ADHD in older adults may resemble early onset dementia

By Colin McCandless, Contributing Writer 

REGION – An estimated 10 million U.S. adults suffer from attention deficit hyperactivity disorder (ADHD). It’s a neurodevelopmental condition in which people can exhibit a variety of symptoms. This may include difficulty paying attention, impulsiveness, restlessness, problems focusing on a task, poor time management skills, poor planning and trouble coping with stress.  

Causes are varied

Psychiatrist Dr. David Brendel, M.D., Ph.D., who runs a psychiatry practice in Belmont, explained that ADHD is caused by a “combination of biological vulnerabilities and likely some complex genetics. Plus environmental factors and various kinds of work tasks that are challenging for certain people’s brains.” 

While people may be more familiar with childhood ADHD, Brendel, who specializes in treating ADHD and mood and anxiety disorders in adults, said the symptoms of adult ADHD resemble those in children, they just show up differently because of the contrasting roles and responsibilities.

“Adults tend to be in school. College or graduate school. Or in jobs,” he explained. “Outside of the professional realm they’re involved in all types of other things at home like parenting or running a household.”

“So the tasks and the challenges are different—the dynamics in many ways are the same,” Brendel added. “People have difficulty with focusing and locking in on a particular task, such as reading or writing a report, completing a work project, organizing schedules for their kids or organizing a household and keeping things together. When they’re multi-tasking, it can become extremely stressful and overwhelming.”  

This can sometimes lead to serious anxiety, stress or depression and hamper work productivity or amplify the difficulty of juggling family responsibilities. Then other vulnerabilities an adult might have may begin to manifest themselves including eating disorders and substance abuse. 

“This is one of the reasons why ADHD is comorbid—accompanied by other psychiatric conditions,” said Brendel. 

Distinguishing among ADHD and aging-related diseases

For someone who wasn’t already diagnosed with ADHD in childhood or as a young adult, some symptoms of ADHD in adults over 50 may resemble those of early onset dementia, which besides being clinically confusing, can be concerning to loved ones. According to Brendel, there is an overlap in symptoms among ADHD and Alzheimer’s and dementia. With both, adults exhibit cognitive decline, hindering an individual’s ability to organize, plan and carry out tasks. However, there are differences as well. 

Alzheimer’s and dementia cause forgetfulness and short-term memory loss, but a person with these conditions might not be as inattentive to specific tasks. ADHD is less about forgetfulness than performing tasks like reading without becoming easily distracted. It deals more with attentiveness. 

“With Alzheimer’s the forgetfulness is pretty persistent across all situations,” he noted. “With ADHD, the symptoms tend to worsen with stress, more tasks and more challenging tasks. So, if it’s a new onset thing, if a person did not have ADHD symptoms before 50 and they did not have evidence of dementia before 50 it can be hard to distinguish.”

“That’s where clinical evaluation comes in,” Brendel emphasized. “If a person or their loved ones are starting to observe this, the best place to start is by bringing it up with a primary care doctor.”

Treatments include medication and counseling

The most effective medications in treating ADHD are psychostimulants including the methylphenidate compounds Ritalin and Concerta, and amphetamine salts like Adderall and Dexedrine. Brendel advised caution when using these medications. “Psychostimulants should be taken only as needed,” he warned. “If a person does not need an extra boost to deal with a challenging task it’s best to take days off it to avoid having the brain get habituated or develop a tolerance to the medication. And also create a risk of dependency or addiction.” 

Psychostimulants can potentially cause side effects such as sleep problems, reduced appetite and weight loss, heart racing and nervousness. People over 50 with medical conditions like a heart condition should be careful. For most conditions a psychiatrist can determine if it’s safe to take a medication, but for further questions about medical comorbidities, Brendel recommended consulting with a primary care physician.  

Other effective non-medication treatments encompass various types of counseling like cognitive behavior therapy and executive function, or ADHD coaching. An adult with ADHD can work with an executive function coach to establish systems or techniques to stay focused. It might entail using a smartphone calendar or apps to introduce structure and create accountability, ensuring tasks get done. Additionally, mindfulness techniques such as mindfulness meditation or controlled breathing exercises can help people “stay grounded in the moment,” according to Brendel, “and that can help train the mind to be in the present moment with equanimity and focus.” His practice offers all three treatments. “I really believe in very much a holistic approach that usually involves a combination of medications, executive function coaching and mindfulness work,” he said. 

ADHD coaching and support groups

Jenna Knight, a certified ADHD coach and founder of Never Defeated Coaching, has been working on behalf of people with ADHD since 2004. Knight assists all age ranges, primarily women, but also parents of children with ADHD, to guide them in implementing successful, proven strategies to minimize the challenges of living with ADHD. Her oldest client is 71.

Knight’s motivation stems from the fact that she was diagnosed with ADHD at age 28 and has navigated the daunting disorder firsthand. Her symptoms include inattentiveness, impulsivity and hyperactivity. She initially self-medicated with drugs to cope but is now 27 years clean and sober.  

Knight is a member of CHADD of Central Massachusetts, a nonprofit ADHD advocacy organization supplying education and resources to those affected by ADHD in communities. She also belongs to ADDA (Attention Deficit Disorder Association), an organization serving adults with ADHD. ADDA provides support groups, establishing a community for ADHD adults that helps with time management, planning and organizing and healthy habits. 

When Knight was diagnosed, these resources weren’t available. “I didn’t know about coaching back then. And I had to learn strategies myself. I had no support,” she recalled. Knight researched ADHD extensively in the library, reading everything about it. The first title she read was “Driven to Distraction,” a seminal 1992 book about ADHD. “And I worked my way through it,” related Knight of her experience. “Through tears, frustration, anger. Until I finally got a handle on it. Some days I don’t. Some days I do have my moments. But that comes with the territory.”  

Knight eventually started working with the Massachusetts Rehabilitation Commission as a learning disabilities and ADHD consultant. Her job was ensuring that services were being provided to this cohort. She helped launch a support group for adults with ADHD and learning disabilities and collaborated with MRC’s training department to create an ADHD and learning disabilities training for the vocational rehab counselors. “I’m very, very proud of those accomplishments and those collaborations that I did with my team,” proclaimed Knight. 

Despite the progress, she still observed a gap in ADHD services. In 2010 she met a woman who was an ADHD coach and had an epiphany. By 2011, Knight had launched her own ADHD coaching business and has never looked back. “I’ve gotten testimony from many of my clients thanking me for changing their life,” she said. 

ADHD misdiagnosis: A cautionary tale

It can be challenging to diagnose ADHD in adults because some of its symptoms resemble those caused by other mental health conditions such as anxiety or mood disorders. Knight cited this major overlap between ADHD and other disorders like bipolar and anxiety. “That’s why people get misdiagnosed,” she said. 

JP Amin, who asked to be identified with a pseudonym, was one of those people who got misdiagnosed, and it had devastating repercussions. Amin was misdiagnosed with ADHD in 2009 at age 36 and prescribed Adderall. He spent 10 years addicted before a hospital visit saved him. “I’ve lived through hell,” reflected Amin. 

Prior to receiving the inaccurate diagnosis, Amin had a good job working in financial services and was married with children. But he was simultaneously dealing with irrational fears and crippling anxiety, including a fear of disappointing his wife and kids. What he didn’t understand then is that he was suffering from anxiety. “Unfortunately ADHD and anxiety go hand-in-hand,” noted Amin.

After his struggles began causing issues at home with his marriage, Amin saw a therapist. Following his third visit to the therapist, he was diagnosed with ADHD, and the therapist contacted his doctor, who prescribed him Adderall. He started out taking 20 milligrams. Initially it seemed to work. “I remember feeling like I was on top of the world,” he recalled. “It was the honeymoon period. Now I know what addiction is.” 

A few weeks in he went to work feeling strong, almost euphoric. He shared these feelings with his psychiatrist, who told him it must be working. The hospital would later tell him this was a red flag and that he should have been taken off Adderall immediately. His 20-milligram dosage increased to 30 after two months. Amin took Adderall until late 2019, when he was 46. 

His wife is now his ex-wife. He eventually lost his job of 23 years in 2017. At one point he contemplated suicidal thoughts. All because of Adderall. 

“There was a fire burning in my brain and it was like pouring gasoline on it,” Amin recalled. The drug took a tremendous physical toll on him. He would be sweating and rambling during job interviews and would shake uncontrollably in front of his family. Amin yelled and screamed and was not himself. He abruptly cut conversations short and dismissed loved ones’ concerns or advice. As his dependency on Adderall grew, he went through withdrawals and began drinking in the evenings, compounding the drug’s effects. He told his doctor about it and was advised to take Adderall later in the day.

On Dec. 1, 2019, a desperate Amin admitted himself into Harrington Hospital in Southbridge. To his dismay, he was told he didn’t have ADHD and didn’t need Adderall. Because of the addiction, Amin thought he couldn’t function without it. He met with a team of therapists and was given a choice to stop taking it. Five days off the drug he started feeling better. Amin attended group sessions and read other harrowing stories of Adderall addiction. He found particularly insightful information from adult ADHD author and educator Gina Pera’s blog “ADHD Rollercoaster,” whose entry “Madderall” examines the overprescribing of Adderall. 

Amin underwent an intensive therapy and recovery program through the hospital. 

After just two months of not using Adderall, Amin applied for four jobs and was hired for all four. He now works remotely in financial services. He believes Adderall is one of the most overprescribed drugs in the country. “I had a very successful career and then plummeted,” he said. 

In October 2020 he shared a lengthy Facebook post explaining what happened. Amin hopes that no one else will endure what he did. “I never wish what it did to my family on anybody,” he said. His advice for those who are prescribed Adderall is to educate yourself on the drug. “If you can’t function without it and go through withdrawal symptoms, you shouldn’t take it,” he cautioned. “If you’ve been diagnosed with ADHD, you really should see a mental health professional.”   

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