Beware of attention‐deficit/hyperactivity disorder (ADHD) in older adults

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a lifespan disorder that can affect overall quality of life. At least two-thirds of people diagnosed with ADHD at a young age continue to have symptoms into adulthood. 1 However, ADHD in older adults is difficult to diagnose and often goes undiagnosed, leading to inappropriate treatment. The clinical observation that older ADHD patients are not being properly diagnosed and treated can be broadly divided into two categories: misdiagnosis and comorbidity.Misdiagnosis is being recognised and treated as a different disease. The most common misdiagnosis is that the disease is treated as dementia. In a study analyzing 446 consecutive patients at a dementia clinic, seven patients (1.6%) initially suspected to have Alzheimer's disease were found to have ADHD upon closer examination. 2 These older ADHD patients were characterised by a predominance of inattention-related symptoms and stressful life events prior to the onset of symptoms when compared to dementia patients. Symptoms of forgetfulness and inattention in older ADHD patients may improve with appropriate dopaminemodulating pharmacotherapy. 2 Considering ADHD in older adults as a differential disease for dementia is necessary in daily psychiatric practice.The other group is when ADHD comorbidities are diagnosed but the underlying ADHD is neither diagnosed nor treated. 3,4 In a nationwide Danish cohort, ADHD patients had a high prevalence of comorbid psychiatric and various medical conditions, excluding neoplasms. 5 Thus, comorbidities of ADHD can be divided into two main groups: psychiatric and physical disorders. Psychiatric comorbidities include affective disorders, personality disorders, social relations disorders, sleep disorders, and drug dependence. 3 Physical comorbidities include irritable bowel syndrome,