Adult ADHD: Risk Factor for Dementia or Phenotypic Mimic?
Adult ADHD: Risk Factor for Dementia or Phenotypic Mimic?
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DOI：
10.3389/fnagi.2017.00260
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发表时间：
2017-08-03
影响因子：
4.8
通讯作者：
Black, Sandra E.
中科院分区：
文献类型：
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作者：
Callahan, Brandy L.;Bierstone, Daniel;Black, Sandra E.
注意力缺陷多动障碍（ADHD）历来被认为是一种儿童和青少年时期的疾病。然而，现在人们认识到，多达 60% 的人 ADHD 症状持续到成年。 ADHD 的一些认知症状（无法提供持续的注意力或脑力劳动、组织或多任务困难、健忘）可能与前驱痴呆的症状非常相似，也通常称为轻度认知障碍 (MCI)，特别是在 50 岁以上的患者中。除了认知症状的重叠之外，患有 ADHD 的成年人和患有 MCI 的成年人还可能有许多共同的行为和精神症状，包括睡眠障碍、抑郁和焦虑。因此，在老年患者中，这两种综合征可能很难在临床上区分，特别是那些因主观认知问题而到记忆诊所就诊并担心神经退行性过程发生的患者：是多动症、轻度认知障碍还是两者兼而有之？目前，尚不清楚 ADHD 是否与早期痴呆有关，或者由于症状重叠而被误诊为 MCI，因为现有数据支持这两种可能性。在这里，我们的目的是通过概述 ADHD 和 MCI 可能相互关联的三种假设方式来阐明这个问题，概述与每个假设相关的证据，并描绘未来研究的领域。这是一个相当重要的问题，对于提高早期痴呆症的诊断特异性、提高疾病患病率估计的准确性以及更好地识别个体进行针对性治疗具有重要意义。
Attention-deficit hyperactivity disorder (ADHD) has historically been considered a disorder of childhood and adolescence. However, it is now recognized that ADHD symptoms persist into adulthood in up to 60% of individuals. Some of the cognitive symptoms that characterize ADHD (inability to provide sustained attention or mental effort, difficulty organizing or multi-tasking, forgetfulness) may closely resemble symptoms of prodromal dementia, also often referred to as mild cognitive impairment (MCI), particularly in patients over age 50. In addition to the overlap in cognitive symptoms, adults with ADHD and those with MCI may also share a number of behavioral and psychiatric symptoms, including sleep disturbances, depression, and anxiety. As a result, both syndromes may be difficult to distinguish clinically in older patients, particularly those who present to memory clinics with subjective cognitive complaints and fear the onset of a neurodegenerative process: is it ADHD, MCI, or both? Currently, it is unclear whether ADHD is associated with incipient dementia or is being misdiagnosed as MCI due to symptom overlap, as there exist data supporting either possibility. Here, we aim to elucidate this issue by outlining three hypothetical ways in which ADHD and MCI might relate to each other, providing an overview of the evidence relevant to each hypothesis, and delineating areas for future research. This is a question of considerable importance, with implications for improved diagnostic specificity of early dementia, improved accuracy of disease prevalence estimates, and better identification of individuals for targeted treatment.