A recent article published by the American Association for Retired Persons (AARP) discusses, among other topics, hormones, ADHD, and the older brain.
Three-quarters of adults ages 18 to 44 who are found to have ADHD were never diagnosed as children; among adults 60 and older, that number is 100 percent, says David Goodman, M.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. That’s primarily because, half a century ago, clinicians simply didn’t know to screen for it in children.
“It’s a neuropsychiatric disorder that starts in childhood and continues your whole life,” he says. “It doesn’t go away when you get your AARP card.”
Hyperactivity, distractibility and executive function challenges (among them time management and impulse control) are all classic symptoms of ADHD. And when women reach perimenopause and menopause, the drop in estrogen can make ADHD symptoms significantly worse.
Of considerable interest is the article’s section titled, Doctors in the Dark.
ADHD is seldom taken into consideration when assessing older people with cognitive complaints. Only 1 in 5 memory disorder clinics actively screen for ADHD. “People can have ADHD their whole life and they are now developing dementia,” Goodman says. “At that point, you have two processes contributing to cognitive difficulty.”
Menopausal women experiencing cognitive decline should be screened for ADHD, Goodman says, even if they have never been diagnosed with the disorder. Those who test positive have several avenues to explore, often a combination of behavior strategies, counseling and medication.
Stimulants such as Adderall, Dexedrine and Ritalin are typically used to treat ADHD in young people, but many doctors are hesitant to prescribe them to older people. “We were all trained that stimulants cause serious cardiovascular problems,” Goodman says. But he questions how common that is.
ADHD is truly a problem of executive function. While attention is a component of executive function, it is only one of many components including organization, working memory, emotion regulation, prioritization, task switching, self checking, and others. These are cognitive skills that are commonly weak or deficit in ADHD persons. However, they can be learned at any age.
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