Prevalence of attention deficit hyperactivity disorder in elderly individuals, clinical characteristics, and the relationship with quality of life

Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that starts in childhood and can continue in adolescence, adulthood and even elderliness. The clinical presentation in adults and the elderly may be quite different from what is known in children. Moreover, the excess of comorbid conditions results in misdiagnosis, inadequate treatment, polypharmacy, impaired functionality and a serious financial burden in these patients. Material and Method: 70 patients who were aged 65 and over and who admitted to Çukurova University Faculty of Medicine, Balcalı Hospital, Department of Psychiatry, and 70 controls with similar socio-demographic characteristics were included in our study. After the participants had been informed, the socio-demographic data form which was by the researchers was filled in during the interview and the Structured Clinical Interview-Clinical Version (SCID-5-CV) for DSM-5 Disorders was performed. Standardized Mini Mental Test/Mini Mental Test for the Uneducated was used to determine the accompanying dementia. Wender Utah Rating Scale was used to question childhood ADHD symptoms of the participants, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) was used to detect their adult ADHD symptoms; Barratt Impulsivity Scale-11 (BIS-11), Standardized Beck Anxiety Inventory (BAI), Geriatric Depression Scale Short Form (GDS-SF) were used to evaluate accompanying symptoms and the participants were asked to fill out the Quality of Life Scale for the Elderly (OPQOL-brief) tests in order to evaluate their quality of life. Results: In our study, the prevalence of childhood ADHD (C-ADHD) was found 26%, and the prevalence of adult ADHD (A-ADHD) was found 11% among elderly patients who were under the follow-up in our outpatient clinic. The prevalence of C-ADHD in the control group was 4.2%. When gender ratios, years of education, marital status, and smoking were taken into consideration, no significant difference was found in terms of C-ADHD or A-ADHD in both groups. The rate of alcohol use is significantly higher among patients who were diagnosed with C-ADHD that were under the follow-up in our outpatient clinic. 62.5% of patients with A-ADHD were accompanied by Depressive Disorder, 12.5% were accompanied by Anxiety Disorder, 25% were accompanied by other psychiatric disorders and 87.5% were accompanied by physical illness. The GDS-SF and BAS scores of the patients diagnosed with A-ADHD were found to be significantly higher than those without a diagnosis of A-ADHD. There was no significant difference between the groups in terms of the incidence of mental illness in the families of the patients who were diagnosed with A-ADHD. The rate of suicide attempt, experiencing a forensic event and being involved in a traffic accident were statistically higher in the patients with C-ADHD, but no significant difference was found in terms of the presence of A-ADHD. When the effects of the diseases on the quality of life were taken into consideration, no significant relationship was found between the groups in terms of C-ADHD or A-ADHD. When we dealt with the relationship between impulsivity and C-ADHD, BIS-11-total and all subscale scores were found to be significantly higher in patients who were diagnosed with CO-ADHD compared to those who were diagnosed without C-ADHD. On the other hand, a significant correlation was found between BIS-11-motor subscale scores in patients with A-ADHD. In our study, no relationship was found between the presence of ADHD and MMSE scores. Conclusion: In our study, the prevalence of C-ADHD and A-ADHD was found to be higher in the clinical sample compared to epidemiological studies. Besides, the presence of C-ADHD was found to be closely correlated with impulsivity. It was also noted that comorbid psychiatric diseases and accompanying physiological diseases were very common in people with A-ADHD. However, the number of participants in our study was limited and there is a need to clarify the prevalence, etiology, diagnosis and treatment algorithms of the disease through studies that are carried out with larger samples. Keywords: Attention deficit hyperactivity disorder, elderliness, prevalence