Psychiatric Times flags ADHD in elders
- Psychiatric Times on November 19, 2025 published David W. Goodman’s review arguing that lifelong attention-deficit/hyperactivity disorder in older adults can look like mild cognitive impairment or early dementia. - Goodman wrote that ADHD prevalence in older adults is estimated at 2.18% in community samples, versus just 0.23% in clinical records, underscoring how often the condition goes unrecognized. - Research in memory clinics has found older adults with ADHD and mild cognitive impairment can post similarly poor cognitive results, complicating diagnosis. (frontiersin.org)
Attention-deficit/hyperactivity disorder can persist into old age, and a November 19, 2025 Psychiatric Times review says it is often mistaken for mild cognitive impairment or early dementia. (psychiatrictimes.com) The review, by psychiatrist David W. Goodman, says older adults with lifelong inattention, disorganization, forgetfulness, and poor task management may arrive in primary care or memory clinics fearing neurodegeneration. (psychiatrictimes.com) (ncbi.nlm.nih.gov) Mild cognitive impairment is a clinical label for thinking problems that are noticeable but do not yet significantly disrupt daily independence. The National Institute on Aging says some memory and thinking complaints are treatable, which is why clinicians are told to look beyond dementia first. (nia.nih.gov) Goodman says the key distinction is timing: ADHD begins in childhood, while mild cognitive impairment or early dementia reflects a later decline from a previous baseline. He recommends asking patients and relatives whether distractibility, missed deadlines, and chronic disorganization were present decades earlier. (psychiatrictimes.com) (ncbi.nlm.nih.gov) That history matters because cognitive testing alone may not separate the two conditions. A 2021 cross-sectional study of 107 older adults found participants with ADHD and those with mild cognitive impairment performed comparably across all cognitive domains measured. (frontiersin.org) A separate memory-clinic study comparing 40 older adults with ADHD, 29 with mild cognitive impairment, and 37 controls found both patient groups showed memory impairment, but with different patterns. The authors reported a storage deficit with smaller hippocampi in mild cognitive impairment and an encoding deficit with frontal lobe thinning in ADHD. (ncbi.nlm.nih.gov) Goodman also points clinicians to reversible or confounding factors that can cloud the picture in older adults, including depression, anxiety, sleep problems, substance use, and medication burden. The National Institute on Aging and the Alzheimer’s Association both note that some cognitive symptoms can stem from treatable conditions or medications rather than progressive dementia. (psychiatrictimes.com) (nia.nih.gov) (alz.org) The review says ADHD in older adults is underrecognized even before dementia enters the differential. Goodman cites a meta-analysis estimating ADHD prevalence at 2.18% in older adults when validated community scales are used, compared with 0.23% in electronic health record diagnoses. (psychiatrictimes.com) A 2024 scoping review found only 17 peer-reviewed primary studies focused on adults age 60 and older with ADHD, a thin evidence base for a growing age group. The same review said depression and anxiety were the most common comorbidities and that age-related changes can amplify symptom burden. (tandfonline.com) The Psychiatric Times piece does not argue that dementia concerns should be dismissed. It argues that before labeling a new cognitive complaint as neurodegeneration, clinicians should establish whether the pattern is new, progressive, and corroborated by family or old records. (psychiatrictimes.com)
