ADHD in later life

ADHD (attention-deficit/hyperactivity disorder) is a brain-based condition that starts in childhood. It causes ongoing trouble with focus, restlessness or acting on impulse. For many people, it does not go away with age. Some people are only diagnosed in their 60s, 70s or later.^1,3

In later life, ADHD can be hard to spot. Forgetfulness and losing track of tasks can look like normal aging, or like early memory disease. This page explains how ADHD looks after 60, how doctors tell it apart from mild cognitive impairment, and how to use ADHD medicines more safely.

Does ADHD last into old age?

For many people, yes. A 2020 review pooled 20 studies of older adults. About 2 in 100 (2.2%) had strong ADHD symptoms on rating scales. But only about 2 in 1,000 (0.23%) had a doctor's diagnosis, and even fewer were being treated.¹ That gap suggests many older adults live with ADHD without knowing it. A Dutch study found ADHD in about 3 to 4 in 100 people over 60.⁷

ADHD is also being diagnosed more in adults overall. A 2023 U.S. survey found that about 1 in 16 adults (6%) had a current ADHD diagnosis. More than half of them were first diagnosed as adults. People 65 and older made up about 1 in 20 of the adults with ADHD in that survey.²

How it can look after 60. In adults, hyperactivity often turns into an inner sense of restlessness. Trouble paying attention tends to last.⁸ Some people no longer have enough symptoms to meet the full definition, but still struggle day to day.⁸ Older adults with ADHD also report more anxiety, low mood, health problems, loneliness and money stress.⁷ You can read about common symptoms on our page about signs of ADHD in adults.

Why some people first ask about ADHD after 60

Lifelong habits can become harder to manage when life changes. Retirement can remove the daily structure a job used to give. A spouse who handled bills and appointments may get sick or die. Some people start to wonder about ADHD after a child or grandchild is diagnosed and they see themselves in the description.

Others notice new forgetfulness and worry about dementia. A memory clinic visit may then raise the question of ADHD instead.⁴ Whatever the reason, it is worth a careful look. The right answer leads to the right kind of help.

ADHD or mild cognitive impairment?

Mild cognitive impairment, or MCI, means memory or thinking problems that are worse than usual for your age. People with MCI can still take care of themselves and handle daily life. MCI can be an early sign of Alzheimer's disease, but not everyone with MCI gets dementia.⁶ See our full page on mild cognitive impairment.

After age 50, adult ADHD and MCI share many of the same complaints. Both can bring trouble staying focused, poor organization, trouble juggling tasks and forgetfulness. Both often come with sleep problems, depression or anxiety.⁴

Memory tests alone may not tell them apart. In one memory-clinic study, older adults with ADHD and older adults with MCI scored about the same on thinking tests. Both groups scored lower than people without either condition.⁵ The researchers stressed that a detailed life history is the key.⁵

These are clues, not rules. A person can have both lifelong ADHD and a new memory problem. Doctors may need to repeat memory checks over time to see which way things are going. The National Institute on Aging suggests that people with memory problems have their memory checked every 6 to 12 months.⁶

Does ADHD raise the risk of dementia?

Researchers do not know yet. A 2022 review looked at eight studies, most using large health record databases. Several found that people with ADHD had a higher chance of later brain diseases, especially Lewy body diseases.⁹ (Lewy body diseases include Parkinson's disease and Lewy body dementia.)

But the studies had real weaknesses. Some relied on billing codes that can be wrong. Many did not account for things more common in ADHD, such as head injury, smoking and high blood pressure.⁹ The authors said the link is possible but not proven.⁹ Another expert team put it this way: it is still unclear whether ADHD leads to dementia, or is simply being mistaken for early memory loss.⁴

What you can do is the same either way. Protect your brain by treating blood pressure, staying active, not smoking and getting help for hearing loss. See ways to lower your dementia risk.

Other things that can look like ADHD

Many problems common in later life can cause poor focus or forgetfulness. Before calling it ADHD or MCI, a good doctor looks for these:^6,8

• Side effects from medicines, or from taking many medicines together
• Sleep problems, including sleep apnea
• Depression or anxiety
• Low vitamin B12, or thyroid, kidney or liver problems
• Hearing or vision loss
• Long-term pain
• Alcohol or drug use
• Grief, stress or a big life change

Some of these are fully treatable. Our page on treatable conditions that look like dementia has more detail.

Getting a first diagnosis after 60

There is no blood test or brain scan for ADHD. A diagnosis comes from a careful interview about your whole life. In later life, this is harder because memory problems, many medicines, sleep trouble, pain and hearing loss can all blur the picture.⁸

The official definition says several symptoms must have started before age 12.⁷ Many adults do not remember their childhood well, so doctors often talk with someone who knew them back then.⁷ Some studies have described ADHD that seems to start in adulthood. Experts say these findings are debated, and many such people turned out to have had milder signs as children.⁷ If problems with focus truly begin for the first time after 60, doctors look hard for another cause.

1. Write down your story. List the focus, memory or planning problems you have now, and when you first remember having them.
2. Find old clues. School report cards, teacher notes or old work reviews can show patterns from long ago.
3. Bring a helper. A spouse, sibling or close friend can describe what they have seen over the years.
4. Bring every medicine. Include prescriptions, over-the-counter pills, sleep aids and supplements.
5. Ask about memory testing. A full set of thinking tests, often by a neuropsychologist (a specialist in brain and behavior testing), can help sort out ADHD, MCI and mood problems.
6. Plan a follow-up. If the answer is unclear, ask to be checked again in 6 to 12 months.⁶

Our page on getting an adult ADHD diagnosis covers screening tools and what a full evaluation includes.

Medicine safety in later life

Stimulant medicines, such as methylphenidate and amphetamine products, are the first choice for adult ADHD. They work well in the short term for younger adults.⁸ But no controlled trials have tested ADHD medicines in people 50 and older. Reports from clinics suggest they help some older adults. Experts think the benefit may be smaller after about age 65.⁸ Limited research

Checks before starting. Experts advise a full exam and medical history, and an ECG (a quick heart tracing) for older adults.⁸ Your pulse, blood pressure and weight should be checked before treatment and at follow-up visits.^7,8 Your doctor starts low and goes slow.⁸

Risks to know about:

• Heart and blood pressure. Stimulants can raise heart rate and blood pressure. Older adults may be more sensitive to this.⁸ A large Swedish study found that each year of ADHD medicine use was linked to about a 4% higher chance of heart and blood vessel disease, mostly high blood pressure.¹¹ That study only included people up to age 64, so the risk in older adults is not well known.¹¹
• Sleep, appetite and weight. Trouble sleeping, less appetite, weight loss, nervousness, dizziness and headache are common.¹⁰ Weight loss and poor sleep can matter more in older people.⁸
• Eyes and circulation. Tell your doctor if you have glaucoma, or poor blood flow in your fingers or toes.^8,10
• Misuse. Stimulants carry the FDA's strongest (boxed) warning because they can be misused and lead to addiction. Taking more than prescribed can cause overdose.¹⁰
• Mood. Tell your doctor about any history of depression, bipolar disorder or suicidal thoughts.¹⁰

Medicine interactions. Older adults often take many medicines. Stimulants must not be mixed with a group of drugs called MAO inhibitors. These include selegiline and rasagiline, which some people take for Parkinson's disease, and the antibiotic linezolid.^7,10 Some antidepressants, such as fluoxetine and paroxetine, can raise amphetamine levels in the body.⁷ Your pharmacist can check your full list.

Non-stimulant options. Atomoxetine is one non-stimulant ADHD medicine. It can also raise blood pressure and heart rate. It can cause dry mouth, constipation and trouble urinating.¹² These effects may matter more for some older adults. See ADHD medicines for the full range of options.

Talk with your doctor or pharmacist before starting, stopping or changing any medicine.

Help beyond medicine

Treatment for ADHD is not only pills. Therapy, such as cognitive behavioral therapy (CBT), can teach practical skills for planning and follow-through.³ Simple tools often help too: one calendar, phone alarms, a set place for keys and a weekly planning time.

• Therapy and coaching for ADHD
• Everyday strategies for ADHD
• Memory notebook tool
• ADHD with anxiety, depression and substance use

Questions to ask the doctor

Could this be ADHD, MCI or something else?

• What makes you think it is or is not ADHD?
• Should I have full memory and thinking tests?
• Could my medicines, sleep, mood, hearing or thyroid be part of this?
• When should we check again to see if things are changing?

Is ADHD medicine safe for me?

• Do I need an ECG or other heart checks first?
• How will we watch my blood pressure and pulse?
• Does this medicine mix badly with anything I take now?
• What side effects should make me call you?

What else can help?

• Can you refer me to a therapist or coach who works with adults with ADHD?
• Are there groups or classes for older adults with ADHD near me?

When to get help

See your doctor if focus or memory problems are getting worse, worry you or your family, or make it hard to handle bills, medicines or driving.⁶ Also ask for an earlier visit if you get lost in familiar places or keep asking the same questions.⁶

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.