A systematic review of neuroimaging studies of adults aged 35 and older with clinical, symptomatic and genetic risk for attention-deficit/hyperactivity disorder.

TL;DR

This systematic review of 13 neuroimaging studies in adults ≥35 years with clinical, symptomatic, or genetic ADHD risk found persistent fronto-striatal and fronto-parietal alterations with age-dependent patterns. ADHD-related brain changes may interact with aging and neuropathology, particularly Alzheimer's disease processes, highlighting a potential link between ADHD and cognitive decline in later life.

Key findings

• ADHD groups showed altered fronto-striatal, fronto-parietal, and limbic systems involved in executive control and attention compared to controls
• Middle-aged adults with clinical ADHD displayed more widespread cortical differences, while older adults showed primarily frontal abnormalities, suggesting age-dependent attenuation
• Functional imaging revealed frontal hypoactivation with compensatory parietal hyperactivation in those with clinical ADHD
• Genetic ADHD risk interacted with Alzheimer's disease pathology in undiagnosed samples, affecting brain and cognitive outcomes

Why this matters at the bedside

Understanding persistent ADHD-related brain alterations into older age is relevant for recognizing cognitive decline mechanisms and potential dementia risk in aging ADHD populations, informing clinical monitoring strategies.