Thanks for your answer, if you can find this article would be great

Hi Andre'

This is a very interesting question. As a developmental paediatrician I have often wondered about long-term implications for children with ADHD apart from those known in psychosocial and psychaitry literature. One could postulate that since frontal lobes and deeper striatal pathways are involved in ADHD maybe this could link to increased risk for dementia? However, I do not know of any specific studies done to examine this question.

Dear Sandra and Marisol. you know that dementia is an extremely difficult field, last year I worked with inequalities in health in the English Longitudinal Study on Ageing (ELSA), and I learned how difficult is to isolate a biological from a social factor. Possibly ADHD can be amplified by social environment and behaviors (drugs, tobacco, alcohol) and determine in the future cognitive decline and dementia.

Thank you Marisol for those references.

There is an interesting article:

A. Golimstok, J L Rojas.

"Previous adult attention- deficit and hiperactivity disorder symptoms and risk of dementia with Lewy bodies: a Case - Control Study".

European Journal of Neurology, 2011; 18(1):78.

It´s important to make a Systematic Review of this topic.

Another article:

Barbara L. Fischer, Gail Gunter- Hunt

The identification and Assesment of Late- Life ADHD in Memory Clinics.

Journal of Attention Disorders May 2012 vol 16 nº 4 333-338.

It´s necessary to make Systematic Review about this theme.

I think it to be one of the really crucial questions of the next decade of ADHD research in adult. As already mentioned dementia is extremly complex and is per se determined as a decline of brain structures.

There are two questions, which need to be clarified at once:

a. Among all the cases which present clinically as dementia the vast majority are not confirmed by reliable diagnostic imaging procedures. So a remarkable part of them may suffer from other illnesses and present as dementia. ADHD as an impairment of all cultural abilities is compensated in many subclinical cases until the age of around 35 years of age. With the natural decline of brain power from that age on the compnsatory mechanisms begin to fail. This failing gets worse with age and can mean a progredient "dissolving" of the former identity of the ADHD-affected. The more traumatic this decline is, the greater the intraindividual conflict is and the thoroughly the basal cognitive abilities are affected.

I saw e.g. a scool director, forced to quit service at the age of 50 and now 5 years later nearly not capable to cope with the daily life she had passed diagnostic process at an university so dementia is doubtless excluded. The grade of impairment resembles a mild to moderate dementia and may increase in the future. I really expect as my personal opinion many cases of clinical diagnosed dementia to be found a worn out ADHD.

b. With the intrapsychal conflicts of the decline of brain function and the observation, that used brain areas grow and not used areas atrophy I don't think it to be impossible, that classical dementia ist the terminal structural result of the ADHD decline process.

Traumatic Brain Injury (TBI) can often produce ADD like symptoms and also those of dementia. For example:

From 2009-2012 my clinics performed the world’s largest brain imaging and rehabilitation study on active and retired professional football players. The results of our study were very clear, a very high percentage of our 135 players had

very clear evidence of traumatic brain injury patterns on their scans and they showed the evidence of it in their lives with a high incidence of depression, dementia, obesity and ADD like symptoms. In fact, 81% of our players complained of attention problems, and showed concentration problems on the psychological testing we performed.

In head injury induced ADD the symptoms follow a significant head injury and frequently look like one of the types of ADD. If the injury just affected the prefrontal cortex it could look like Type 1 or Type 2. If the injury affected the prefrontal cortex and temporal lobes, which is very common because of the location of the temporal lobes, it could look like Type 4. If the injury damaged the anterior cingulate gyrus it could look like Type 3.

People with ADD also have many more medical visits and emergency-room visits and get injured up to 5 times more than others.

I would say that TBI would be the factor which makes these cases of ADD vulnerable to dementia.

Additionally, people with ADD have a tendency toward addictions, such as food, alcohol, drugs, even work. Drug or alcohol addictions cause obvious work problems. Food addictions cause health and self-image problems which can impact work. Addiction to work is also a serious problem, because it causes burnout and family problems that eventually show up as problems at work.

-52 percent of untreated teens and adults abuse drugs or alcohol,

-19 percent smoke cigarettes (compared to 10 percent of the general population)

These negative behaviors contribute to one's risk of dementia and Alzheimer's Disease.

In these cases I would have to say that the negative behaviors associated with ADD would contribute to one's risk for dementia.

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