Highlights from 2024 NEI Congress: A Broken Cog: Distinguishing Between Adult ADHD and Dementia
Thursday, November , 2024
As the prevalence of cognitive disorders such as mild cognitive impairment (MCI) and dementia increases, distinguishing these conditions from neurodevelopmental disorders like attention-deficit/hyperactivity disorder (ADHD) in older adults has become increasingly critical. Once thought of as primarily a childhood disorder, ADHD is now recognized as a lifelong condition that can persist into older age, often remaining undiagnosed or misdiagnosed until later in life. Both ADHD and neurodegenerative diseases like Alzheimer's disease (AD) can present with similar cognitive challenges, including forgetfulness, disorganization, and difficulties with attention and planning. These overlapping symptoms can complicate diagnosis and treatment in older adults who may have lived with undiagnosed ADHD while also facing age-related cognitive decline. For clinicians, understanding the nuances and potential coexistence of these conditions is essential to optimizing care and improving patient outcomes.
In a talk titled "A Broken Cog: Distinguishing Between Adult ADHD and Dementia," psychiatrist Dr. David Goodman and neurologist Dr. Dani Cabral explored the complexities of diagnosing ADHD and MCI/dementia in older adults. The session kicked off with a case study of a 62-year-old white male physician whose worsening cognitive symptoms over the past two years prompted him to seek medical evaluation (Figure 1). The patient, still actively working and married, had a complex medical and psychiatric history that included a traumatic brain injury (TBI) and long-term depression managed with antidepressants. His cognitive concerns included frequent memory lapses, such as misplacing keys and missing appointments, cognitive fatigue throughout the day, difficulty finding words, and poor working memory. These issues had become severe enough to force him to resign from key leadership positions.
Dr. Goodman was immediately concerned about both ADHD and MCI given the patient's lifelong disorganization, procrastination, and sloppy work habits. Despite these longstanding difficulties, his self-reported ADHD symptoms—rated retrospectively for childhood and rated by his first wife for adulthood—were moderate, with hyperactive-impulsive behaviors being more prominent than inattentiveness. His first wife had also described him as forgetful and disorganized. Based on his symptom history and self-reports, Dr. Goodman diagnosed the patient with ADHD.
Dr. Cabral, acting as the presenting neurologist, conducted an in-depth review of the patient’s neurological findings. MRI results showed only minor microvascular changes that were not sufficient to explain the cognitive symptoms. Neuropsychological testing revealed mild deficits in attention, memory, and language, meeting the criteria for amnestic mild cognitive impairment (MCI), a condition often associated with Alzheimer's disease. Further bloodwork analyzing AD biomarkers supported the likelihood of underlying Alzheimer's disease. The overall diagnostic impression was amnestic MCI due to Alzheimer’s disease superimposed on chronic, recently diagnosed/treated ADHD.
Overall, this session highlighted the diagnostic challenges in distinguishing between ADHD and MCI in older adults, particularly when ADHD has remained undiagnosed for years. Neuropsychological testing and a thorough medical history were essential for this patient’s diagnosis and subsequent treatment. Indeed, Dr Goodman and Dr Cabral highlighted the need for comprehensive diagnostic evaluations and interdisciplinary collaboration to effectively manage patients with overlapping ADHD and neurodegenerative conditions, ensuring optimal care and improving their quality of life.
Figure.
The recording of this presentation, as well as all of the presentations from 2024 NEI Fall Congress, will be made available on the NEI website as Encore Presentations for NEI Members.
Source:
David W. Goodman, MD, LFAPA and Dani Cabral, MD. A Broken Cog: Distinguishing Between Adult ADHD and Dementia. Presented November 7 at the 2024 NEI Congress, Colorado Springs, CO.