Abstract
AbstractBackgroundPrevious research has indicated that attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for dementia, but studies are scarce and inconclusive. We aimed to investigate the association between ADHD, and dementia and mild cognitive impairment (MCI). Additionally, we aimed to investigate the impact of comorbid conditions, educational attainment, head injuries, other developmental disorders, and sex on the association.MethodsThe study population consisted of 3,591,689 individuals born between 1932 and 1963, identified from Swedish population-based registers. Cases of ADHD, dementia and MCI were defined according to ICD diagnostic codes and ATC codes for medication prescriptions. A Cox proportional hazards model was used to test the associations between ADHD, and dementia and MCI.ResultsIndividuals with ADHD had an increased risk for dementia and MCI. After adjusting for sex and birth year, a hazard ratio (HR) was 2.92 (95% confidence interval 2.40–3.57) for dementia, and 6.21 (5.25–7.35) for MCI. Additional adjustment for psychiatric disorders (depression, anxiety, substance use disorder, and bipolar disorder) substantially attenuated the associations, HR = 1.62 (1.32–1.98) for dementia, and 2.54 (2.14–3.01) for MCI. Common metabolic disorders (hypertension, type 2 diabetes, and obesity), sleep disorders, head injuries, educational attainment, and other developmental disorders, had a limited impact on the association. The association between ADHD and dementia was stronger in men.ConclusionsADHD is a potential risk factor for dementia and MCI, although the risk significantly attenuates after controlling for psychiatric disorders. Further research is needed to confirm these findings and to explore underlying mechanisms of the associations.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common, childhood-onset neurodevelopmental disorder and an important risk factor for many psychiatric [1,2] and general medical disorders [2] across the life span
We identified 9,532 (0.3%) people diagnosed with attention-deficit/hyperactivity disorder (ADHD) diagnosis/medication prescription, among which 5,168 (54.2%) were male (Table 1)
Median age at diagnosis for dementia and mild cognitive impairment (MCI) was significantly lower in individuals diagnosed with ADHD compared to those without ADHD (Table 1; Wilcoxon Two-Sample Test: for dementia, Z = À9.02, p < 0.0001; for MCI, Z = À11.55, p < 0.0001)
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common, childhood-onset neurodevelopmental disorder and an important risk factor for many psychiatric [1,2] and general medical disorders [2] across the life span. A cross-sectional study from the United States [8] did not find a significant association between childhood symptoms of ADHD and dementia/MCI in later life. Limitations of these studies were the use of inpatient-care data that cover more severe cases of ADHD and dementia [6], while most patients with ADHD are treated in outpatient care, and over-representation of males and individuals aged 18–54 years old in the study population [5]. Further research is needed to confirm these findings and to explore underlying mechanisms of the associations
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