In adults, attention deficit hyperactivity disorder is often misunderstood. The idea still lingers that ADHD is a condition linked to childhood, destined to disappear with time, but for a third of children with neurodivergence this is not the case: they will have to live with this condition for their entire lives.
It is estimated that up to 5% of the population could have ADHD: some have always known it, for others the diagnosis arrives late, for others it will never arrive and will hide behind labels such as being eccentric, disorganised, very creative or simply with your head in the clouds.
The problem is that several studies are showing that untreated ADHD is a risk factor for a number of health challenges and problems, including unsafe driving, substance abuse and, last but not least, major possibility of developing dementia. And since medications and lifestyle changes can reduce these risks, it becomes increasingly important to be able to obtain a definitive diagnosis.
ADHD and the brain
Among the many negative impacts of ADHD on the brain, a large and in-depth international study has shown that neurodivergence in adults is associated with a 2.77-fold increased risk of dementia. It is worth underlining that that published on Jama Network Open It is an epidemiological analysis that can only highlight an association and cannot tell us whether ADHD is actually a direct cause of cognitive decline, but the results suggest that if you suffer from attention deficit disorder you will have more problems with normal brain aging. In short: it is a statistically significant risk factor.
The good news is that “psychostimulant drugs can attenuate the predisposition”, explains the professor Stephen Levine from the School of Public Health at the University of Haifa, Israel, lead author of the study. “Lifestyle changes, such as better sleep and maintaining social engagement, can also reduce the risk of dementia.” But the problem always remains the same: having the awareness of being neurodivergent.
The study on ADHD and the risk of dementia
To investigate the link between adult ADHD and dementia, Levine and colleagues analyzed more than 17 years of electronic health records from 109,218 undiagnosed people, aged 51 to 70, and found that over that time 730 (0.7%) had received a diagnosis of ADHD and 7,726 (7.1%) had developed dementia. But if you look only at the subgroup with ADHD, 13.2% experienced brain aging problems, with a higher risk than the general population.
Interestingly, adults with ADHD who were taking a psychostimulant drug did not show an increased risk of developing dementia, telling us how undiagnosed neurodivergence affects the odds more.
One of the strengths of the research is that it takes into account 18 other potentially confounding factors. For example, adults with ADHD are more likely to smoke and have co-occurring health conditions such as hypertension and depression, which are also known as risk factors for dementia. But even taking this into account, the associated increased risk remained.
“The article in question is a very significant epidemiological study”, comments the professor Paolo Maria Rossini, head of the Department of Neurological and Rehabilitation Sciences at the Irccs San Raffaele in Rome, who has studied dementia and Alzheimer’s all his life. “Now, the main challenge lies in interpreting this data. It is not new that many psychiatric illnesses are an outpost or in any case linked to dementia. We already know the link in those suffering from depression, bipolar disorder, psychosis or schizophrenia, pathologies that all have a high genetic component. In the case of neurodivergence, the diagnosis can be complicated, and only becomes evident when social complications occur. So this makes the situation more complex, and the possibility of prevention.”
As the neurologist is keen to point out, “Adhd is a condition that is almost in fashion. Many people self-attribute it and since there is no instrumental test to demonstrate it, some cases can be misunderstood. Not all people are forgetful, disorganized or distracted have a neurodivergence. Temperament and genetic basis seem to play a key role in some psychiatric diseases, such as for example in obsessive-compulsive disorder, just as in turn non-hereditary dementia also shows a very high familiality”.
The complexity of psychiatric diseases and genetic factors “makes the interpretation of epidemiological data a challenge – concludes Rossini -. Over the years, various discrepancies have been demonstrated between epidemiological and prospective studies regarding, for example, the protective effect on dementia in progestins after menopause or prolonged use of anti-inflammatory drugs, which have not subsequently proven effective”. In short, parents of children with ADHD should not panic, nor should those with a diagnosis: awareness of a predisposition can motivate them to adopt a healthier lifestyle, to undergo medical checks and regular screening. Just as it remains essential not to self-diagnose following Tik Tok trends, turning to a doctor and not an influencer to obtain your own ADHD diagnosis.
What we don’t know
It is not yet known which biological mechanisms may explain the link between neurodivergence and dementia but second Sara Beckerresearcher at the University of Calgary and author of a recent Systematic review on the risk of neurodegenerative disease or dementia in adults with ADHD it is possible that “those who suffer from it have less brain reserve, or ability to maintain cognitive functioning and compensate for age-related changes. Attention deficit disorder can make people more subject to patho-biological changes in brain, associated with dementia. And because ADHD is linked to worse vascular health, we are currently studying whether specific vascular changes in the brain are linked to increased dementia risk.”
It should also be said that ADHD and dementia have some similarities in their cognitive symptoms, which can be easy to confuse. But “being aware of risk factors – concludes Becker – can only be positive: paying attention to your health and taking care of your brain are things that we should all do”.
by Valentina Arcovio