TL;DR
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A study published in JAMA Psychiatry found that adults with ADHD were more likely to develop dementia or mild cognitive impairment in later life than adults without ADHD. The observational findings show an association, not proof that ADHD causes cognitive decline; researchers also found a link with genetic risk for ADHD.
A study of more than 187,000 U.S. adults aged 50 and older found that participants with attention-deficit/hyperactivity disorder (ADHD) were more likely to develop dementia or mild cognitive impairment than those without ADHD. Published October 7 in JAMA Psychiatry, the research also linked higher genetic risk for ADHD with greater dementia risk, but it does not establish that ADHD causes cognitive decline.
Researchers led by the University of Pittsburgh School of Medicine analyzed health records and genetic data from people enrolled in the National Institutes of Health’s All of Us Research Program. During the study, 6.7% of participants with ADHD developed dementia or cognitive impairment, compared with 3.4% of participants without ADHD. These percentages describe the groups in this study; they do not, on their own, establish an individual’s likelihood of developing the condition.
After accounting for factors including age, sex and other health conditions, the team reported that participants with ADHD had more than four times the risk of developing cognitive impairment over time. The researchers also calculated genetic risk scores based on common genetic variants associated with ADHD. Participants with the highest scores had a 35% greater chance of dementia than those with the lowest scores. A genetic risk score indicates statistical association; it is not a diagnosis of ADHD or a prediction that a particular person will develop dementia.
The study also examined outcomes among participants who developed cognitive impairment. Those with a recorded ADHD diagnosis reported worse mental health, lower quality of life and less social satisfaction than those with cognitive impairment alone. They used about 20% more health care in the year after diagnosis, according to the report. These findings describe differences within the study population and do not establish why they occurred.
ADHD and Cognitive Aging
The findings add evidence that ADHD may be relevant to cognitive health in later life, a period when dementia and mild cognitive impairment become more common. The study’s combination of health records and genetic data offers researchers two ways to examine the association in the same population. That may help guide further investigation into how ADHD, health conditions and cognitive aging relate.
The results could also matter for support needs after a cognitive impairment diagnosis. In this study, participants with both conditions reported lower quality of life and used more health care. Those observations point to a possible added care burden, though the research does not show that ADHD itself caused the differences or indicate what specific care would improve outcomes.
For readers, the study is not evidence that an ADHD diagnosis means dementia is inevitable. Nor does it show that treating ADHD prevents dementia. The authors identify unanswered questions about possible explanations and modifiable factors, including cardiovascular health and ADHD medication use.
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How Researchers Tested the Link
The study builds on earlier work from senior author Tharick A. Pascoal’s research group. A 2022 study linked genetic risk for ADHD with Alzheimer’s-related brain changes in older adults who had no cognitive impairment. The new research examined clinical diagnoses and genetic information together in a larger U.S. sample, extending that line of investigation.
One challenge in studying ADHD and dementia is that early cognitive symptoms might be mistaken for ADHD before dementia is formally identified. The researchers tested this possibility by requiring at least eight years between an ADHD diagnosis and the onset of cognitive impairment. The association remained statistically significant under that analysis, which makes this explanation less likely to account for the entire finding but does not rule out other sources of bias or confounding.
The study was published as “Attention-Deficit/Hyperactivity Disorder and Late-Life Cognitive Impairment” in JAMA Psychiatry. Its reported results are associations drawn from health records and genetic data, rather than evidence from a trial that assigned treatment or established a biological cause.
“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 show that ADHD causes dementia or mild cognitive impairment. Health-record studies can identify associations, but factors not fully captured in the data may contribute to the results. The genetic analysis also indicates a relationship between inherited variants and outcomes at a group level; it does not establish how those variants affect an individual’s health.
Researchers said it remains unclear whether ADHD medications, including stimulants, change dementia risk over time. They also raised the possibility that cardiovascular health—already associated with both ADHD and dementia—could help explain some of the relationship, but the study did not establish that improving cardiovascular health would prevent cognitive impairment.
The source report does not provide enough detail to determine how the findings apply across different demographic groups, how ADHD or cognitive impairment may have been missed in some records, or whether the results extend to populations outside the All of Us sample. The eight-year analysis addresses one possible explanation involving early symptoms, not every limitation of observational research.
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Questions for Future Studies
The researchers say additional work is needed to identify what may drive the observed association and whether any contributing factors can be changed. Studies tracking participants over longer periods could clarify when cognitive changes emerge relative to ADHD diagnosis and how treatment histories relate to later outcomes.
Further research could also examine cardiovascular health and ADHD medication use directly, while testing whether the reported patterns hold in other populations. Until such evidence is available, the findings support further study of ADHD and cognitive aging, not a conclusion that ADHD treatment prevents dementia or that people with ADHD will develop it.
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Key Questions
Does this study prove 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 large was the study?
Researchers analyzed health records and genetic data from more than 187,000 adults aged 50 and older enrolled in the NIH All of Us Research Program.
What did the study find about genetic risk?
Participants with the highest genetic risk scores for ADHD had a 35% greater chance of dementia than those with the lowest scores. The score reflects genetic associations and is not a personal diagnosis or prediction.
Do ADHD medications reduce dementia risk?
The study did not answer whether stimulants or other ADHD medications affect later dementia risk. The researchers identified medication use as a question for future research.
What remains uncertain?
Researchers have not established the cause of the association, whether cardiovascular health or treatment affects it, or how well the results apply beyond the study population. The findings do not mean that everyone with ADHD will develop dementia.
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