When Forgetfulness Isn't Cognitive Decline: ADHD in Older Adults

You forget to pay bills, miss appointments and frequently lose things. You have always been scattered, but now your brain is starting to feel a little more dispersed. Like many people over 50, you may begin to worry that your memory is declining and are concerned you may be developing dementia.

However, there may be another issue at play. Symptoms like these may instead be signs of undiagnosed attention deficit disorder. You may think, "Wait a minute! Isn't that a problem just for kids?" 

ADHD (attention-deficit/hyperactivity disorder) is commonly diagnosed in children these days, but historically, it was not when you were a child. Today, an estimated 4.4% of adults have ADHD, with many unaware they are burdened. Are you one of them?

According to the National Institute of Mental Health, ADHD is a regular lack of attention or impulsiveness that interferes with normal function or development. 

ADHD did not become a common diagnosis until the 1990s, and even then, it was primarily a diagnosis limited to children. This means for many of the estimated 8 million adults in the United States living with ADHD, the diagnosis could have been overlooked or not even considered when they were young, even if the symptoms were present. 

Many adults may have gone most of their lives functioning well enough to get by with little interference from their symptoms until life grew more demanding in adulthood. If they struggled as children, they may have been labeled the class clown, a poor student or lazy for not completing their work. 

As adults, they likely continue to have difficulty completing projects or tasks. With aging, some of the common symptoms of ADHD can grow more exaggerated or noticeable. Adults with ADHD may become more impulsive. They may interrupt others more frequently during conversations or start to answer questions before they are done being asked. Some may fidget or become restless, finding it harder to sit idle. 

These symptoms can begin to affect their day-to-day lives. They may arrive late to work or appointments more frequently or are more challenged to stay productive or finish assignments at work and tasks at home.

Research shows when older adults talk with their health care provider about symptoms, their provider may not consider ADHD, or they may get misdiagnosed with a different condition like cognitive decline instead.

One estimate shows fewer than 20% of adults with ADHD receive an accurate diagnosis and treatment. George Keepers, MD, the Chair and Professor of Psychiatry at Oregon Health & Science University and the Attending Physician for OHSU's Adult ADHD Clinic in Portland, Oregon, states, "There is a large overlap of the symptoms with cognitive decline in older people with ADHD."

Signs include losing needed things frequently like keys, eyeglasses and phones, forgetting appointments, getting distracted during tasks and chores, and needing to listen when someone is speaking directly to them.

Additionally, ADHD in adults frequently occurs with other psychiatric conditions that may hide or mask the symptoms of ADHD. These include:

· Bipolar disorder

· Major depression

· Anxiety

· Personality disorder

· History of concussion

· Substance abuse disorders (including nicotine, alcohol, marijuana and other drugs)

Keepers notes there are distinguishing characteristics in the memory deficits between ADHD and dementia. "People who have cognitive problems because of dementia have, over the course of the illness, profound decline in their ability to remember things that have happened recently." 

"Their short-term memory may be so impaired that they lose track of all kinds of events and sometimes it gets so severe that their longer-term memory is affected, and they become unable to recognize even relatives and close friends," he explains. "That's not the case in ADHD."

The tide is changing as adults getting diagnosed with ADHD is becoming more common. A recent study showed adults getting an ADHD diagnosis is growing four times faster than children getting the same diagnosis. There are also efforts nationally by the American Society of ADHD and Related Disorders (APSARD) to develop better guidelines for diagnosing ADHD in adults.

Keepers would encourage someone of any age to get evaluated for ADHD if they have concerns, even if they have been diagnosed with cognitive decline. 

"You would not want to miss the opportunity to diagnose this condition and treat it in an older individual because treatment is very effective and can maintain the person's function for a long period of time," he says, adding the oldest patient he has so far diagnosed was 80 years old. 

If you have concerns about ADHD, be proactive and schedule an appointment to talk with your health care provider. A health care provider can do a full review of your history along with screenings to help clarify and provide a correct diagnosis. Here is some information you may be asked to provide:

• List the symptoms you feel are related, such as having difficulty finishing projects, losing things and interrupting people during conversations. Also, consider any signs you've had during your entire lifetime.
• Be open and honest with the information you provide. The health care professional cannot provide the best care and help you if they do not fully understand your symptoms and feelings.
• The latter extends to any mental health and substance use issues you are experiencing. 
• Bring in a list of your medications, vitamins and supplements.
• Bring a friend or family member who can report signs they see when interacting with you.
• Be bold and ask questions. This is, after all, your visit and your health. Make sure you understand their interpretation of findings and recommendations.

The impact of misdiagnosis is substantial, not only for differences in treatment but in how patients perceive themselves. For someone who does not know they have ADHD, getting an accurate diagnosis can be life-changing. 

Older adults should not assume all memory issues are signs of cognitive decline. It is never too late to get an accurate diagnosis and treatment for ADHD or any other mental health concern. Effective treatment can make day-to-day life easier for most adults and their families.

Leanna Coy, MN, FNP-BC, is a freelance writer and primary care provider based in Oregon. With more than 20 years in nursing, she has a solid background in healthcare information and an understanding of the human experience, which is reflected in her writing.

She specializes in writing health and wellness articles and web content on women’s health, reproductive health, and preventive care. She can be found at TheProviderPerspective. Read More