Key takeaways:

• Researchers examined ADHD diagnoses and polygenic risk scores that gauge genetic risk.
• Comorbid ADHD and cognitive impairment diagnoses were also associated with poorer mental health and quality of life.

Among people aged 50 years and older, ADHD was associated with a more than four-fold higher risk for cognitive impairment, according to research published in JAMA Psychiatry.

Individuals with ADHD who developed cognitive impairment also reported poorer mental health, quality of life and social satisfaction, which suggests broader implications for overall well-being, said Douglas Teixeira Leffa, MD, PhD, a psychiatrist and former resident with the University of Pittsburgh Medical Center, where the research was conducted.

Data derived from Bauer-Negrini G, et al. JAMA Psychiatry. 2026: doi:10.1001/jamapsychiatry.2026.3165.

“As people with ADHD age, clinicians should also be attentive to meaningful changes in memory or other aspects of cognition rather than attributing new difficulties to longstanding ADHD,” Leffa told Healio.

Researchers examined data from 187,341 people (mean age, 56.41 years; 57% female) enrolled in the U.S. All of Us Research Program between May 2018 and October 2023 and for whom electronic health records dated back to January 1985.

All individuals included in the study were aged 50 years or older. Mean follow-up was 10.26 years.

In addition to checking ADHD diagnoses through the EHR, researchers examined ADHD polygenic risk score (ADHD PRS), a genetic summary score that is used to distinguish individuals with higher versus lower genetic liability for ADHD.

According to Leffa and colleagues, the study was the first of its kind to examine whether an ADHD diagnosis and ADHD PRS data provided complimentary findings about risk for mild cognitive impairment (MCI).

It was also the first study to explore associations between ADHD diagnosis and self-reported healthcare use, they added.

A total of 1.6% of the study population was diagnosed with ADHD, while 3.4% received a diagnosis of either MCI or dementia.

Results showed that people with ADHD had a more than four-fold higher risk for cognitive impairment compared with those who did not have ADHD (HR = 4.6; 95% CI, 3.99–5.29).

After adjusting for neuropsychiatric comorbidities, the association attenuated but remained significant (HR = 3.19; 95% CI, 2.76–3.68), the researchers wrote.

Laffa said the direction of the association was consistent with prior research.

“Our study adds to this literature by demonstrating convergence of clinical and genetic findings within the same population, which gives us greater confidence that the association is not simply explained by how ADHD is diagnosed or documented in clinical records,” he said.

Researchers also saw an association between ADHD PRS and MCI or dementia. People within the highest quintile of ADHD PRS were significantly more likely to develop cognitive impairment than those in the lowest quintile (HR = 1.35; 95% CI, 1.25–1.46).

Among those who developed cognitive impairment, a comorbid ADHD diagnosis was associated with suboptimal mental health (OR = 1.69; 95% CI, 1.18–2.39), quality of life (OR = 1.66; 95% CI, 1.14–2.39) and social satisfaction (OR = 2.39; 95% CI, 1.69–3.37).

People with ADHD also had a 20% higher use of healthcare (IRR = 1.2; 95% CI, 1.09–1.34) and a 34% higher outpatient visit rates (IRR = 1.34; 95% CI, 1.15–1.56).

Associations with ADHD PRS and suboptimal mental health, quality of life and social satisfaction were more limited. This indicates that genetic liability for ADHD alone does not capture the burden of fully expressed ADHD, according to the authors.

However, higher ADHD PRS was associated with 42% higher ED visit rates (IRR = 1.42; 95% CI, 1.15–1.75).

Leffa emphasized that most individuals with ADHD in the study did not develop cognitive impairment, and the findings should not be interpreted as demonstrating that ADHD causes dementia.

Moving forward, Leffa said future research needs to explore why the association exists and whether pathways linking ADHD to cognitive impairment are modifiable.

A long-term study that follows people with ADHD throughout adulthood and into older age could provide more insight into whether ADHD treatment prevents later cognitive decline, he added.

Leffa and colleagues said the findings support the need for targeted monitoring and integrated care for older people with ADHD as a way to potentially lower risk.

“Clinicians can support patients by emphasizing factors that are also important for brain health in the general population, such as regular physical activity, good sleep, management of cardiovascular and metabolic risk factors, avoiding smoking and harmful substance use, and remaining socially and cognitively engaged,” Leffa told Healio.

For more information:

Douglas Teixeira Leffa, MD, PhD, can be reached at neurology@healio.com.