Longitudinal Cognitive Performance of Older Adults With ADHD Presenting to a Cognitive Neurology Clinic: A Case Series of Change Up to 21 Years.

Brandy L. Callahan,Nayani Ramakrishnan,Prathiba Shammi,Sandra E. Black,Rebecca Taylor

doi:10.3389/fnagi.2021.726374

Abstract

Background: The neuropsychological features of older adults with ADHD are largely unknown. This retrospective chart review aims to elucidate their cognitive trajectories using a case series of six older adults with ADHD presenting with memory complaints to a cognitive neurology clinic, whom we argue are a particularly relevant group to study due to their potential to mimic neurodegenerative syndromes.Methods: Participants were included if they were age 40 or older at intake, had ADHD based on DSM-5 criteria, and had cognitive data collected prior to 2014 with follow-up at least 5 years later.Results: Five men and one woman were included (M = 53.8 years at intake) and had an average of 135.0 months of follow-up data available. Despite notable between- and within-subject variability, cognition generally improved or remained stable across visits. Two participants experienced notable memory decline, but a global consideration of their performance in other domains suggests these deficits may be frontally-mediated.Conclusion: In this small sample, cognition remained generally unchanged across 5–21 years. Isolated impairments likely reflect substantial intra-individual variability across time and measures.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is conceptualized as a childhood disorder, but what happens to these children as they grow up, and grow old? ADHD is known to persist into later life in 40–60% of cases (Volkow and Swanson, 2013; Faraone et al, 2015; Asherson et al, 2016), it is rarely studied past middle age: to our knowledge, only four published studies (Semeijn et al, 2015; Thorell et al, 2017; Klein et al, 2019a; Nyström et al, 2020) have investigated participants aged 50 or older, and only one (Klein et al, 2019a) explored longitudinalCognitive Change in Adult ADHD cognitive outcomes
Longitudinal studies of ADHD in adults of any age are scarce, though they are necessary to elucidate cognitive trajectories and outcomes related to brain health
We acknowledge that a retrospective design biases the sample toward the inclusion of persistent ADHD cases whose cognitive performance is relatively stable. We propose these cases are ideal to study because they arguably represent a relatively “pure” ADHD group, with low likelihood of comorbid neurodegenerative pathology, and in this sense will provide compelling evidence for the expected cognitive trajectories associated with ADHD in later life, in the absence of comorbid pathology

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is conceptualized as a childhood disorder, but what happens to these children as they grow up, and grow old? ADHD is known to persist into later life in 40–60% of cases (Volkow and Swanson, 2013; Faraone et al, 2015; Asherson et al, 2016), it is rarely studied past middle age: to our knowledge, only four published studies (Semeijn et al, 2015; Thorell et al, 2017; Klein et al, 2019a; Nyström et al, 2020) have investigated participants aged 50 or older, and only one (Klein et al, 2019a) explored longitudinalCognitive Change in Adult ADHD cognitive outcomes (over 2 years). Elucidating the later-life trajectories of ADHD is imperative, as aging baby boomers will comprise an increasing share of the population in the 10– 20 years (Centers for Disease Control and Prevention, 2003), of whom an estimated 4% will have persistent ADHD symptoms from childhood (Semeijn et al, 2016). It is well-understood that a history of psychiatric illness [e.g., depression (Byers and Yaffe, 2011), schizophrenia (Cai and Huang, 2018)] negatively impacts brain health in old age; specific knowledge on how ADHD affects cognition in older adults is lacking. This retrospective chart review aims to elucidate their cognitive trajectories using a case series of six older adults with ADHD presenting with memory complaints to a cognitive neurology clinic, whom we argue are a relevant group to study due to their potential to mimic neurodegenerative syndromes

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Conclusion