ADHD in Later Life Tied to Dementia Risk, Study Finds Fourfold Increase
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- Studi terbaru dari University of Pittsburgh School of Medicine menemukan bahwa orang dewasa dengan ADHD memiliki risiko lebih tinggi mengalami gangguan kognitif ringan di usia lanjut.
- Penelitian yang melibatkan lebih dari 187.000 partisipan ini menunjukkan bahwa faktor genetik ADHD juga berkontribusi terhadap peningkatan risiko demensia, meskipun mekanisme pastinya belum diketahui.
- Para ahli menekankan bahwa ADHD tidak secara langsung menyebabkan demensia, namun penting untuk memantau kesehatan kognitif jangka panjang pada individu dengan kondisi ini.
A recent study led by scientists from the University of Pittsburgh School of Medicine (UPMC) reveals that adults with attention-deficit/hyperactivity disorder (ADHD) are at greater risk of developing mild cognitive impairment later in life. The findings were published in JAMA Psychiatry and are drawing attention because mild cognitive impairment is often a precursor to dementia.
The study analyzed data from 187,341 adults aged 50 and older enrolled in the National Institutes of Health (NIH) All of Us Research Program. Of that number, 3,026 participants were diagnosed with ADHD. As a result, 6.7% of participants with ADHD experienced cognitive decline as they aged, while only 3.4% of participants without ADHD did. This means individuals with ADHD have more than four times the risk of experiencing cognitive impairment compared with those without ADHD.
Notably, this risk remained consistent even after researchers accounted for factors such as age, biological sex, and comorbidities. In addition, when the team calculated genetic risk scores for ADHD, they found that participants with the highest genetic risk had a 35% greater chance of developing dementia compared with those with the lowest genetic risk. These findings provide additional evidence that the association is not solely due to how ADHD is diagnosed or recorded in health care.
Nevertheless, the study did not examine the mechanism behind the association. However, an earlier study from the University of Geneva (UNIGE) in Switzerland published in Psychiatry and Clinical Neuroscience in 2025 offers an early clue. That study used brain imaging with quantitative susceptibility mapping (QSM) via MRI to look for signs of brain changes linked to dementia risk. They observed iron content in the brains of 32 adults with ADHD and 29 without ADHD, and measured levels of the protein neurofilament light chain (NfL) in the blood. As a result, people with ADHD showed different iron accumulation in several brain areas and higher blood NfL levels, both of which are associated with neurodegeneration.
The study's lead author, Douglas Teixeira Leffa, MD, PhD, explained that the reason behind this increased risk remains a major question. "One possibility is that ADHD is associated with lower cognitive reserve or resilience, so people with ADHD may be less able to compensate for age-related pathological changes in the brain, and symptoms such as memory problems may appear earlier," he said. "Another possibility is that people with ADHD are on average more exposed to factors related to poor cognitive health, including sleep problems, cardiometabolic risk, less physical activity, substance use, chronic stress, and social difficulties."
"We need to look beyond ADHD as a condition that only affects attention and concentration. It can affect executive function, sleep, emotion regulation, and overall health throughout a person's life, all of which can shape long-term cognitive well-being."
— Thomas MacLaren, BMBS, MRCPsych, consultant psychiatrist at Re:Cognition Health, London
MacLaren, who was not involved in the study, stressed that we cannot directly conclude that ADHD causes cognitive decline. "This study shows that genetic vulnerability to ADHD may be associated with a greater risk of cognitive impairment later in life. However, we cannot yet say that ADHD directly causes this increased risk. Comorbid conditions such as depression, anxiety, and sleep disorders may also contribute," he explained. He also added that shared genetic factors may play a role.
Both Teixeira Leffa and MacLaren agree that having ADHD does not mean someone will definitely develop dementia. "Most individuals with ADHD in our study did not experience cognitive impairment, and our findings should not be interpreted as evidence that ADHD causes dementia," Teixeira Leffa stressed. "At present, we also do not have convincing evidence that any particular ADHD treatment prevents cognitive impairment later in life."
To maintain brain health, Teixeira Leffa suggests that people with ADHD follow the same advice as the general population: regular physical activity, adequate sleep, managing cardiovascular and metabolic risk factors, avoiding smoking and harmful substances, and staying socially and cognitively active. MacLaren added the importance of seeking appropriate support for ADHD and comorbid conditions. "Treatment can improve symptoms and daily functioning, although we do not yet know whether ADHD medication reduces the risk of dementia in the future," he said.
Going forward, Teixeira Leffa plans to understand why this association exists. "We need long-term studies that follow well-characterized people with ADHD throughout adulthood into later life, ideally with repeated cognitive assessments, biomarkers, and information about treatment and other health and lifestyle factors," he concluded. MacLaren also hopes for research that can distinguish long-standing ADHD symptoms from early signs of cognitive decline, so that early intervention can be carried out without causing unnecessary alarm.
