ADHD in the Elderly: Diagnosis and Treatment

“Dropping estrogen levels affect short-term memory and ability to concentrate, and contribute to the brain fog that so many women going through menopause describe,” says psychologist Kathleen Nadeau, author of Still Distracted After All These Years: Help and Support for Seniors with ADHD.

When estrogen drops at menopause, even ADHD stimulants can lose their effectiveness, says Bill Dodson, MD, a Denver psychiatrist who specializes in adults with ADHD. But the problem seems to affect women specifically. “The level of male hormones such as testosterone appears to have no effect on ADHD impairments or the effects of ADHD medications in men,” he notes.

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Doctors in the dark

ADHD is rarely considered when evaluating older people with cognitive impairment. Only 1 in 5 memory clinics actively screen for ADHD. “People can have ADHD all their lives and now they develop dementia,” says Goodman. “At this point, you have two processes that are contributing to the cognitive difficulty.”

Postmenopausal women who experience cognitive decline should be screened for ADHD, Goodman says, even if they have never been diagnosed with the disorder. People who test positive have several avenues to explore, often a combination of behavioral strategies, counseling and medication.

Stimulants such as Adderall, Dexedrine, and Ritalin are commonly used to treat ADHD in young people, but many doctors are hesitant to prescribe them to older people. “We’ve all been trained that stimulants cause serious cardiovascular problems,” says Goodman. But he wonders how common it is.

A 2020 review of studies in the Journal of the American College of Cardiology found a link between stimulant use and “modest elevation in resting heart rate and blood pressure” as well as other symptoms, so it’s important that older people using ADHD medications be regularly monitored by a doctor. But the review concluded that there is little evidence regarding the long-term effects of these drugs, calling for more study. Dodson argues that the effects seen in the 2020 study were “tiny” and “clinically meaningless”.

ADHD in the Elderly: Diagnosis and Treatment

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