ADHD in Older Women | 5 Ways Aging Can Intersect with ADHD
ADHD isn’t confined to childhood and can affect women* into their senior years. As women age, they encounter a host of cognitive and hormonal changes, which can further complicate the management of their ADHD symptoms.
The prevalence of ADHD is believed to decline with age, but there is still a lot we don’t know. Adults over the age of 65 with ADHD are typically excluded from ADHD trials and are therefore an understudied segment of the population with ADHD. Furthermore, the majority of people over the age of 65 with ADHD were not diagnosed with ADHD as children and have a high chance of experiencing undiagnosed ADHD. Many signs of normal aging also overlap with symptoms of ADHD and can make it even more difficult to determine if changes in cognitive ability are due to aging or an exacerbation of ADHD symptoms.
Five ways that aging can intersect with symptoms of ADHD in older women
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Menopause
Hormonal changes that naturally come about with perimenopause and menopause can amplify emotional dysregulation and onset greater executive function difficulties often associated with ADHD. For example, dips in estrogen and progesterone during perimenopause and menopause can increase symptoms of ADHD in older women, partly through the influence of these hormones on dopamine levels. Perimenopause can occur anywhere from a few months to ten years before menopause, which means it is possible to have an extended period of hormonal changes influencing ADHD symptoms!
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Normal Age-Related Changes
The cognitive changes that signify normal aging could also be considered hallmark symptoms of ADHD outside of the context of aging. For example, becoming more distractible, having difficulty remembering where things are, struggling with verbal recall, or forgetting details of a conversation can be symptoms of ADHD—but they can also be normative signs of aging. This is true for both men and women. However, on average, women have a faster rate of decline in global cognitive and executive functioning.
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Mobility and Sleep Changes
Changes in physical mobility and sleep are common as we age, but these changes can also impact the presentation of ADHD symptoms. Adequate exercise and sleep are effective strategies to help manage some symptoms of ADHD. However, if an injury or physical health condition restricts movement or mobility, that may mean symptoms of ADHD can feel more prominent, like restlessness. For example, in older adults, particularly women, we see high rates of falls and injuries. Similarly, high quality sleep tends to diminish as we age, which may also make some symptoms of ADHD in older women more prominent.
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Health Comorbidities & Medications
As we age, our rate of co-occurring health conditions tend to increase. Osteoporosis is one such condition that disproportionately impacts older women and has been correlated with cognitive impairments. Relatedly, older adults are more likely to be prescribed medication and to be taking multiple medications. In many cases, medication side effects can actually mimic or worsen ADHD symptoms. For example, medications taken in older adulthood and into seniors years can have side effects that further impact memory and impair cognition.
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Mild Cognitive Impairment and Dementia
Mild cognitive impairment and dementia can also significantly mimic and worsen symptoms of ADHD in older women. Women have a two thirds higher rate of developing dementia, and are twice as likely to be diagnosed with Alzheimer’s disease than men. Some early signs of dementia can include memory loss, difficulty concentrating, struggling to follow a conversation, and mood lability, making it particularly difficult to disentangle for older women if executive function impairments are related to ADHD symptoms or potentially early signs of dementia.
The approach to treating ADHD in older women may require adjustments to accommodate the aging process. Differential diagnosis is important and symptoms of ADHD should be screened.
*Note, while this article predominantly discusses differences in terms of men and women, it is important to note that there are both sex and gender influences on ADHD presentation. Scientific papers vary on which term they use.
