Could Forgetfulness and Disorganization in Seniors Be ADHD, and Not Mild Cognitive Impairment?

Q. Lately, I’ve become quite forgetful and have been struggling with paying attention to things, impulsivity, and an inability to plan as well as I used to. When I think of cognitive impairment, I think of short-term memory loss, and that doesn’t exactly describe what is happening with me. Oddly, I feel more like my preteen grandson with his disorganized belongings and his struggles to pay attention in class. But, I’m 68 years old! Can seniors have ADHD, even if we were never diagnosed with it in the past? If so, what are the differences between the symptoms for ADHD and mild cognitive impairment, and are there treatments available for seniors? Thanks for your help!

A. As we get older, we may forget things occasionally and worry if this could possibly be the start of dementia. But it could also be the same illness that afflicts about 10 percent of children from ages 4 to 17, Attention Deficit Hyperactivity Disorder (ADHD).

The National Institute of Mental Health describes ADHD as a lack of attention or impulsiveness that interferes with normal function or development. When most of us think of ADHD, the first thing that comes to mind are school-age children who have trouble paying attention in class and can’t sit still. What many of us don’t realize is that ADHD is a condition that may persist throughout adulthood and into old age. In fact, more than 8 million adults in the US live with ADHD, a diagnosis which could have been overlooked or not even considered when they were younger, even if the symptoms were present. It’s important to note that doctors didn’t start diagnosing ADHD until the late ‘80s–early ‘90s. 

Symptoms of ADHD in Seniors 

So, what are the symptoms of ADHD in older adults? According to the Cleveland Clinic, adults with ADHD struggle with disorganization, forgetfulness, losing things often, getting easily distracted, and procrastination. They may struggle with finishing projects or remembering information consistently, and they may become distracted during conversations and experience difficulty maintaining relationships. Adults with ADHD may become more impulsive, interrupting conversations, and answering questions before they are asked. Similar to those in the younger generation with ADHD, they may fidget or become restless, finding it difficult to sit still. They may arrive late to work or appointments more frequently or find it more challenging to stay productive or finish assignments at work and tasks at home. Hyperactive symptoms of adult ADHD might include restlessness, difficulty engaging in quiet activities, an overpacked daily schedule, talking excessively, or getting quickly irritable when waiting in line or stuck in traffic. These symptoms can have an adverse effect on their day-to-day lives. 

When older adults retire and lose the structure of employment, they may experience an exacerbation of symptoms, similar to when young adults with ADHD lose the structure of school. During retirement, older adults may start to reexperience challenges with time management and procrastination. What distinguishes ADHD from normal age-related changes, however, is that the patient with ADHD would have been doing these kinds of things for most of their lives. ADHD is not a behavior that slowly evolves or happens overnight.  According to Dr. Samoon Ahmad, Clinical Professor of Psychiatry at the NYU Grossman School of Medicine, “(i)t’s more likely to be ADHD if you can recall always losing things as a kid; it’s more apt to be age-related cognitive decline if you first start misplacing things in your 50s.” 

When Is It Dementia, and When Is It ADHD? 

ADHD is a lifespan disorder that can affect your overall quality of life. At least two-thirds of people diagnosed with ADHD at a young age continue to have symptoms into adulthood. But doctors aren’t typically taught to look for ADHD in people over 60. When people share concerns with their doctor about their memory, attention, or difficulty completing tasks, they may receive a diagnosis of mild cognitive impairment (MCI), a stage between normal aging and dementia.  

Older adults with ADHD may never have received a diagnosis of ADHD, especially if they had learned skills to compensate during their lifetime. To help doctors differentiate between mild cognitive impairment and ADHD in old age, the timing of symptoms and family history can provide good clues that it’s ADHD (and not MCI, dementia, or a stroke). There are currently efforts nationally by the American Professional Society of ADHD and Related Disorders (APSARD) to develop better guidelines for diagnosing ADHD in adults. 

So, what are some other differences between ADHD and MCI? Here are some things you should know: 

• There are distinguishing characteristics in the memory deficits between ADHD and MCI. People who have cognitive problems because of dementia typically have a noticeable decline in their ability to remember things that have happened recently. This does not occur with ADHD.
• You should consider getting checked for ADHD if you are continuously losing needed things frequently such as keys, eyeglasses, or phones, forgetting appointments, getting distracted during tasks and chores, and needing to focus better when someone is speaking directly to you.
• ADHD is hereditary. You’re nine times more likely to get it if a close relative has it. Many older adults first notice their own ADHD symptoms only when a family member, such as a child or grandchild, gets a diagnosis.
• For those going through menopause, hormonal changes can make women with ADHD more prone to depression, anxiety, and increased inattention.
• With cognitive impairment, short-term memory may be so impaired that you lose track of all kinds of things and important events. Sometimes it gets so severe that longer-term memory is affected, and you become unable to recognize even relatives and close friends. That’s not the case with ADHD. 

Getting Treatment for Adult ADHD 

If you suspect your symptoms may be the result of ADHD, especially if a close family member has received this diagnosis, do not hesitate to ask your primary care physician for a referral to a specialist with expertise in the diagnosis and management of ADHD in older adults. 

If it turns out that you do have ADHD, therapists or coaches can help older adults through the use of behavioral therapies, which may lead to improved time and money management, increased productivity, reduced anxiety, and higher life satisfaction. Medications are also available. Be sure to consult a doctor for a diagnosis and to find a treatment that is best for you.  

Besides treatment, be sure to stay active, as exercise increases brain neurotransmitters such as dopamine, norepinephrine, and serotonin, which can help lessen the severity of symptoms. Also, try to always get a good night’s sleep to help boost alertness and attentiveness. Seek the help of family members with creating structure and simplifying tasks, if needed. Lastly, to stay organized, use of calendars, alarms, written notes, smartphone apps, and lists can be helpful for remembering tasks.  

If you suspect you might have MCI, see a doctor to get diagnosed. For more details, please read my article “Seven Million Americans Have Mild Cognitive Impairment and May Not Know It.” 

Planning for Long-Term Care 

If you or a loved one are in the early stages of dementia, it is likely that your loved one will eventually need long-term care in a nursing home, which in the DC Metro area costs between $14,000–$17,000 a month, a catastrophic amount for most of us. With proper planning, Medicaid will pay for most or all of the nursing home expenses. 

 In cases where a family member is in the early stages of dementia or Alzheimer’s disease, early planning is especially important. The family member needs to make decisions about financial matters while he or she still has the mental capacity to do so. Please make an appointment to plan ahead and discuss options:  

Fairfax Elder Law: 703-691-1888 
Fredericksburg Elder Law: 540-479-1435 
Rockville Elder Law: 301-519-8041 
DC Elder Law: 202-587-2797