View Full Version : Undiagnosed ADHD in Elderly Adults and Mild Cognitive Impairment


PoppnNSailinMan
07-23-17, 03:31 PM
I was diagnosed with ADHD-PI five years ago at the age of 51 and at the time, I couldn’t help thinking that my dad might also have undiagnosed ADHD. The two of us share a lot of similarities. Observers often comment that we have a lot of shared mannerisms. We both pace a lot and are quite disorganized. Growing up, my mother, a stay-at-home housewife, was always the organized one who was finding things for both of us that we had misplaced. She was the one who did almost all the cooking and cleaning. Whenever she left for a week or two to visit my maternal grandparents or a friend, the house always started to descend into chaos. According to Thomas Brown in his new book, Outside the Box: Rethinking ADD/ADHD in Children and Adults - A Practical Guide (Arlington, VA: American Psychiatric Association Publishing, 2017), p. 4:

ADHD is highly heritable; it runs in families. Twenty-five percent of children with ADHD have a parent with ADHD, and 30% have a brother or sister with ADHD.

My first cousin’s son, now about 25, was also diagnosed with ADHD when he was in school and I wouldn't be surprised if his father (my first cousin) also has undiagnosed ADHD.

Well, last year, my dad, who is almost 82, seemed to be having more noticeable short-term memory problems (his long-term memory is still excellent, even better than mine). My mother and I went with him to see a neurologist late last year and he was diagnosed with Mild Cognitive Impairment (MCI) and the neurologist gave my dad a prescription for Aricept which is used to treat mild to moderate dementia caused by Alzheimer’s diseases. My dad has another appointment with the neurologist next month and I’m going to be going home (about a 10-hour drive from where I live) to go with him for this appointment and it just occurred to me about a week ago that I should have told the neurologist last year that I was diagnosed with ADHD and that I suspect my dad might have undiagnosed ADHD. It never crossed my mind to say anything about my own ADHD at the last appointment for my dad with the neurologist.

I recently did a google search on ADHD and Mild Cognitive Impairment and came across some interesting things. There was an article that was published on September 28, 2015 in the New York Times with the title, “Is It Old Age, or A.D.H.D.” by Judith Berck. She tells about a 73-year-old widow who was diagnosed with ADHD by Dr. David Goodman, an assistant professor in the psychiatry and behavioral sciences department at Johns Hopkins School of Medicine, and he put her on Vyvanse. According to the article, “a few weeks later, the difference was remarkable.”

The article then goes on to say:

Heightened awareness of A.D.H.D. is bringing increased referrals of elderly adults to specialty clinics. “A child had been treated, then a parent, then everyone started looking at Grandpa, and saying, ‘Oh my gosh,’ and they would bring him in,” said Dr. Martin Wetzel, associate clinical professor of psychiatry at the University of Nebraska Medical Center.

Yet many general practitioners and mental health experts mistake symptoms like impaired short-term memory or an inability to stay focused on a task as something else.

“We do a horrible job of training health care professionals about adult A.D.H.D.,” Dr. Wetzel said.

Dr. Brown said, “Most doctors are not thinking of A.D.H.D. as a characteristic of somebody who is 60 or over.” Hence, the condition may be overlooked in the 80-year-old who has trouble staying engaged at the senior center, despite a lifelong history of inattention. “They figure it’s just cognitive decline from aging” or diagnose depression or anxiety in such patients, which may or may not be the case, he said.

Until about three years ago, most geriatric cognitive and memory studies did not include any people with A.D.H.D., at least not knowingly.

“Deeply hidden in all the studies about mild cognitive impairment and early Alzheimer’s are significant numbers of people with A.D.H.D.,” Dr. Wetzel said. “We have no idea who in those studies had it or didn’t have it, because nobody was asking the question.”

I then found an interesting article in Current Psychiatry Reports from 2013 by Nikki Ivanchack et al., “Attention Deficit/Hyperactivity Disorder in Older Adults: Prevalence and Possible Connections to Mild Cognitive Impairment” which can be found on the website for the National Institutes of Health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718885/

According to this article:

It is currently unclear if other developmental disorders such as ADHD also predispose to the development of late-life cognitive decline. Many genetic, molecular, and neuroanatomic/neurochemical alterations have been described in individuals with ADHD, that share some similarity and overlap with the neuroanatomic/neurochemical alterations implicated in the development of late-life dementias such as AD, dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).

Inherent in the clinical pathogenesis of slowly progressive degenerative dementia is a prodromal state, referred to as mild cognitive impairment (MCI), where subtle signs and symptoms of cognitive, behavioral, and neuropsychiatric decline appear years before the development of functional decline sufficient to warrant the diagnosis of dementia [6–10]. Thus, one can envision 2 scenarios whereby ADHD could be linked to late life cognitive diagnoses, including (1) a true molecular/neuroanatomic/neurochemical predisposition to de novo late life neurodegeneration, or (2) non-pathologic, age-related cognitive decline superimposed on a fragile substrate, augmenting lifelong persistent learning disabilities, misdiagnosed as the development of MCI, or degenerative dementia distinct from the diagnosis of ADHD.

The article then goes on to say:

While cognitive deficits related to ADHD may persist into the geriatric years, when persons are at highest risk for the development of MCI or dementia, they are generally felt to represent static deficits that are seldom confused with a progressive dementing condition, although this hypothesis has not been studied to date and so any conclusions regarding the static nature of ADHD may be incorrect [3•, 24, 25]. In fact, some adults may feel like their symptoms of inattention have worsened over time potentially mimicking a degenerative condition [26].

So the question arises, if my dad has had ADHD all this time (which I’m inclined to think is the case), is his current worsening of short-term memory just a worsening of his ADHD rather than a precursor to something like Alzheimer’s? I would also hate for him to be taking a medication like Aricept for possible Alzheimer’s when it’s just his ADHD. And his physical health is actually quite good so that he might benefit from being put on a stimulant.

As the article above by Judith Berck says:

Why treat people at an advanced age for something they have had their entire life?

“Let’s say you’ve spent your whole life not functioning at a level that you could, and you believed that was an outgrowth of you as a person, and all of a sudden you received a diagnosis and medication that showed you that all of the criticism from the environment wasn’t because of who you were, it was because of what you had,” Dr. Goodman said. “That it is a very liberating experience, even if you’re 65, 72 or 83.”

Also relevant to this whole issue is another recent article in the Washington Post from July 19 of this year, "PET scans show many Alzheimer’s patients may not actually have the disease," which reported about PET scans (Positive Emission Tomography scans) that were give to people diagnosed with Mild Cognitive Impairment (MCI) and dementia to test for the amaloyd plaques associated with Alzheimer's:

A significant portion of people with mild cognitive impairment or dementia who are taking medication for Alzheimer’s may not actually have the disease, according to interim results of a major study underway to see how PET scans could change the nature of Alzheimer’s diagnosis and treatment.

The findings, presented Wednesday at the Alzheimer’s Association International Conference in London, come from a four-year study launched in 2016 that is testing over 18,000 Medicare beneficiaries with MCI or dementia to see if their brains contain the amyloid plaques that are one of the two hallmarks of the disease.

So far, the results have been dramatic. Among 4,000 people tested so far in the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study, researchers from the Memory and Aging Center at the University of California at San Francisco found that just 54.3 percent of MCI patients and 70.5 percent of dementia patients had the plaques.

Anyway, I just wanted to raise this issue here and see what everyone thinks.

PoppnNSailinMan
07-23-17, 04:11 PM
I should add to the above post that PET scans cost between $3,000 and $4,000 and are not usually covered by insurance, nor will Medicare pay for them. So if someone diagnosed with MCI wants to have a PET scan to see if the amyloid plaques associated with Alzheimer's are present, they'll have to pay out of pocket for one.

sarahsweets
07-24-17, 05:06 AM
I agree that its all something to think about. Does he have a good neurologist that he deals with? They are the best when it comes to adhd in the elderly and alzheimers. I dont know if at this point the why matters but maybe stimulant treatment would help?

Little Missy
07-24-17, 05:26 AM
I honestly know nothing about the aforementioned but I know for a fact that many elderly people do well on amphetamines and stimulants because a couple of shrinks I knew spoke about it with me and the improvements they saw in their patients. And those were drs in three different states with happier patients.

PoppnNSailinMan
07-24-17, 06:33 AM
I agree that its all something to think about. Does he have a good neurologist that he deals with? They are the best when it comes to adhd in the elderly and alzheimers. I dont know if at this point the why matters but maybe stimulant treatment would help?

Thanks for responding and thanks for reading my rather long, complicated and somewhat winding original post.

My dad lives in a rural area and he's seeing someone who is probably the only neurologist for miles around. I have no idea whether he's a good neurologist or whether he has any experience spotting elderly patients who have undiagnosed ADHD.

As the articles I quoted from seem to imply, there are probably lots of elderly people out there who are being diagnosed with Mild Cognitive Impairment and are being treated for early Alzheimer's and given drugs like Aricept who don't have Alzheimer's. Some of those people probably have undiagnosed ADHD. According to Ari Tuckman in his book More Attention, Less Deficit (p. 53), perhaps as many as 90 percent of adults with ADHD are undiagnosed and untreated (and, of course, some of them are now elderly).

As the one article in Current Psychiatry points out, ADHD might not be static and some of its symptoms might get worse with age and mimic the early stages of some kind of dementia like early Alzheimer's. That has implications for all of us with ADHD as we age.

Anyway, in my dad's case, I just realized about a week ago that I need to bring up the issue of my own ADHD (and that ADHD probably runs in our family) with his neurologist when I see him next month and alert him to the possibility that some of my dad's symptoms might be related to undiagnosed ADHD. Even I have noticed that my dad's short term memory seems to be worse than it was, but perhaps that is what will happen to all of us with ADHD as we age.

stef
07-24-17, 06:49 AM
I was diagnosed with ADHD-PI five years ago at the age of 51 and at the time, I couldn’t help thinking that my dad might also have undiagnosed ADHD. The two of us share a lot of similarities. Observers often comment that we have a lot of shared mannerisms. We both pace a lot and are quite disorganized. Growing up, my mother, a stay-at-home housewife, was always the organized one who was finding things for both of us that we had misplaced. She was the one who did almost all the cooking and cleaning. Whenever she left for a week or two to visit my maternal grandparents or a friend, the house always started to descend into chaos. .

This was very much my situation, growing up :)

I remember once out of nowhere, my dad saying to me that his memory was terrible and he worried he had some neurological problem. (he must have been near 50 at the time).

I suppose neither of us noticed our respective "problems" as we were mirror images in mannerisms and forgetfulness.
My mom was the organized one who ran almost everything, but i never questioned that either, as my dad "had a busy job" (he was a successful salesman) and i suppose I figured, that's how a household worked.

I only found out about adhd after 40 (I am not diagnosed thought), then I looked back and realized just how scattered he was and how difficult things may have been for him sometimes. I'm sure it's hereditary and I reunited with my cousin on my Dad's side this summer after 20 years, and she is truly my ADHD twin.

I so wish I could have told him about this.

PoppnNSailinMan
07-24-17, 06:51 AM
I honestly know nothing about the aforementioned but I know for a fact that many elderly people do well on amphetamines and stimulants because a couple of shrinks I knew spoke about it with me and the improvements they saw in their patients. And those were drs in three different states with happier patients.

Convincing some ignorant medical professionals that it's OK for some elderly people who don't have heart problems or high blood pressure to take stimulants is probably going to be a challenge. Just a couple of weeks ago, I had a psychiatric Nurse Practitioner (NP) tell me that I'm too old to take stimulants and I'm only 56. But I don't have any heart problems that I know of and my blood pressure is good, so he obviously doesn't know what he's talking about. And I could tell from my conversation with him that he doesn't know anything about treating adults with ADHD. Fortunately, I've found someone else who is much more knowledgeable about adult ADHD who can help me.

Little Missy
07-24-17, 07:22 AM
Convincing some ignorant medical professionals that it's OK for some elderly people who don't have heart problems or high blood pressure to take stimulants is probably going to be a challenge. Just a couple of weeks ago, I had a psychiatric Nurse Practitioner (NP) tell me that I'm too old to take stimulants and I'm only 56. But I don't have any heart problems that I know of and my blood pressure is good, so he obviously doesn't know what he's talking about. And I could tell from my conversation with him that he doesn't know anything about treating adults with ADHD. Fortunately, I've found someone else who is much more knowledgeable about adult ADHD who can help me.

Unfortunately, this is common with the NP's coming out of college, etc. They are fervently taught NOT to do this type of prescribing. My daughter finishes her NP this spring and she is absolutely aghast at what I'm prescribed. She would never do it. I respect her but I do not agree with her. I just never bring it up. She was born 40 years old and would never dream of doing anything she thought or was taught to be wrong. I say, think for yourself, but hey, it is her license.
Unless they are working with an older doctor who believes if the ADHD person is responsible, paying bills on time and can live independently without parental help, then prescribe away!

Honestly, I just feel so blessed to have been able to return to my state of choice and that my original doc of 35+ years is still here, and teaching all of his NP's, whether psychiatric or not, to prescribe as HE sees fit. If the NP's do not want to, then he picks up their patients. win-win!

BUT, too many patients, even as we read on here, are incapable of taking meds as prescribed, do not work, are utterly dependant upon their parents and continue to play with controlled substances.

The shrinks I know that shared with me their successes with elderly people are just so great. It is about the quality of life for the patient.

I'm three years older than you.

PoppnNSailinMan
07-27-17, 09:59 PM
This was very much my situation, growing up :)

I remember once out of nowhere, my dad saying to me that his memory was terrible and he worried he had some neurological problem. (he must have been near 50 at the time).

I suppose neither of us noticed our respective "problems" as we were mirror images in mannerisms and forgetfulness.
My mom was the organized one who ran almost everything, but i never questioned that either, as my dad "had a busy job" (he was a successful salesman) and i suppose I figured, that's how a household worked.

I only found out about adhd after 40 (I am not diagnosed thought), then I looked back and realized just how scattered he was and how difficult things may have been for him sometimes. I'm sure it's hereditary and I reunited with my cousin on my Dad's side this summer after 20 years, and she is truly my ADHD twin.

I so wish I could have told him about this.

The heritability of ADHD is an interesting issue. I'm pretty sure that my dad has undiagnosed ADHD and my first cousin's son was diagnosed with ADHD. Thinking back, I can also see signs of possible ADHD in my dad's mother (my paternal grandmother), in her brother (my dad's maternal uncle), and from stories my dad has told me, in his maternal grandfather (my great grandfather).

My dad's mother was never a very good housekeeper and my grandfather did most of the cooking. I remember visiting her brother (my great-uncle) and he had stuff stacked all over the floor in his house so that you had to walk in little narrow paths between and around all of it. My great-grandfather's house was the same. All very disorganized. Maybe it's too much to try using anecdotal evidence to diagnose ADHD in someone born before 1880 like my great-grandfather, but there's a lot of suggestive evidence that this is where my family might have inherited this disorder.

someothertime
07-27-17, 11:32 PM
I share a similar experience to you with my Dad in the later ( 8ish years ) of his life.

He had the regular messy workstyle etc. etc. for most of his life.... to some degree..... i suppose he reached a sort of equilibrium with his life..... in that, he maintained his job..... and whatever isolated existence that worked for him?

Now when these "newer" symptoms arose..... I also felt he would need some intervention..... eventually...... but at the same time...... your conflicted as to whether to intervene in a system that worked / has been working for him.


While you could more strongly argue that his whole of life treatment was perhaps not targeted / identified so well in alignment with ADHD induced symptoms....... therefore earlier interventions would have been more warranted / effectual.

There are just heaps of reasons "new" ( ADHD ) treatment in the later years ( cognitive decline ) could, even if to some extent related, be complicated / arguably more risky than remedial.

-Heart / General physiological additional stress
-Masking more deterioritive conditions
-"Shaking up" the habits / solutions that have worked for them
-Bringing up "identity" doubts / unsettling "identity" and beliefs in later years being more harm than good.

I don't say these things in black and white.... and i'm sure this scale slides with the more an individual ages / other stressors "bring on" or "intensify" symptoms.....

I guess what i'm trying to say is that, from a treatment perspective..... for the majority ( not all ) of individuals who are faced with declining cognition et. al. new treatment while a reasonable idea logically..... in practice.... perhaps becomes not feasable for alot of the reasons mentioned above....

But yes, from the outside it can be revealing and saddening at the same time. And I encourage discussion just as to "where is the line"..... i also champion individuals who recieve respite and proper treatment from diagnosis later in life. a true miracle.

apologies if this post comes across as sweepingly age-ist in any way..... and could apply to any age, where cognitive impairment is exasurbated by compound condition.

PoppnNSailinMan
07-28-17, 12:06 AM
I share a similar experience to you with my Dad in the later ( 8ish years ) of his life.

He had the regular messy workstyle etc. etc. for most of his life.... to some degree..... i suppose he reached a sort of equilibrium with his life..... in that, he maintained his job..... and whatever isolated existence that worked for him?

Now when these "newer" symptoms arose..... I also felt he would need some intervention..... eventually...... but at the same time...... your conflicted as to whether to intervene in a system that worked / has been working for him.


While you could more strongly argue that his whole of life treatment was perhaps not targeted / identified so well in alignment with ADHD induced symptoms....... therefore earlier interventions would have been more warranted / effectual.

There are just heaps of reasons "new" ( ADHD ) treatment in the later years ( cognitive decline ) could, even if to some extent related, be complicated / arguably more risky than remedial.

-Heart / General physiological additional stress
-Masking more deterioritive conditions
-"Shaking up" the habits / solutions that have worked for them
-Bringing up "identity" doubts / unsettling "identity" and beliefs in later years being more harm than good.

I don't say these things in black and white.... and i'm sure this scale slides with the more an individual ages / other stressors "bring on" or "intensify" symptoms.....

I guess what i'm trying to say is that, from a treatment perspective..... for the majority ( not all ) of individuals who are faced with declining cognition et. al. new treatment while a reasonable idea logically..... in practice.... perhaps becomes not feasable for alot of the reasons mentioned above....

But yes, from the outside it can be revealing and saddening at the same time. And I encourage discussion just as to "where is the line"..... i also champion individuals who recieve respite and proper treatment from diagnosis later in life. a true miracle.

apologies if this post comes across as sweepingly age-ist in any way..... and could apply to any age, where cognitive impairment is exasurbated by compound condition.

I agree that it might not be worth trying to put someone in their 80s on a stimulant who has lived all their life without this kind of medication for all the health reason you mention. And, of course, most medications, including stimulants, can have side effects that might not be worth it to someone that age. On the identity issue, by dad is aware of my own ADHD diagnosis and we've discussed the possibility that he might also have ADHD and he agrees.

But I think that it's still important to fill my dad's neurologist in next month on the fact that my dad probably has undiagnosed ADHD and that our family has a history of ADHD just so that he's aware of the situation. This information might change how he decides to treat my dad. He might decide that his short term memory problems are not related to possible impending Alzheimer's and that he shouldn't be on an Alzheimer's medication like Aricept. Or he might also have Alzheimer's or some other dementia coming on in addition to having undiagnosed ADHD.

ToneTone
08-07-17, 08:08 PM
You might ask your dad if you can speak with his neurologist and share your ideas with the neurologist.

My mother was undiagnosed ADHD, but on the milder side. She developed a lot of coping strategies ... one of them was to take care of things right away.

She used to say, "I have to do it (whatever task) right now while it's on my mind or I'll forget it." When I'd go out with her, she would try to outsource her memory to me. "Don't let me forget to pick up x," she would say as she was going shopping.

Anyway, as she hit her late 80's, her memory declined ... she couldn't remember to take her medicines or remember that she had a pot on the stove. What made her situation really complicated was that she had a thyroid problem ... and a bad thyroid means certain hormones aren't well regulated and this can present as cognitive impairment and bad memory.

Trouble was my mom also had a bad heart, so the doctor couldn't jack the thyroid medicine to the max. She got placed on Aricept at one point, but that just made her kinda paranoid and strange ... We got her off that one quite quick. Her doctor did give her an antidepressant, Zoloft, to help with her mood, which was declining. And Zoloft seemed to help a lot! ...

Anyway, tough situation ... I'd say just observe the Aricept ... is dad better on it ... give it a chance .... tinker with the dosage if there are no severe problems ... then make a judgment and go from there ....

Oh ... my mother's internist, her "regular" doctor, was extremely helpful on the cognitive stuff and the mood stuff ... My mother really trusted this woman ... and so you might find it helpful to get your dad's regular doctor in on the process of figuring out how to treat his cognitive decline.

Good luck.

Tone

DJ Bill
08-08-17, 05:53 PM
I've had a discussion about this with a friend who was taking care of an Alzheimer's man for years....As I get older I am afraid of having dementia. When I asked him about it, he said....you are missing the personality changes. I have also been told it is normal to have memory issues as we get older anyway. It still frustrates the heck out of me when I lay everything out to go on a task, and leave without it all because I got interrupted in the middle of leaving. I'm gonna be 57 this month by the way.

ginniebean
08-08-17, 06:16 PM
There is cognitive and memory decline as everyone ages, the same is true for those with ADHD. I'm pretty sure a lot of elderly ADHD people are not getting diagnosed and it's just chalked up to dementia. The Doc might be open to your information or not. There is likely little understanding of geriatric ADHD.

mildadhd
08-08-17, 06:42 PM
Undiagnosed elderly people still had ADHD since childhood.

They just never got diagnosed.

I met a hyperkinetic lady in her 70's, at a Adult ADHD Information session/meeting put on by Vancouver ADHD Coach Pete Quily.

The elderly lady told me she was diagnosed, and prescribed medication by Dr. Gabor Mate.




M

mildadhd
08-08-17, 08:07 PM
I found my father really understood me and my deficits of self-regulation better, as he got older and more confused.

Like he could relate to what I was experiencing.

Maybe some of the same brain systems involved in both?






M