Neuropsychological deficits in adults age 60 and above with attention deficit hyperactivity disorder

Nordic Journal of Psychiatry

Holst

Sjöwall

2019

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age !60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD. Methods: The study included 158 participants in three groups: (1) older adults (60-75 years of age) with ADHD (n ¼ 42), (2) healthy controls of the same age (n ¼ 58), and (3) younger adults (age 18-45 years of age) with ADHD (n ¼ 56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests. Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels. Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients. ARTICLE HISTORY

Section: Adhd In Older Adulthoodcontrasting

confidence: 46%

Section: Adhd In Older Adulthoodmentioning

confidence: 99%

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Nordic Journal of Psychiatry

Holst

Sjöwall

2019

“…This finding is in line with the dual pathway hypothesis (Sonuga-Barke, 2003). In addition, it has been shown that the overlap between working memory, inhibition, and speed of processing is larger in younger (18-45 years) than in older adults (60-75 years), with 11% of older adults and 30% of younger adults showing deficits in all three domains (Thorell, Holst, et al, 2017). There are very few studies examining the extent to which emotion dysregulation overlaps with other neuropsychological deficits in relation to adult ADHD.…”

Section: Overlap Between Different Neuropsychological Deficits In Adhdsupporting

confidence: 87%

Neuropsychological deficits in relation to ADHD symptoms, quality of life, and daily life functioning in young adulthood

Sjöwall

Applied Neuropsychology: Adult

2019

Attention-deficit/hyperactivity disorder (ADHD) is related to multiple neuropsychological deficits. However, most previous studies, especially studies of adult samples, have not taken the overlap between different neuropsychological deficits into account. In addition, the link between neuropsychological deficits and daily life functioning and quality of life needs to be further investigated. The aim was therefore to investigate the independent effects of executive deficits, delay-related behaviors and emotion dysregulation on ADHD symptom levels, daily life functioning, and quality of life in a non-clinical sample of younger adults. Results showed independent effects of all three neuropsychological deficits on the two ADHD symptom domains. With regard to daily life functioning and quality of life, bivariate relations were found to all three neuropsychological deficits. However, it was primarily the associations to executive deficits that remained significant when studying independent effects. Executive deficits were related to daily life functioning and quality of life also when controlling for ADHD symptom levels. Conclusively, this study shows that ADHD is related to multiple neuropsychological deficits, even in adulthood. Previous studies may have overestimated the importance of delay-related behaviors and emotion dysregulation for daily life functioning, as they have failed to control for the effects of executive deficits.

“…2,3 A cross-national prevalence of 2.8% has been reported for ADHD in young to middle adulthood. [8][9][10] Regarding cognitive functioning, results are less clear with one recent study showing lower performance on several neuropsychological measures among older adults with ADHD compared with healthy matched controls, 11 while another study demonstrated no differences after controlling for comorbid depression. 6,7 Adults with ADHD aged 60 years and older have been found to have similar impairments as younger adults with ADHD in terms of comorbid psychiatric disorders (eg, mood and anxiety disorders), equally lower educational achievements, impaired social functioning, and lower quality of life.…”

mentioning

confidence: 99%

“…6,7 Adults with ADHD aged 60 years and older have been found to have similar impairments as younger adults with ADHD in terms of comorbid psychiatric disorders (eg, mood and anxiety disorders), equally lower educational achievements, impaired social functioning, and lower quality of life. [8][9][10] Regarding cognitive functioning, results are less clear with one recent study showing lower performance on several neuropsychological measures among older adults with ADHD compared with healthy matched controls, 11 while another study demonstrated no differences after controlling for comorbid depression. 12 Thus, ADHD has been shown to be a serious condition with large functional impairments also in older adults, and this calls for validation of psychometric assessment tools for ADHD in this age group.…”

mentioning

confidence: 99%

Objective assessment of attention‐deficit/hyperactivity disorder in older adults compared with controls using the QbTest

Bijlenga

Ulberstad

Int J Geriat Psychiatry

et al. 2019

Objectives Attention‐deficit/hyperactivity disorder (ADHD) persists into old age, with prevalence rates of 2.8% to 3.3% in adults over 60 years of age. Most diagnostic assessment tools are not validated for older adults. The Quantified behavioral Test (QbTest) is an objective assessment for the core symptoms of ADHD and is validated for children and younger adults. We investigated whether the QbTest can be used to differentiate between older adults with ADHD and healthy controls. Methods Older adults aged 55 to 79 years with (n = 97) or without (n = 112) ADHD were assessed with the QbTest. They also rated their ADHD symptom severity. QbTest raw scores were compared between groups. Factor scores were computed using factor loadings from a confirmatory factor analysis (CFA). Multilevel regressions were used to determine effects of background characteristics and comorbidity. Logistic regressions were performed to determine whether the QbTest differentiated between patients with ADHD and healthy controls. Results The factor structure of the CFA was comparable with that of younger age groups. Older age was associated with higher Inattention score. Parameters comprising the factors Hyperactivity and Inattention, but not Impulsivity, were shown to contribute significantly in differentiating between the groups. The QbTest had a correct classification rate of 70%, which was increased to 91% when combining QbTest scores and self‐reports of ADHD symptom severity. Conclusions The QbTest is feasible for older adults, and the factors Hyperactivity and Inattention are valid parameters for the diagnostic assessment of ADHD in older adults, when used in addition to self‐reports.