Longitudinal Neuropsychological Assessment in Two Elderly Adults With Attention-Deficit/Hyperactivity Disorder: Case Report.

Maria Aparecida Silva,Antonio De Padua Serafim,Mario R Louzã,Cristiana Castanho De Almeida Rocca,Gabriel Okawa Belizario,Margarete Klein

doi:10.3389/fpsyg.2019.01119

Abstract

The neuropsychological deficits in attention-deficit/hyperactivity disorder (ADHD) may present clinical features similar to mild and/or major neurocognitive disorder and may act as a confounding factor, making it difficult to detect cognitive decline. In this paper, we present the results of longitudinal neuropsychological evaluations in two elderly women with ADHD. Three neuropsychological assessments were performed in two women with ADHD (60 and 77 years old) between 2010 and 2013 at intervals varying from 12 to 15 months. We used structural magnetic resonance imaging to rule out significant abnormalities that could account for cognitive impairment. The results showed two different cognitive profiles with fluctuations in performance over these 2 years, sometimes with improvement and sometimes with decline of some functions such as attention, memory, inhibitory control, and reaction time. To minimize confounding aspects of these fluctuations in clinical practice, we used a longer follow-up with the application of a reliable change index and a minimum of three spaced assessments to provide a more consistent baseline cognitive profile. Our findings did not indicate a consistent cognitive decline, suggesting a less pessimistic perspective about cognitive impairments that could be a prodrome of ADHD-related dementia.

Highlights

According to the American Psychiatric Association (American Psychiatric Association [APA], 2013), attention-deficit/hyperactivity disorder (ADHD) is a complex neuropsychiatric disorder with a persistent pattern of inattention and/or hyperactivity–impulsivity throughout the lifetime
This disorder occurs in most cultures in approximately 5% of children and 2.5% of adults (American Psychiatric Association [APA], 2013); a prevalence of approximately 3% in older people has been described (Guldberg-Kjär and Johansson, 2009; Michielsen et al, 2012)
Studies show an age-dependent decline in ADHD symptoms (Michielsen et al, 2012; Das et al, 2014), the persistence of symptoms might lead to significant impairment in older age with a cumulative impact (Kooij et al, 2016; Srinivasan et al, 2016)

Summary

INTRODUCTION

According to the American Psychiatric Association (American Psychiatric Association [APA], 2013), attention-deficit/hyperactivity disorder (ADHD) is a complex neuropsychiatric disorder with a persistent pattern of inattention and/or hyperactivity–impulsivity throughout the lifetime. In relation to symptoms across the adult life span, studies have analyzed the association between ADHD and mild cognitive impairment (MCI, currently mNCD) and dementia. Mrs G.F., 60 years old, married, oceanographer, civil servant She exhibited behaviors such as inattentiveness and forgetfulness dating back to childhood, when they were associated with poor performance at school to the point where she had to repeat grade 1. In adulthood, she exhibited significant functional impairment due to the inability to self-organize or prioritize tasks, a tendency to procrastinate, and a need for silence to concentrate and be productive. The clinical evaluation of the two cases can be found in the Supplementary Material

Procedures

Findings

DISCUSSION

ETHICS STATEMENT