Attention-deficit/hyperactivity disorder (ADHD) is a lifelong brain disorder that many people have since childhood. However, there is little information about how ADHD changes as people get older or how it relates to mild cognitive impairment (MCI) or early dementia. The number of people over 65 years old in the U.S. is expected to rise from 58 million in 2022 to 82 million by 2050—a 47% increase. This means ADHD will affect more older adults, adding to health challenges in this age group.
Studies have shown ADHD continues to affect adults, but most research stops around middle age. Adults over 65 are often left out of studies. This happens because it is hard to tell ADHD apart from other age-related cognitive problems. Also, older adults are usually excluded from drug trials to avoid mixing ADHD with other disorders.
A recent large study combined data from over 20 million people. It found that about 2.18% of older adults have ADHD based on community surveys. But only 0.23% had ADHD recorded officially in their medical records. Even fewer were treated for ADHD—only 0.09%. Other global studies find ADHD rates in older adults between 2.8% and 3.5%. The rates seem to decrease with age, and people in clinics usually show higher rates than the general public.
Training for health professionals about adult ADHD, especially in older patients, is very limited. Many doctors and nurses are not skilled in spotting or treating ADHD in elderly patients. This lack of knowledge and some biases mean ADHD is often missed in older adults. When doctors do decide to treat ADHD in older patients, they must carefully balance benefits and risks.
Diagnosing ADHD in older adults is hard because symptoms overlap with those of other conditions. Doctors look at how long symptoms have been present, their stability, and whether they started in childhood. Symptoms of ADHD like forgetfulness or trouble focusing also appear in depression, anxiety, or dementia, making diagnosis tricky. For many older adults, ADHD was not diagnosed in childhood simply because it was less understood then.
Doctors must also consider many other possible causes before diagnosing ADHD, including medical problems like brain injury or medication effects and mental health issues like depression or PTSD. Neuropsychological testing is not always useful to tell ADHD apart from other cognitive problems in older people. Some symptom scales exist but remembering childhood symptoms accurately can be difficult, so relatives’ information is important.
Mild cognitive impairment, now called mild neurocognitive disorder (MND) in medical manuals, shares many symptoms with ADHD. However, MND often includes specific language problems not seen in ADHD, like trouble finding the right words or using vague terms such as “stuff” or “things.” These language symptoms can help doctors differentiate MND from ADHD.
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