Adults With ADHD Have Increased Dementia Risk
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Adults who are diagnosed with attention deficit hyperactivity disorder (ADHD) face a likelihood of developing dementia that is almost three times higher than adults without ADHD, according to a large new observational study.
ADHD is one of the most common neurodevelopmental disorders of childhood, according to the Centers for Disease Control and Prevention (CDC). The condition also affects an estimated 4.4 percent of adults in the United States, per Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
The dementia risk in this adult population might be lowered, however, by taking common ADHD medications, such as Ritalin, Concerta, and Adderall, researchers noted.
“ADHD is a chronic pervasive condition, and we assumed that since there is some level of brain compromise in ADHD, then in old age this will present as low brain and cognitive resilience accompanied by higher dementia risk,” says Michal Schnaider Beeri, PhD, the director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center at Rutgers Brain Health Institute.
“ADHD adults should inform their physician of their condition and be attentive to cognitive changes, which they should share with their physician,” says Dr. Beeri, a coauthor of the new study. “This proactive approach ensures a thorough assessment and intervention if necessary.”
ADHD Findings Were Based on More Than 100,000 Adults
Published this week in JAMA Network Open, the research followed more than 109,000 participants in Israel over the course of 17 years. They ranged in age from 51 to 70 at the study start in 2002, and were almost evenly split between male and female.
During follow-up, 730 participants (0.7 percent) received a diagnosis of adult ADHD, and 7,726 (7.1 percent) received a diagnosis of dementia. Dementia occurred among 96 of those with ADHD (13.2 percent) and 7,630 of 108,488 participants (7.0 percent) without adult ADHD.
After taking into account confounders (such as cardiovascular condition), the investigators calculated that ADHD was associated with a 2.77-fold increased risk of dementia, including Alzheimer’s disease.
The study authors stress that this is an observational study that shows an association, but does not demonstrate in any way that ADHD causes dementia.
ADHD Medications Might Cut Dementia Risk
Additionally, the analysis found no clear increase in dementia risk linked with adult ADHD among those who received psychostimulant medication.
Beeri and her colleagues suggest that psychostimulants (such as Adderall, Ritalin, and Concerta) might lower the risk of dementia as they have been shown to modify the trajectory of cognitive impairment, which has been suggested in previous research. They, however, would like to see a clinical trial to further explore how these medications may affect dementia risk.
“These medications may support a person’s ability to compensate [for the cognitive effects of the disorder],” says Joel Salinas, MD, a clinical assistant professor of neurology at NYU Langone Health and the chief medical officer at Isaac Health (a virtual and in-home clinical service for dementia and other brain health conditions). “I would say that at least, this study shows that the risk of people who are on these medications doesn’t necessarily increase dramatically.”
Dr. Salinas, who was not involved in the new research, warns against misinterpreting these findings.
“I wouldn’t want somebody to walk away with the impression that if they have ADHD that it’s absolutely critical that they’d be on a psychostimulant to reduce the risk of dementia,” he says.
He further suggests that certain ADHD medications may increase cardiovascular risks among some older patients, so they need to proceed with caution.
Patients are advised to consult with their doctor — effective treatment may go beyond drugs and include nonmedication interventions, such as psychotherapy.
“ADHD is a complex neurodevelopmental disorder that is not only going to respond to medication — it can respond to lifestyle and behavioral changes, cognitive skills training, and other approaches,” says Salinas. “It is key to get a proper diagnosis and treatment.”
Beeri urges ADHD patients to be proactive and alert their physician to any cognitive changes in order to get an accurate diagnosis and pursue the best potential interventions. When it comes to identifying dementia, the sooner, the better.
“The earlier you’re able to detect and diagnose and intervene, the greater the impact on the long-term trajectory of the condition, and in this way, patients can be much more involved in the actual planning around their condition and their life,” says Salinas.
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