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Struggling with attention and organization as you age? It could be ADHD, not dementia

April 21, 2020

By Stephanie Collier, MD, MPH, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

As we get older, occasional forgetfulness may become more worrisome. Is this the start of dementia, or are we just stressed? Has the loss of structure due to retirement led to this change? Or could we be suffering from another illness, maybe the same illness as our son or granddaughter, who also struggle with attention and organization?

What are the symptoms of ADHD in older adults?

Although the diagnosis of ADHD (attention deficit hyperactivity disorder) is often associated with school-age children, this condition may persist throughout adulthood and into old age. Older adults with ADHD struggle with attention, memory, and planning. They may struggle with finishing projects or remembering information consistently, and they may become distracted during conversations and experience difficulty maintaining relationships. When older adults lose the structure of employment, they may experience an exacerbation of symptoms, similar to when young adults with ADHD lose the structure of school. During retirement older adults may start to re-experience challenges with time-management and procrastination, which may result in feelings of anxiety or guilt.

Is it normal aging or ADHD?

When people share concerns with their doctor about their memory, attention, or difficulty completing tasks, they may receive a diagnosis of mild cognitive impairment (MCI), a stage between normal aging and dementia. However, older adults with ADHD may never have received a diagnosis of ADHD, especially if they had learned skills to compensate during their lifetime. To help doctors differentiate between mild cognitive impairment and ADHD in old age, the timing of symptoms and family history can provide good clues (after ruling out potential medical causes, such as thyroid or seizure disorders).

ADHD is one of the most heritable disorders in medicine, so having children, grandchildren, or siblings with this diagnosis should increase a doctor’s suspicion that their patient’s symptoms may be the result of ADHD. Understanding a patient’s timeline of symptoms is also crucial, as symptoms must have occurred in childhood to make the diagnosis of ADHD. Screening tools in adults may also be useful, such as the ADHD Self-Report Scale, although a positive screen doesn’t always mean you have ADHD.

What are effective treatments for ADHD in older adults?

The most effective medications for the treatment of ADHD in older adults are stimulant medications such as methylphenidate or dextroamphetamine. These medications provide significant benefit to older adults, as well as children and younger adults. However, in older adults doctors must also consider the cardiac risks of these medications, including increased blood pressure and heart rate, as well as a potential increase in the risk of an irregular heartbeat, particularly in people with known heart blockage.

Nonmedication options are also valuable to help a person create structure and learn organization tools, such as use of a daily planner, alarms, and lists. Therapists or coaches can help older adults with ADHD through the use of behavioral therapies, which may lead to improved time and money management, increased productivity, reduced anxiety, and higher life satisfaction.

What can you do in addition to getting medical treatment?

If you suspect your symptoms may be the result of ADHD, especially if a close family member has received this diagnosis, do not hesitate to ask your primary care physician for a referral to a specialist with expertise in the diagnosis and management of ADHD in older adults. In addition, the following strategies can be useful in managing symptoms at home.

Exercise regularly. Physical activity increases brain neurotransmitters, such as dopamine, norepinephrine, and serotonin, which can affect attention.

Improve sleep. Set up a bedtime routine, avoid caffeine after noon, and try to avoid electronic devices within an hour of bedtime.

Enlist the help of others. Family members and other supports may help with creating structure and simplifying tasks.

Set reminders. Calendars, alarms, written notes, and lists can provide additional assistance in remembering tasks.

About the Author

Stephanie Collier, MD, MPH, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Stephanie Collier is the director of education in the division of geriatric psychiatry at McLean Hospital; consulting psychiatrist for the population health management team at Newton-Wellesley Hospital; and instructor in psychiatry at Harvard Medical School. … See Full Bio

View all posts by Stephanie Collier, MD, MPH

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