
The study was published in the journal JAMA Psychiatry on October 7. ADHD is one of the most common neurodevelopmental disorders among children, and often lasts into adulthood. Around 15½ million U.S. adults have ADHD, according to the Centers for Disease Control and Prevention (CDC).
Adults with ADHD may struggle with managing their attention, completing lengthy and mundane tasks, staying organized, controlling their behavior and may experience hyperactive symptoms like restlessness, as well as many others. Genetics, environmental factors, alcohol and tobacco use, child health conditions and parental mental health are all known risk factors for ADHD. The team of researchers reviewed the clinical data of almost 200,000 Americans aged 50 or older and found that around 7 percent of the participants who had ADHD went on to develop cognitive impairment, compared to 3 percent of those without ADHD.
The scientists also found that those with cognitive impairment and ADHD experienced "poorer mental health, lower quality of life and social satisfaction, and used health services more, compared with people with cognitive impairment who did not have ADHD." Reasons for these connections could be because ADHD "can be associated with difficulties in attention, organization, planning, emotional regulation, and everyday functioning throughout life," the study's co-first author Dr. Douglas Teixeira Leffa, who is also a practicing psychiatrist in Pittsburgh, told Newsweek. He said that when "cognitive impairment develops on top of those preexisting difficulties, the combined burden may make it harder to manage daily activities, relationships, healthcare, and other demands." Although, he said that "why individuals with ADHD may be more likely to develop dementia remains a crucial unanswered question." Leffa said that research now needs to try and uncover "why this relationship exists." He said another important question is "whether ADHD treatment, or better management of associated risk factors, can influence later cognitive outcomes," but added that at this point, "we do not have convincing evidence to answer that question." Greg Fabiano, a professor of psychology at Florida International University, told Newsweek that these findings "add to the accumulating research evidence that having ADHD is a risk factor for challenging outcomes across development, up to and including later adulthood." Fabiano said that it’s difficult to know yet what mechanisms could be contributing to the association between ADHD and an increased risk of cognitive impairment or dementia.
"Differences in brain structures, neurotransmitters, and brain function that result in the presentation of ADHD symptoms in childhood and adolescence might also contribute to the development of dementia later in life," he said. Leffa said that ADHD can be "associated with lower cognitive reserve or resilience, meaning that people with ADHD may have less ability to compensate for pathological age-related changes in the brain, so symptoms such as memory problems could become noticeable earlier." He also said that another possibility is that people with ADHD are, "on average, more exposed over the life course to factors that are themselves associated with poorer cognitive health, including sleep problems, cardiometabolic risk, physical inactivity, substance use, chronic stress, and social adversity." Fabiano said that, likely, an "interaction between neurological and environmental influences contribute to these results." For example, he said that people with ADHD are more at risk of "accidental injury, have lower educational attainment, job status, and lifetime earnings, and experience social impairments that may result in isolation during adulthood." "These factors may not only result in additional risk for negative health outcomes, but they may also result in reduced social support and access to quality preventive and targeted healthcare once these health concerns are present," he said. Fabiano said that as ADHD is "now widely viewed as a life-course persistent condition, this type of work is really important as it pushes the field to consider how to also prevent and treat potential concerns that arise later in life." "These findings also push the field to consider that treatments cannot be viewed as short-term fixes, and to consider a broad time horizon of sustained support and intervention," he added.
Guilherme Bauer-Negrini, Douglas Teixeira Leffa, Pamela C.L. Ferreira, Bruna Bellaver, Guilherme Povala, Marina S. Tudorascu, Samuele Cortese, Luis Augusto Rohde, Brooke S.G.
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