ADHD in Older Adults: Diagnostic Confusion and Treatment Hesitancy

Abstract

Attention Deficit Hyperactivity Disorder is an unrecognized disorder in patients over the age of 50. The evaluation of cognitive symptoms in older adults rarely considers ADHD in the differential diagnoses. His presentation will review the prevalence of ADHD in adults and its persistence over the age of 50. I will discuss the clinical presentation and subjective symptoms of these patients. I'll review ADHD symptom checklist that complements the clinical evaluation. Because of age, there are multiple factors contributing to cognitive complaints that will be discussed for a differential diagnosis. Beyond the differential diagnoses, there is a necessity to assess for other concurrent psychiatric and medical disorders that may contribute to cognitive changes. The enumeration of concurrency facilitates a diagnostic prioritization of psychiatric disorders in order to develop a thoughtful pharmacologic and treatment sequence. This sequencing will be discussed along with the medications used to treat ADHD in older adults. Because polypharmacy is often present in older adults, medical illnesses are an important consideration when prescribing ADHD medications. Drug interaction, both dynamic and kinetic, will be reviewed to highlight safe prescription practice.For older women, peri-menopause may present with declining cognition secondary to declining estrogen. This presentation will discuss diagnostic distinguish factors for ADHD in peri-menopausal women. Unfortunately, there is a paucity of clinical research from which clinicians can receive guidance. I intend to review this subject in my presentation.