Attention Deficit/Hyperactivity Disorder Symptoms and Cognitive Abilities in the Late-Life Cohort of the PATH through Life Study

Das, Debjani; Cherbuin, Nicolas; Easteal, Simon; Anstey, Kaarin J. · 2014 · OpenAlex-citations

DOI: 10.1371/journal.pone.0086552

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Summary

This study investigates the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) symptoms and their relationship with cognitive abilities in older adults, a demographic historically underrepresented in ADHD research. The authors address the gap in understanding how ADHD persists into late life and how its association with cognitive performance changes with age, particularly in the context of comorbid mood disorders. The research was motivated by the need to determine if diagnostic tools validated for younger adults apply to older populations and to clarify whether cognitive deficits in older adults with ADHD symptoms are direct effects of ADHD or mediated by anxiety and depression. The study utilized data from the third wave of the PATH Through Life Study, a large population-based longitudinal cohort in Australia. The final sample comprised 3,443 participants, divided into a middle-age (MA) cohort (48–52 years) and an older-age (OA) cohort (68–74 years). ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS), while mood symptoms were measured via the Patient Health Questionnaire. Cognitive performance was evaluated using a battery of tests including verbal ability, task-switching, processing speed, memory, and reaction time. The researchers employed multi-group structural equation modeling (SEM) to test the invariance of the ASRS factor structure across age groups and to compare the direct and indirect pathways between ADHD symptoms, mood disorders, and cognitive outcomes. Results indicated that older adults reported significantly lower levels of ADHD, depression, and anxiety symptoms compared to middle-aged adults. Only 2.2% of the OA cohort met the ASRS cut-off for potential ADHD diagnosis, compared to 6.2% of the MA cohort. The ASRS demonstrated the same two-factor structure (inattention and hyperactivity) in both groups, though the covariance between factors was lower in older adults. In the MA cohort, higher ADHD symptoms were generally associated with poorer cognitive performance. However, in the OA cohort, the relationship between ADHD symptoms and cognition was largely indirect, mediated by depression symptoms. Notably, higher inattention symptoms were associated with better verbal ability in both cohorts, and greater hyperactivity was surprisingly associated with better task-switching abilities in older adults. The study concludes that while ADHD symptom prevalence decreases with age, the nature of its impact on cognition shifts significantly. In older adults, depression symptoms are stronger predictors of cognitive performance and likely mediate the effect of ADHD symptoms, suggesting that functional impairments in this age group may be driven more by comorbid mood disorders than by ADHD itself. These findings highlight the necessity for age-appropriate diagnostic criteria and treatment strategies that account for the changing interplay between ADHD, mood disorders, and cognitive decline in late life.

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• cognitive aging