Okay so 6% increased chance of dementia for those with ADHD.
Maybe there’s something neurologically wrong from the beginning that manifests as ADHD and later turns into dementia?
It’s definitely weird how I am just completely unmotivated by anything for months at a time then suddenly will be intensely motivated and impossibly into something new.
I have a brain disease driven by an infection that gets better with long term antibiotics.
One of my main symptoms was MCI. Interesting that after long term treatment not only the MCI improved or subsided but also my very long standing ADHD (present for as long as I can remember) got dramatically better, makes you wonder.
That actually makes a lot of sense to me. ADHD can be phrased as a regulation disorder. Emotions, executive function/ attention. If anything internal (literally any kind of pain) presents itself for my attention, it wins. No contest.
I have nasty seasonal allergies (at least one per season). Whenever it flares up, the is a marked increase in my needs and decrease in my productivity. I'm hoping to start immunotherapy for them soon. I get my ADHD and my allergies from my dad and immunotherapy has done him wonders.
Meditative techniques can assist with the regulation of emotions/attention. I speak from experience. It takes practice when you’re feeling well to be able to channel it when you’re not feeling well. It’s not as hippy-dippy as you might think (unless you want it to be). No yoga mat required.
> Maybe there’s something neurologically wrong from the beginning that manifests as ADHD and later turns into dementia?
I can’t speak to the dementia portion, but it would not surprise me. As for the adhd being the result of something ‘neurologically wrong’… I feel like we should replace ‘wrong’ with something less charged, maybe ‘sub-optimal’ or ‘problematic’, but you intuited your way into something I’ve spent years in therapy and reading books to finally grok.
Two specific books that come to mind:
The Myth of Normal
and
What Happened to you
I think there are configurations that are objectively wrong. I think we’ve overreacted to be inclusive and this creates blind spots in our current approach.
We can define wrong as counterproductive, while seeking to accommodate those configurations and seek to reduce their affects or mitigate them entirely
adhd is largely maladaptive in the modern world but the question is whether it was maladaptive in a hunter-gatherer society
personally I feel that the symptoms of adhd are less relevant and doesn't impair my daily functions as much if I focus my entire waking time on outdoor activities like biking and swimming, and while I never hunted with primitive tools it might share some similarities
I think this is something that could be verified in practice too, since we still have hunter-gatherers societies
For those who might not know, this is the difference between "percentage" and "percentage points". It is not 6% higher, it is 6 percentage points higher.
This really matters for things with a very low probability.
"Per cent means one hundredth of something. Percentage point is used when comparing percentages to one another. For example, when inflation drops from three to two per cent, inflation decreases by one percentage point and 33.3 per cent."
This is a nice simple explanation of it. It's also why stock holders use "points" instead of "dollars." A stock share going up $1.50 is amazing if it was a penny stock, and absolutely not worth mentioning if it was say, Tesla. But the points have the same meaning for either stock - one is just a lot higher of a point than the other, even though the dollar change was the same.
A percentage always reflects a ratio between a quantity and another reference quantity. When you say a value is 6 percent higher, you are saying it went from X to (X + X*(6/100)) = (X*106/100) = 106% of the value you had before (whatever it was).
When you say it is 6 percentage points higher it means you had a percentage Y% and it is now (Y+6)%, a value which cannot be determined unless you know Y, never mind the reference absolute value it relates to.
In this particular case you can say it went from 7% to 13.2%, so if you ignore "%" as the unit the actual change is from 7 to 13.2; a ((13.2-7)/7) ≈ 0.8857 = 88% change. Had the original percentage been say 67%, a 6.2 p.p. change would have increased the percentage to 73.2%; a much smaller ((73.2-67)/67) ≈ 0.0925 = 9% change.
Had the change been "six percent of seven percent", the new value would be 7+7*(6/100) = 7.42 (percent).
ADHD is statistically associated with lots of adverse mental health outcomes including...
* Doubled rate of premature death (largely attributed to accidental injury)
* 47% anxiety disorder comorbidity
* 38% severe mood disorder comorbidity (including depression)
* 15% substance abuse disorder comorbidity
Between the heightened risk of concussions, anxiety, depression, and substance abuse, it's not at all surprising that dementia shows up twice as often in the statistics. With that being said, it doesn't tell us much at all about whether there's a shared pathology.
(No, I don’t mean a fee applied by a government, I mean more associated physical and mental issues which are co-morbid with or indirectly caused by ADHD)
I got ADHD and autism and I don't see myself and feel attacked.
The difficulty for me is that people make assumptions about me, I get nerfed constantly by people(0)(1)(2)
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Acceptance and peace. What else is there? New things are always coming out, let’s check back in a few years and work in that ounce of prevention for a pound of cure.
I have ADHD. I personally don’t worry about all this doom and gloom stuff.
I think ADHD is great. People with ADHD are fun, and interesting and just generally cool people. It could be worse, you could be an actual boring neurotypical person - I genuinely think that would be so boring.
Honestly, if someone who describes themselves as neurodivergent says it's bad, that's kind of a positive sign to me. Every single person I've met in real life who refers to themselves like that is insane
The quality of this website does not give me a lot of confidence in whatever content lives in the narrow window I can see on mobile.
I don’t know if I have adhd… it seems like the definition of adhd is almost constantly expanding. Whatever the case, I hope dementia becomes treatable or curable in my lifetime. My grandfather suffered with it and it was awful.
"According to Journal Citation Reports, the journal has a 2021 impact factor of 13.353, ranking it 15th out of 172 journals in the category "Medicine, General & Internal". Additionally, it ranks 5th among purely open access journals in that subject category."
Ignoring JAMA Network Open because it doesn't look pretty on a cell phone isn't a great move.
It hasn't changed since the 60's. Listening to people who self-diagnose ADHD might give you that impression. Same with Autism, which seems to be every third person if you believe social media over actual doctors. People seem to feel this makes them more interesting. It doesn't, really. It makes them a different kind of statistic.
ADHD is more well understood now (which is why it is separated into Compulsive, Hyperactive or both) but the diagnostics, as determined by professionals in psychiatry, have not changed in decades. The biggest change in studies for ADHD is how it affects females differently than males.
> it seems like the definition of adhd is almost constantly expanding.
Nah, it's pretty stable. What sometimes changes is the exact wording to describe it or the wording of diagnostics or new insights from comorbidities for better differential diagnosis. But the core adhd concept has been stable for a long time.
> There was, however, no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication, and evidence of reverse causation was mild.
Given that the risk of dementia can be reduced with regular exercise and improved blood flow to the brain, would it be reasonable to assume that those two things have some relation to ADHD?
After skimming the article, it seems like they are suggesting a connection between some established/known trends that makes it easier for a person with ADHD to develop dementia.
Known:
- Dementia has many lifestyle risk factors (poor education, hypertension, obesity, hearing loss, depression, diabetes, physical inactivity, smoking, drinking, social isolation)
- ADHD can make it easy to have certain lifestyles (addictions to drugs or food, trouble maintaining relationships, emotional dysregulation, poor education, poor work performance, high risk behavior)
What is the connection between ADHD and the Big Five personality trait of Conscientiousness? I know that they are negatively associated with one another, but I have trouble imagining the life of a high-C person who also has ADHD.
[1] leads me to believe they would look like someone with a high degree of hyperactivity and a low degree of inattentiveness.
ADHD has treatments which help significantly (structured lifestyle, medication). It’s like asking how half blind people can drive (answer is: they wear glasses to help them see)
It's not really like asking that. Blindness is a direct impact on vision -- ADHD is not a direct impact on Conscientiousness in all cases. That's why I linked the paper.
I guess it depends if you're judging high-C by an internal desire/goal to be conscientious, or by actually planning and executing - because ADHD is characterised by a deficiency in the latter. A desire to be conscientious, coupled with continual failure to live up to it... that's what it's like.
I'm a high-C person who was recently diagnosed with ADHD. In my case, I was compensating for ADHD symptoms with extreme anxiety, which eventually became unsustainable.
That sounds like an awful dose to have. I think I'd rather just be a happy, non-anxious layabout than that. Did you have to go through a phase like that while weaning yourself off of anxiety as a driver of your own productivity?
I've been working on managing my anxiety for several years, and my productivity has been getting worse as my anxiety lessened (which was counterintuitive to me). That's how I ended up figuring out I might have ADHD.
Abusing dopaminergic drugs like cocaine (not dissimilar in effects from methylphenidate) and methamphetamine (not dissimilar from amphetamine) increase the risk of Parkinson’s down the line. It’s possible the same mechanism is at play here, either just because some people are more sensitive to medication at therapeutic doses than others or because some portion of people with this condition abuse their medication (or both).
As others have mentioned, ADHD is also comorbid with other mental health disorders including eg depression and alcoholism. That’s also a reasonable mechanism. Personally as someone with the condition a 6% increased chance does not scare me though it’d be great to understand the mechanism in case it’s caused by preventable behaviors rather than the condition itself.
They said there was no clear association between adult ADHD and dementia among individuals with ADHD who received psychostimulant medications. And they adjusted for covariates including depression. Not alcoholism though.
Ok, you got me to dig into the study. Really what’s most noticeable to me is that the dementia rate in the ADHD cohort was 13.2% but only 7% in the general population, before any kind of statistical massaging, which I’d have expected to push even further towards correlating ADHD with dementia given it’s much more diagnosed now than in the past and most people with dementia are older.
But the way they’re controlling for stimulants is very poor. To begin with, out of the 100k in the study, only 730 had ADHD and of that only 163 were in the psychostimulant cohort. So to establish statistical significance regarding dementia, which only affected 96 people out of the 730 with ADHD, would be almost impossible if the relationship were mild. And you see that in the huge P-value for the infra-ADHD comparison (0.74) which shows a slight decrease in dementia for stimulant-takers. Basically there is too little data to take that seriously at all.
The comparison across ADHD and no-ADHD populations regarding psychostimulants is deeply flawed too. They’re bucketing [0] dopaminergic stimulants with modafinil (much less dopaminergic) and even nootropics like racetams - literally prescribed to heal brain damage and treat or prevent dementia in former Soviet Union countries, with an entirely different safety profile and mechanism compared to dopaminergic stimulants. Having trouble finding data on racetam legality and use in Israel, so they may not be in scope given the medication would need to be formally prescribed IIUC. But that leaves the remainder as likely taking prescribed dopaminergic stimulants and modafinil, which for those without ADHD are mostly taken by those with narcolepsy. So the non-ADHD psychostimulant users are likely strongly biased towards narcoleptics with the remainder being those taking drugs for the purpose of treating or preventing cognitive decline, and the intra-cohort ratio is 1.1:22.3 so roughly only 5% of the ADHD-stimulant group is comparable to the nonADHD-stimulant group assuming similar, uncorrelated incidence of narcolepsy.
In other words, their two attempts to control for stimulant use either have a uselessly low amount of data giving a p-value of 0.74, or are confounded by comparing against narcoleptics taking stimulants’ dementia rates (not healthy people taking stimulants; they wouldn’t have been prescribed stimulants so long without having ADHD or narcolepsy) with the possible wildcard of some of these “psychostimulant” users taking non-dopaminergic stimulants or even non-stimulant nootropics.
In encounters with medical professionals related to my elderly relatives, I was told several times the same kind of anecdotal observation: that "intelligent" patients seem to decline more rapidly with dementia; the hypothesis is that diagnosis is simply delayed with these patients, because their cognitive skills allow them to better cope and mask the early stages of the disease. Then when their coping skills are overwhelmed, the true depth of their impairment gets exposed. I don't think they meant "intelligent" as in IQ test results, but in some observed functional characteristic they would see in geriatric clinical interaction.
It makes me wonder if ADHD patients would more often fall on the other side of this functional/coping divide and so get earlier diagnoses. And if so, how could you control for this? Across a population, I would think that delayed detection means lower diagnosis rates since some patients would die before the delayed diagnosis could happen.
The youngest person in the study was born in 1952. All ADHD and dementia diagnoses were after 2003.
The relationship between dementia and ADHD wasn't mild. So the claim a mild relationship would have been impossible to detect is irrelevant even if true. And they didn't say to to take the less elevated risk in the stimulant taking ADHD group as conclusive evidence of a real effect.
Dopaminergic stimulants and modafinil are nootropics prescribed to treat dementia also. And you would need to suppose those drugs were prescribed more to people without ADHD or dementia diagnoses to believe this explained the elevated risk of dementia in people with ADHD.
"For both men and women, childhood physical abuse was associated with significantly higher odds of reporting ADHD (men odds ratio [OR] = 1.66, p < .001; women OR = 1.95, p < .001). For both genders, childhood sexual abuse was also significantly related to higher odds of ADHD (men OR = 2.57, p < .001; women OR = 2.55, p < .001); however, exposure to parental domestic violence was only associated with elevated odds of ADHD among women (men OR = 0.89, p = .60; women OR = 1.54, p = .03). The results demonstrate a link between childhood physical and sexual abuse and ADHD for both men and women."
I don't have numbers like this well-researched response, but apparently neglected children have higher odds of being diagnosed with ADHD, which is seen through the very high occurrence of ADHD and similar in children who entered foster care at very young ages (in this case, younger than 5 years, well before ADHD is diagnosed). This elevated risk of ADHD apparently doesn't show itself in children put in foster care at later ages.
The specific symptom they were looking at in what I was reading, was how people with ADHD easily walk away from things (friends, family, etc.), never to return. Basically a lot of kids attempt to run away, but people with ADHD are far less likely to return if they succeed in "getting away".
The article was relating having lived the earliest part of their lives being pushed away, to the ability to more easily separate and push everyone away permanently later in life (which they referred to as "shutting down"), and the possibility that ADHD itself might be a coping and survival mechanism.
I too would like to see where this research is because it describes me to a tee - I'm very much prone to throwing my hands up in the air at a certain point and going full scorched earth - I think that's the rejection sensitive dysphoria mechanism, but could be a few other things wrapped up amongst that.
And also note that dementia is associated with a very high incidence of depression. So the question now is: How many of these ADHD->Dementia or Depression->Dementia cases were actually a sort of early onset cognitive problem that was lumped into the closest matching mental health condition?
ADHD cohorts are especially difficult to evaluate because the clinical diagnostic standards are all over the place. A proper diagnosis requires ruling out other common causes of attention problems (insomnia, depression, sleep apnea and other common conditions can have severe attention problems as a secondary effect) but rushed providers will often hand the patient a questionnaire and then hand them a diagnosis if the number is above the threshold. As my friends in clinical practice will lament, there are a lot of people with underlying conditions who are getting ADHD diagnoses because it doesn’t carry the stigma of a depression diagnosis (for reasons I still can’t understand) and it’s easier to “diagnose” than doing a proper work up and background history to check for other conditions like apnea. This makes correlational studies with ADHD even harder to interpret.
"There was no clear association between adult ADHD and dementia among individuals with ADHD who received psychostimulant medications."
This is super interesting. The authors point to some needed future research into this in their discussion:
"There are different interpretations of the finding that adult ADHD treated with psychostimulant medication was not clearly associated with an increased dementia risk. It is possible that ADHD treated with medication reflects more severe ADHD compared with ADHD not treated with prescribed psychostimulants, which may reflect milder symptoms or even a less-accurate diagnosis. Also, ADHD is a chronic condition and may have negative long-term sequelae when untreated. Hence, the lack of association among individuals exposed to psychostimulants contradicts the conclusion that ADHD is associated with dementia risk. Alternatively, one may accept our ADHD ascertainment procedures. Among patients with adult ADHD, psychostimulant exposure is uncommon (22.3% in our study and less elsewhere5). The ADHD medication and diagnosis combination is 0.5% (567 of 109 218), possibly an underestimate of adult ADHD. Also, psychostimulants are cognitive enhancers hypothesized to reduce dementia risk.19 In addition, our study results should be interpreted within the broader literature that generally supports the association between adult ADHD and dementia.14-17 Seen this way, including psychostimulants in the association between adult ADHD and dementia risk may account for confounding by medication. That said, future research is necessary, including the assessment of adult ADHD symptom severity, to examine the role of psychostimulant medication in old age."
Indeed, very interesting. Also note that among the adhd population the smokers had a lower HR than the non-smokers. Nicotine is known as a stimulant and to be used by undiagnosed adhd patients as self-medication. Would be interesting to see the HR for the smoker split among the medication exposed subgroup.
ADHD is so poorly defined and with such terrible standards of evidence for a valid 'theory' with an incredibly wide source of potentional causes of ADHD thoughtout one's lifetime, that I question if any correlation tied to the concept of ADHD means anything at all.
The amount of money and researches dumped into dopamine transporter studies, brain diffusion tensor image scanning, the outspoken desire to test the pre-frontal cortex of monkeys, because lab mice don't have them and they still don't have any quality evidence to identify adhd.
Enron has a better return on investment for shareholders than ADHD clients have for research dollars.
Anecdotally but i know a few people with adult adhd, including myself, have trouble maintaining an adequate sleep schedule. This alone may be sufficient to explain the risk of dementia
Anecdotally, I watched my grandfather and now my father fall into dementia. They both suffered from lack of motivation. Years spent mindlessly watching TV. Hearing goes bad and participation in conversations suffers. Plus the fact all they did all day was watch TV they ran out of things to talk about. Thus, they retreat back to the TV and amplify their condition.
I’m of the opinion, as a sufferer and an offspring, their lack of motivation comes from undiagnosed adhd (different times).
There’s Alzheimer’s and then there’s OldTimers. The latter is a correctable condition that if prevented could, (again, my own opinion) stave off the former. The brain is a muscle, do not let it atrophy. You need to exercise all parts of it - especially social which is difficult for seniors.
71 comments
[ 11.8 ms ] story [ 320 ms ] threadMaybe there’s something neurologically wrong from the beginning that manifests as ADHD and later turns into dementia?
It’s definitely weird how I am just completely unmotivated by anything for months at a time then suddenly will be intensely motivated and impossibly into something new.
One of my main symptoms was MCI. Interesting that after long term treatment not only the MCI improved or subsided but also my very long standing ADHD (present for as long as I can remember) got dramatically better, makes you wonder.
I have nasty seasonal allergies (at least one per season). Whenever it flares up, the is a marked increase in my needs and decrease in my productivity. I'm hoping to start immunotherapy for them soon. I get my ADHD and my allergies from my dad and immunotherapy has done him wonders.
I can’t speak to the dementia portion, but it would not surprise me. As for the adhd being the result of something ‘neurologically wrong’… I feel like we should replace ‘wrong’ with something less charged, maybe ‘sub-optimal’ or ‘problematic’, but you intuited your way into something I’ve spent years in therapy and reading books to finally grok.
Two specific books that come to mind: The Myth of Normal and What Happened to you
We can define wrong as counterproductive, while seeking to accommodate those configurations and seek to reduce their affects or mitigate them entirely
personally I feel that the symptoms of adhd are less relevant and doesn't impair my daily functions as much if I focus my entire waking time on outdoor activities like biking and swimming, and while I never hunted with primitive tools it might share some similarities
I think this is something that could be verified in practice too, since we still have hunter-gatherers societies
"Dementia occurred among 96 of 730 participants (13.2%) with adult ADHD and 7630 of 108 488 participants (7.0%) without adult ADHD."
This really matters for things with a very low probability.
And the difference between the two is?
"Per cent means one hundredth of something. Percentage point is used when comparing percentages to one another. For example, when inflation drops from three to two per cent, inflation decreases by one percentage point and 33.3 per cent."
When you say it is 6 percentage points higher it means you had a percentage Y% and it is now (Y+6)%, a value which cannot be determined unless you know Y, never mind the reference absolute value it relates to.
In this particular case you can say it went from 7% to 13.2%, so if you ignore "%" as the unit the actual change is from 7 to 13.2; a ((13.2-7)/7) ≈ 0.8857 = 88% change. Had the original percentage been say 67%, a 6.2 p.p. change would have increased the percentage to 73.2%; a much smaller ((73.2-67)/67) ≈ 0.0925 = 9% change.
Had the change been "six percent of seven percent", the new value would be 7+7*(6/100) = 7.42 (percent).
* Doubled rate of premature death (largely attributed to accidental injury)
* 47% anxiety disorder comorbidity
* 38% severe mood disorder comorbidity (including depression)
* 15% substance abuse disorder comorbidity
Between the heightened risk of concussions, anxiety, depression, and substance abuse, it's not at all surprising that dementia shows up twice as often in the statistics. With that being said, it doesn't tell us much at all about whether there's a shared pathology.
I hadn’t seen this info before… thanks for mentioning this!
(No, I don’t mean a fee applied by a government, I mean more associated physical and mental issues which are co-morbid with or indirectly caused by ADHD)
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I think ADHD is great. People with ADHD are fun, and interesting and just generally cool people. It could be worse, you could be an actual boring neurotypical person - I genuinely think that would be so boring.
https://www.goodreads.com/book/show/39899253
I don’t know if I have adhd… it seems like the definition of adhd is almost constantly expanding. Whatever the case, I hope dementia becomes treatable or curable in my lifetime. My grandfather suffered with it and it was awful.
From https://en.wikipedia.org/wiki/JAMA_Network_Open:
"According to Journal Citation Reports, the journal has a 2021 impact factor of 13.353, ranking it 15th out of 172 journals in the category "Medicine, General & Internal". Additionally, it ranks 5th among purely open access journals in that subject category."
Ignoring JAMA Network Open because it doesn't look pretty on a cell phone isn't a great move.
ADHD is more well understood now (which is why it is separated into Compulsive, Hyperactive or both) but the diagnostics, as determined by professionals in psychiatry, have not changed in decades. The biggest change in studies for ADHD is how it affects females differently than males.
Nah, it's pretty stable. What sometimes changes is the exact wording to describe it or the wording of diagnostics or new insights from comorbidities for better differential diagnosis. But the core adhd concept has been stable for a long time.
See the latest wording here: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...
https://www.alzheimers.org.uk/about-dementia/risk-factors-an....
Known:
- Dementia has many lifestyle risk factors (poor education, hypertension, obesity, hearing loss, depression, diabetes, physical inactivity, smoking, drinking, social isolation)
- ADHD can make it easy to have certain lifestyles (addictions to drugs or food, trouble maintaining relationships, emotional dysregulation, poor education, poor work performance, high risk behavior)
New connection:
- There is significant overlap in the two
[1] leads me to believe they would look like someone with a high degree of hyperactivity and a low degree of inattentiveness.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821966/
As others have mentioned, ADHD is also comorbid with other mental health disorders including eg depression and alcoholism. That’s also a reasonable mechanism. Personally as someone with the condition a 6% increased chance does not scare me though it’d be great to understand the mechanism in case it’s caused by preventable behaviors rather than the condition itself.
But the way they’re controlling for stimulants is very poor. To begin with, out of the 100k in the study, only 730 had ADHD and of that only 163 were in the psychostimulant cohort. So to establish statistical significance regarding dementia, which only affected 96 people out of the 730 with ADHD, would be almost impossible if the relationship were mild. And you see that in the huge P-value for the infra-ADHD comparison (0.74) which shows a slight decrease in dementia for stimulant-takers. Basically there is too little data to take that seriously at all.
The comparison across ADHD and no-ADHD populations regarding psychostimulants is deeply flawed too. They’re bucketing [0] dopaminergic stimulants with modafinil (much less dopaminergic) and even nootropics like racetams - literally prescribed to heal brain damage and treat or prevent dementia in former Soviet Union countries, with an entirely different safety profile and mechanism compared to dopaminergic stimulants. Having trouble finding data on racetam legality and use in Israel, so they may not be in scope given the medication would need to be formally prescribed IIUC. But that leaves the remainder as likely taking prescribed dopaminergic stimulants and modafinil, which for those without ADHD are mostly taken by those with narcolepsy. So the non-ADHD psychostimulant users are likely strongly biased towards narcoleptics with the remainder being those taking drugs for the purpose of treating or preventing cognitive decline, and the intra-cohort ratio is 1.1:22.3 so roughly only 5% of the ADHD-stimulant group is comparable to the nonADHD-stimulant group assuming similar, uncorrelated incidence of narcolepsy.
In other words, their two attempts to control for stimulant use either have a uselessly low amount of data giving a p-value of 0.74, or are confounded by comparing against narcoleptics taking stimulants’ dementia rates (not healthy people taking stimulants; they wouldn’t have been prescribed stimulants so long without having ADHD or narcolepsy) with the possible wildcard of some of these “psychostimulant” users taking non-dopaminergic stimulants or even non-stimulant nootropics.
[0] https://en.m.wikipedia.org/wiki/ATC_code_N06
It makes me wonder if ADHD patients would more often fall on the other side of this functional/coping divide and so get earlier diagnoses. And if so, how could you control for this? Across a population, I would think that delayed detection means lower diagnosis rates since some patients would die before the delayed diagnosis could happen.
The relationship between dementia and ADHD wasn't mild. So the claim a mild relationship would have been impossible to detect is irrelevant even if true. And they didn't say to to take the less elevated risk in the stimulant taking ADHD group as conclusive evidence of a real effect.
Dopaminergic stimulants and modafinil are nootropics prescribed to treat dementia also. And you would need to suppose those drugs were prescribed more to people without ADHD or dementia diagnoses to believe this explained the elevated risk of dementia in people with ADHD.
https://www.sciencedirect.com/science/article/abs/pii/S01452...
The specific symptom they were looking at in what I was reading, was how people with ADHD easily walk away from things (friends, family, etc.), never to return. Basically a lot of kids attempt to run away, but people with ADHD are far less likely to return if they succeed in "getting away".
The article was relating having lived the earliest part of their lives being pushed away, to the ability to more easily separate and push everyone away permanently later in life (which they referred to as "shutting down"), and the possibility that ADHD itself might be a coping and survival mechanism.
And also note that dementia is associated with a very high incidence of depression. So the question now is: How many of these ADHD->Dementia or Depression->Dementia cases were actually a sort of early onset cognitive problem that was lumped into the closest matching mental health condition?
ADHD cohorts are especially difficult to evaluate because the clinical diagnostic standards are all over the place. A proper diagnosis requires ruling out other common causes of attention problems (insomnia, depression, sleep apnea and other common conditions can have severe attention problems as a secondary effect) but rushed providers will often hand the patient a questionnaire and then hand them a diagnosis if the number is above the threshold. As my friends in clinical practice will lament, there are a lot of people with underlying conditions who are getting ADHD diagnoses because it doesn’t carry the stigma of a depression diagnosis (for reasons I still can’t understand) and it’s easier to “diagnose” than doing a proper work up and background history to check for other conditions like apnea. This makes correlational studies with ADHD even harder to interpret.
This is super interesting. The authors point to some needed future research into this in their discussion:
"There are different interpretations of the finding that adult ADHD treated with psychostimulant medication was not clearly associated with an increased dementia risk. It is possible that ADHD treated with medication reflects more severe ADHD compared with ADHD not treated with prescribed psychostimulants, which may reflect milder symptoms or even a less-accurate diagnosis. Also, ADHD is a chronic condition and may have negative long-term sequelae when untreated. Hence, the lack of association among individuals exposed to psychostimulants contradicts the conclusion that ADHD is associated with dementia risk. Alternatively, one may accept our ADHD ascertainment procedures. Among patients with adult ADHD, psychostimulant exposure is uncommon (22.3% in our study and less elsewhere5). The ADHD medication and diagnosis combination is 0.5% (567 of 109 218), possibly an underestimate of adult ADHD. Also, psychostimulants are cognitive enhancers hypothesized to reduce dementia risk.19 In addition, our study results should be interpreted within the broader literature that generally supports the association between adult ADHD and dementia.14-17 Seen this way, including psychostimulants in the association between adult ADHD and dementia risk may account for confounding by medication. That said, future research is necessary, including the assessment of adult ADHD symptom severity, to examine the role of psychostimulant medication in old age."
The amount of money and researches dumped into dopamine transporter studies, brain diffusion tensor image scanning, the outspoken desire to test the pre-frontal cortex of monkeys, because lab mice don't have them and they still don't have any quality evidence to identify adhd.
Enron has a better return on investment for shareholders than ADHD clients have for research dollars.
I’m of the opinion, as a sufferer and an offspring, their lack of motivation comes from undiagnosed adhd (different times).
There’s Alzheimer’s and then there’s OldTimers. The latter is a correctable condition that if prevented could, (again, my own opinion) stave off the former. The brain is a muscle, do not let it atrophy. You need to exercise all parts of it - especially social which is difficult for seniors.