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A study following 187,341 U.S. adults aged 50 and older found that people with ADHD had a higher risk of mild cognitive impairment or dementia than those without ADHD. Genetic risk analyses also pointed to an association, but the researchers said the findings do not show that ADHD causes cognitive decline or whether treatment changes risk.
A study of 187,341 U.S. adults aged 50 and older found that participants with attention deficit-hyperactivity disorder (ADHD) had a substantially higher rate of later mild cognitive impairment or dementia than participants without ADHD. The findings, published in JAMA Psychiatry, also linked higher genetic risk for ADHD with cognitive impairment, but do not establish that ADHD causes dementia.
Tharick Pascoal, MD, PhD, of the University of Pittsburgh, and colleagues analyzed participants in the All of Us Research Program who had electronic health records and genomic data. The cohort had a mean age of 56, and researchers followed participants for an average of 10.26 years. ADHD and cognitive impairment were identified using health-record algorithms requiring multiple diagnoses or medication records.
After accounting for age, sex and health conditions, an ADHD diagnosis was associated with a hazard ratio of 4.60 for developing mild cognitive impairment or dementia compared with no ADHD diagnosis. The researchers reported a 95% confidence interval of 3.99 to 5.29. The association weakened but remained after further adjustments for factors including comorbidities, education and healthcare use. In an analysis focused on dementia outcomes, the reported hazard ratio was 3.07 (95% CI 2.12-4.44).
In the cohort, 1.6% had ADHD. Cognitive impairment was recorded in 6.7% of participants with ADHD and 3.4% of those without it. Separately, participants in the highest fifth of genetic ADHD risk had a 35% higher rate of incident cognitive impairment than those in the lowest fifth (HR 1.35, 95% CI 1.25-1.46). This genetic analysis supports an association but does not show that genetic risk itself causes cognitive impairment.
The Association Extends Beyond Diagnosis
The study matters because it examines a possible connection between ADHD and cognitive aging in a large U.S. cohort, using both clinical records and genetic-risk estimates. The agreement between these two approaches adds evidence that the observed pattern is not limited to one measure of ADHD, according to the researchers. It does not, however, settle why the association appears or whether it can be altered.
The researchers also reported that, among participants who developed cognitive impairment, those with ADHD had higher odds of suboptimal mental health, quality of life and social satisfaction. They also had greater healthcare use. These results suggest the association may involve care needs beyond cognitive diagnoses, although the study cannot determine what drives those differences.
The findings should not be read as a prediction that an individual with ADHD will develop dementia. The reported percentages describe this study cohort, and observational results can reflect other differences between groups. The study does not test a prevention strategy or support changing ADHD treatment to reduce dementia risk.
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How Researchers Built the Comparison
The analysis drew on adults with both electronic health record and genomic information in the All of Us Research Program. Researchers adjusted for factors including sex at birth, self-identified race and ethnicity, cohort-entry year and APOE4 status. The cohort was 57.3% female; 61.6% of participants were White, 17.3% Black and 13.6% Hispanic.
The team described the work as the largest and most comprehensive study to date to combine ADHD diagnoses and genetic risk scores in the same population. It builds on earlier research by Pascoal and colleagues, including a 2022 study connecting genetic ADHD risk with cognitive decline and Alzheimer’s disease-related processes in cognitively normal older adults. A separate study in Israel suggested that adults diagnosed with ADHD later in life who received stimulant treatment did not have elevated dementia risk, but confounding could not be ruled out.
“Two different kinds of evidence are pointing in the same direction.”
— Tharick Pascoal, study author and University of Pittsburgh researcher
Cause and Treatment Effects Remain Open
The study cannot show that ADHD causes dementia or mild cognitive impairment. Residual confounding may remain even after statistical adjustments, the authors said. Because dementia can develop over a long period, early changes related to the disease might also affect ADHD recognition or diagnosis, creating a possibility of reverse causation.
The authors also cautioned that volunteer participation in All of Us may limit how well the results apply to the broader population. The data do not answer whether treating ADHD changes later cognitive risk. The Israeli treatment study cited by the researchers cannot resolve that question because confounding could not be excluded. The study’s percentages and risk estimates should be understood as findings from this particular cohort, not as an individual prognosis.
Treatment Research Is the Next Test
The immediate next step is further research into whether ADHD treatment is associated with a different cognitive trajectory, and whether the observed link persists in other populations and study designs. The authors identified treatment effects as an unanswered question; this report does not announce a clinical trial or a change to care guidance.
For now, the study adds evidence of an association rather than a basis for altering treatment. Future studies would need to account for the timing of ADHD diagnosis, treatment exposure, other health conditions and the long lead-up to dementia. Until those questions are addressed, whether ADHD contributes directly to late-life cognitive impairment—and whether treatment can modify that risk—remains unclear.
Key Questions
Does this study show that ADHD causes dementia?
No. It found an association between ADHD and later cognitive impairment, but its observational design cannot establish cause and effect.
How much higher was the reported risk?
After adjustment for age, sex and health conditions, the reported hazard ratio for mild cognitive impairment or dementia was 4.60 for participants with ADHD versus those without. The estimate weakened with additional adjustments but remained elevated.
Did the researchers find that ADHD medication prevents dementia?
No. The study did not test whether treatment changes cognitive risk. The authors said treatment effects remain an unanswered research question.
Who was included in the study?
The researchers analyzed 187,341 adults aged 50 and older with electronic health record and genomic data in the All of Us Research Program. Participants were followed for an average of 10.26 years.
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