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A study of more than 187,000 U.S. adults aged 50 and older found that participants with ADHD were more likely to develop dementia or cognitive impairment than those without a recorded diagnosis. Genetic risk for ADHD was also associated with higher dementia risk, but the findings do not establish that ADHD causes dementia.
Adults with ADHD were more likely to develop dementia or other cognitive impairment in later life than adults without a recorded ADHD diagnosis, according to a study published October 7 in JAMA Psychiatry. The research, led by University of Pittsburgh School of Medicine investigators, analyzed health and genetic data from more than 187,000 adults aged 50 and older; it found an association, not proof that ADHD causes dementia.
Among participants with ADHD, 6.7% developed dementia or cognitive impairment, compared with 3.4% of participants without ADHD. After accounting for factors including age, sex and other health conditions, the researchers reported that adults with ADHD had more than four times the risk of developing cognitive impairment over time. The study’s combined outcome included dementia and mild cognitive impairment; the reported percentages should not be read as dementia rates alone.
The team also calculated genetic risk scores based on common variants associated with ADHD, including for participants without a formal ADHD diagnosis. People in the highest genetic-risk group had a 35% greater chance of dementia than those in the lowest group. This result is an association between genetic scores and outcomes, not evidence that a particular gene or score predicts an individual’s future condition.
Among participants who developed cognitive impairment, those with a co-occurring ADHD diagnosis reported worse mental health, lower quality of life and less social satisfaction than those with cognitive impairment alone. They also used about 20% more health care in the year after diagnosis, according to the study. The researchers analyzed participants enrolled in the U.S. National Institutes of Health’s All of Us Research Program.
ADHD May Shape Cognitive-Aging Research
The findings add evidence that a history or genetic susceptibility for ADHD may be relevant to research on cognitive aging. Because the study found a relationship in both clinical records and genetic data, the authors say the pattern merits further investigation. It does not, however, establish that ADHD directly leads to dementia, or that every adult with ADHD faces the same level of risk.
The reported differences in quality of life and health-care use also point to possible added needs when ADHD and cognitive impairment occur together. The study does not show which services would improve outcomes, but it gives researchers reason to examine how these conditions interact and whether care for older adults should account for both.
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Records and Genetic Data Combined
The study builds on earlier work from senior author Tharick A. Pascoal’s research group. A 2022 study from the lab linked genetic risk for ADHD with Alzheimer’s-related brain changes in older adults who did not have cognitive impairment. The new report extends that line of inquiry by combining diagnosed ADHD, later-life clinical outcomes and genetic data in a large U.S. sample.
Lead investigators say similar associations had been observed in research from other countries. The current analysis adds U.S. participants and a genetic-risk measure, but remains observational: researchers examined patterns in existing health records and data rather than assigning ADHD or testing an intervention. The findings were published in JAMA Psychiatry under the title “Attention-Deficit/Hyperactivity Disorder and Late-Life Cognitive Impairment.”
“Two different kinds of evidence are pointing in the same direction.”
— Tharick A. Pascoal, senior author and associate professor of psychiatry and neurology at the University of Pittsburgh
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Cause and Prevention Remain Unknown
The study cannot determine whether ADHD itself contributes to dementia risk or whether other factors help explain the association. The researchers considered age, sex and other health conditions, but an observational analysis cannot rule out all differences between groups. Nor does a genetic-risk score establish that someone will develop dementia.
One possible concern is that early, undetected dementia symptoms could sometimes be mistaken for ADHD before a cognitive diagnosis is made. The authors report that the association remained statistically significant when they required at least eight years between ADHD diagnosis and cognitive impairment, making that explanation less likely to account for the entire finding. It does not rule it out completely. The study also did not establish whether ADHD medication affects later dementia risk or whether cardiovascular-health management changes the association.
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Further Studies to Test Possible Factors
The researchers say more work is needed to identify what may explain the relationship and whether any influences can be changed. Future studies could examine the timing of ADHD and cognitive symptoms, the role of cardiovascular health, and whether ADHD treatments are associated with different cognitive outcomes over time. Those questions were not answered by this analysis.
For now, the report adds an association for researchers to investigate; it does not support a conclusion that ADHD causes dementia or that a particular treatment prevents it. The next evidence will depend on further studies designed to test possible mechanisms and follow cognitive outcomes over time.
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Key Questions
Does this study prove that ADHD causes dementia?
No. The study found an association between ADHD and later-life cognitive impairment, but its observational design cannot establish that ADHD causes dementia.
How many participants developed cognitive impairment?
The report says 6.7% of participants with ADHD and 3.4% of those without ADHD developed dementia or cognitive impairment. The combined outcome includes mild cognitive impairment, so these figures are not dementia-only rates.
What did the genetic analysis find?
Participants in the highest ADHD genetic-risk group had a 35% greater chance of dementia than those in the lowest group. A genetic-risk score is not a diagnosis or a prediction for any one person.
Did the researchers find that ADHD medication prevents dementia?
No. Whether ADHD medicines, including stimulants, affect dementia risk remains unanswered; the study did not test medication as a prevention strategy.
What should readers take away from the findings?
The results support further research into ADHD and cognitive aging, but they do not establish an individual’s risk or show that a specific action prevents dementia. The researchers identified cardiovascular health and ADHD treatment as questions for future study.
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