Clinical Geriatrics

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral condition characterized by symptoms of impulsitivity, distractibility, and impaired concentration stamina. ADHD is present throughout the lifecycle and is associated with significant functional and emotional impairment.1,2 When studied in all other age groups, ADHD demonstrates a consistency of epidemiology and prognosis that would predict similar findings in older adults.3 However, while very little is known regarding prevalence rates, morbidity, and prognosis of ADHD in adults over age 45 years,4 clinical experience supports the occurrence of persistent ADHD in older adults. Adults over age 45 have been included in ADHD clinical psychopharmacology trials,5 and adults in their 50s, 60s, and beyond are presenting for evaluation and treatment in our ADHD clinic.

Core ADHD diagnostic features of older adults are similar to younger adults; however, there is a profound paucity of data to guide clinicians assessing older patients with ADHD. Studies examining ADHD beyond childhood indicate that ADHD prevalence rates decrease with age, and that persistent ADHD is associated with less hyperactivity but ongoing executive function deficits.6,7 Overall, adult ADHD prevalence has been estimated at 4% based on community epidemiology studies6,8 (Figure9). The first large-scale epidemiologic study of psychiatric disorders including adult ADHD as a screened diagnosis excluded adults over the age of 45, citing “concern of recall failure among older adults.”8

This article presents two cases of ADHD in older adults, accompanied by a discussion of observed clinical aspects of this condition that highlight this demographic group in need of further research.

Case I