Journal Article Annotations
2023, 4th Quarter
Annotations by Sneha Jadhav, MD
In this electronic health record (EHR)-based prospective study included over 100,000 individuals followed between 2003 to 2020, the researchers found a 2.77-fold increase in risk of incident dementia in individuals with adult ADHD. There are new findings of mild evidence of reverse causation, namely dementia diagnosis in later life may predispose to ADHD-like symptoms early in life and that ADHD treated with psychostimulants medication was not associated with an increased dementia risk. Factors such as patient sex, smoking status, early or late onset dementia did not attenuate the conclusions from the primary analysis.
Strength and weaknesses:
A prospective study spanning over a decade with a large cohort provides a strong basis for studying a disease which has relatively low rate of diagnosis and treatment among adults. The starting point of the study with no pre-existing ADHD or dementia diagnoses minimizes several potential biases. The diagnostic assessment by trained professionals lends credibility to the diagnoses which are highly clinical and can have overlapping symptoms. The limitations of the study were the lack of information about childhood-onset ADHD and lack of details about ADHD symptom profile, which may vary widely but also may specifically change the risk stratification for future diagnosis of dementia. There are many known dementia risk factors that were not included in the study such as impact of low academic achievement (impaired cognitive reserve), APOE e4 status, and cerebrovascular disease.
It will be critical to assess adults with ADHD early and frequently for dementia symptoms. Since the symptoms of the two conditions can overlap, structuring assessments to account for and differentiate both symptom clusters and establishing thresholds for each diagnosis. It is plausible that the pathological process of ADHD or the day-to-day symptoms themselves reduce the ability of the individual to compensate for later-in-life neurodegenerative and cerebrovascular processes.