Distracted and Forgetful

by Mind Over Matter V 13:

Is it healthy aging, early signs of dementia, or ADHD?

As you and your loved ones get older, you may begin to notice changes in how you think and behave. Sometimes getting distracted or being forgetful may be worrisome. Identifying when these changes started to occur, and how often, are clues to help determine what is happening and whether you should do something about it. 

Until recently, trouble with memory and attention among adults (especially older adults) were usually thought of as early signs of dementia. With fine-tuned diagnostic tools and long-term data now available, medical professionals are starting to consider another diagnosis: attention-deficit/hyperactivity disorder (ADHD).

ADHD and dementia are both neurocognitive disorders that impair the self-management systems of the brain, known as executive functions. 

Overlapping symptoms of these disorders include trouble with routine activities, memory loss, being disorganized, feeling anxious (often related to being disorganized or difficulties with time management), changes in mood, and sleep disturbances.

ADHD IS COMMONLY ASSOCIATED WITH CHILDREN, PARTICULARLY BOYS, WHO HAVE DIFFICULTY SITTING STILL AND/OR PAYING ATTENTION AT SCHOOL, AND WHO EXPERIENCE MOOD SWINGS AND/OR EMOTIONAL OUTBURSTS.

Early onset of symptoms and persistence throughout one’s lifetime are characteristic of ADHD; this type of presentation can be used to rule out dementia. In the case of dementia, cognitive decline usually only begins in adulthood, and typically after the age of 65. Dementia is progressive, with continued deterioration in cognitive function over time. Dementia is caused by a range of diseases and injuries that affect the brain, with Alzheimer’s disease responsible for most cases. Talking to family members and long-term friends about when they started to notice symptoms of cognitive decline can help to distinguish between ADHD and early signs of dementia.

ADHD RUNS IN FAMILIES, DEMENTIA USUALLY DOES NOT

Besides age of onset, another key difference between ADHD and dementia is heritability – that is, whether there are genetic causes that make it more likely for family members to have the disorder. A 2018 review published in Molecular Psychiatry looked at studies on ADHD with families, twins, and adopted children over the last four decades. The authors, Dr. Stephen V. Faraone and Dr. Henrik Larsson, provide clear evidence that ADHD has genetic factors, where people with ADHD are more likely to have relatives with the disorder, generation after generation. 

IF YOU HAVE A CHILD OR GRANDCHILD DIAGNOSED WITH ADHD, THIS IS ANOTHER SIGN THAT ADHD MAY BE THE UNDERLYING CAUSE OF YOUR SYMPTOMS, RATHER THAN DEMENTIA. 

In contrast, only rare types of dementia have a genetic link, which means that in most cases dementia is not passed down to children or grandchildren. 

PREVALENCE OF ADHD

Approximately 7% of people worldwide have been diagnosed with ADHD, with more than twice as many males as females having this condition. In their 2015 review of global data in Pediatrics, Dr. Rae Thomas and colleagues explain that there appear to be regional variations in ADHD prevalence, but this is likely because of how information is collected, rather than true differences. 

For example, in a 2017 study published in The Canadian Journal of Psychiatry, Dr. Helen-Maria Vasiliadis and colleagues show that less than 3% of Canadian children and adults have ADHD, with three times the number of males diagnosed as compared to females. While there has been a slight increase in ADHD prevalence over the last few decades, this is likely related to greater awareness of ADHD signs and symptoms (with more individuals proactively seeking diagnosis for themselves or their family members), and better diagnostic tools.

PREVALENCE OF DEMENTIA

The prevalence of dementia worldwide has increased over time, primarily because of increases in life expectancy. Globally, it is estimated that between 5% to 8% of those aged 60 and over have dementia. Women are disproportionately affected, even after adjusting for longer life expectancies when compared to men. Additionally, individuals in low- and middle-income countries are more likely to have dementia compared to high-income countries. 

While population age distribution is largely responsible for country-
to-country variations, modifiable risk factors (e.g., poor diet and physical inactivity) and uncontrolled medical conditions (e.g., hypertension and diabetes) also play a significant role. In Canada, less than 1% of those aged 65 to 69 have dementia, and this increases to approximately one quarter of the population aged 85 and older.

CAN YOU DEVELOP ADHD AS AN ADULT?

It is widely believed that people diagnosed with ADHD as adults have had the disorder all along. If you are wondering how it is possible to have lived your entire life with ADHD without knowing it, it could be that you were taught how to work around your symptoms as a child to keep them from becoming overwhelming. Alternatively, you may have experienced mild ADHD symptoms as a child, but these symptoms only “flared up” in adulthood because of major life changes such as retirement or the death of a spouse. 

In childhood, you might have learned coping strategies to help keep your ADHD in check and focus on tasks, pay attention when people were talking, and regain control when you felt your emotions bubbling to the surface. Predictable daily schedules during school with dedicated time outdoors can also help children with ADHD manage their symptoms. 

Moreover, it is well established that there are effective non-pharmacological (i.e., drug-free) strategies that involve optimizing the environment or the nature of learning tasks to minimize symptoms of ADHD. Simple changes, like setting up a quiet room for learning with natural light, identifying incremental learning goals, or focusing on a lesson for a short interval, can create a positive learning environment for children with ADHD. 

Yet another possibility for an ADHD diagnosis later in life is related to biological processes. As women go through menopause later in life, levels of the estrogen hormone drop. Estrogen enhances the action of the neurotransmitter dopamine, which plays a key role in tasks related to focus and attention. Consequently, when menopausal women experience a decrease of both estrogen and dopamine, pre-existing ADHD can become obvious for the first time. 

WHAT SHOULD YOU DO IF YOU THINK YOU HAVE ADULT ADHD? 

Family members or lifelong friends can be helpful to talk through your concerns and to determine whether the symptoms that you have noticed are new, more pronounced, or attributable to recent life events. This type of conversation is similar to a clinical interview that you would have with a medical professional to receive a diagnosis and explore treatment options. 

There are several pharmacological treatments available for ADHD, with varying side effects and limitations for long-term use. Stimulants, such as methylphenidate (Ritalin) and amphetamine/dextroamphetamine (Adderall), and non-stimulants, such as atomoxetine, guanfacine, and clonidine, can be effective for both children and adults. 

Although side-effects are typically less pronounced in adults, risks to cardiovascular health, like increased blood pressure, must be weighed carefully and monitored closely. At the same time, adults do not need to worry about whether medications will affect their growth and development. 

MORE RECENTLY, ADULT-ADHD TREATMENT OPTIONS HAVE SHIFTED TOWARDS NON-STIMULANTS TO PREVENT INTERACTIONS WITH OTHER MEDICATIONS AND CONDITIONS, AS WELL AS TO AVOID MISUSE. 

Interestingly, some of the medical treatments currently used to enhance cognition and attention in other disorders like schizophrenia and Alzheimer’s disease are being explored for use with ADHD. Speak with your doctor and/or other medical professionals to learn more about options available to you based on your family history and other health conditions. 

ESTABLISH A PHYSICAL ACTIVITY ROUTINE

No matter whether you are diagnosed as a child or adult, long-term medications for ADHD may lead to weight gain and a higher body mass index (i.e., muscle to fat ratio). This suggests that any treatment plan should include physical activity.

Anyone diagnosed with ADHD (or dementia) can benefit from establishing a physical activity routine in the same way as healthy individuals and younger counterparts. Be sure to include physical activities that you find pleasurable so that you are more likely to schedule them into your day on a regular basis. 

Engaging in physical activities can help to offset the side effects of medications, provide a healthy outlet for expending restless energy, and release mood-enhancing and calming hormones (e.g., endorphins and serotonin). As a bonus, physical activity naturally elevates the brain’s level of dopamine, which helps with focus and attention. 

NORMAL CHANGES IN COGNITIVE FUNCTION WITH AGE

Now, if you find yourself forgetting things, having difficulty organizing your day, or experience emotional outbursts at any age, this does not automatically mean that you have an undiagnosed cognitive disorder. Life and job stressors, lack of sleep, and of course pandemic-related changes to your daily routine can all have negative effects on your memory, ability to plan, and feelings of emotional control. There are also natural changes in cognitive function that occur with age among healthy individuals.  

According to Dr. Karen Campbell, a Canada Research Chair in Cognitive Neuroscience of Aging at Brock University in St. Catharines, Ontario, it is important to keep in mind that “there are age-related changes in memory and cognitive function seen in healthy individuals. Some of our research studies have shown that healthy older adults tend to get distracted by irrelevant cues and don’t do as well in memory tasks when compared to younger adults. It seems that we have trouble filtering out unnecessary information as we age, and this – rather than a problem with the memory system itself – can interfere with memory.”

Given that our brains, bodies, social environments, and family structures (amongst other things) all change over the life course, what can we do to preserve our cognitive function? 

BOOST YOUR BRAIN HEALTH WITH OR WITHOUT AN ADHD DIAGNOSIS 

There are countless ways to boost our brain health (at any age) and to promote healthy aging, including: 

·       Being physically active every day to increase blood flow to the brain – and better yet, do it in green spaces;

·       Making a plan to learn something new, and then setting incremental goals to achieve it;

·       Trying mindful breathing to reduce stress and help you cope with overwhelming emotions;

·       Talking to your neighbours, relatives, and/or friends in person or online to maintain social interactions (for an extra boost, go for a walk while catching up); and

·       Structuring your day to ensure that you have seven to eight hours of uninterrupted sleep to restore your mind and reset your body.