Attention deficit oh look a puppy

But wait, does it lead to ... ???

Spend your professional life interviewing people like I have, and you notice a few patterns.

One has to do with what therapists call a doorknob confession: something people mention toward the end of an interview, sometimes disguised as gallows humor.

It’s often a dark joke about their fear of spending decades building a life, only to develop cognitive decline, and perhaps even become a burden to others.

It’s not every interview, of course, but often enough to notice.

Now, combine that recurring theme with the fact that I’m one of the probably millions of people who reached middle age only to be diagnosed with ADHD, and you’ll understand why I sat up and took notice when I came across an alarming study published in JAMA Psychiatry.

Scientists at the University of Pittsburgh School of Medicine examined health records and genetic data from 187,341 Americans ages 50 and older, and found that adults with diagnosed ADHD had a substantially higher likelihood of developing mild cognitive impairment or dementia.

I mean, seriously? I immediately did three things:

1. I resolved to contact the researchers behind this study and grill them on their findings.

2. Next, I drove my daughter to school, wrote the first draft of a completely unrelated newsletter entry, made some eggs for breakfast, checked my email, played four games of online chess (rapid), made a minor but potentially useful revision of the workflow for my Life Story Magic business, began to brainstorm ideas for Inc.com articles, and then remembered the ADHD study I’d set out to write about to begin with.

3. Finally, I dug up the contact info and reached out.

Fortunately, one of the researchers replied.

This was a statistical study, so the numbers matter. The findings were as follows:

First, in their initial adjusted analysis, the researchers calculated a 4.6-fold higher hazard of developing cognitive impairment among participants with ADHD.

Further adjustments, accounting for things like other health conditions, education, and health care utilization, reduced that estimate, although the association remained significant.

Next, in terms of the actual number of people affected, 6.7 percent of participants with ADHD developed mild cognitive impairment or dementia during the observation period, compared with 3.4 percent of those without ADHD.

The researchers also examined genetic predisposition to ADHD and found that participants with the highest genetic susceptibility had a 35 percent higher hazard of cognitive impairment than those with the lowest.

None of this establishes that ADHD causes dementia. But, it still doesn’t sound very good.

Of course, came up with questions, rapid-fire now. Maybe the study wasn’t all it seemed?

I mean, could it be possible that a lot of people who probably have ADHD never actually get a diagnosis? Would’t that have an effect?

Also, could people with ADHD diagnoses be more likely to have cognitive issues identified?

I mean, if they have an ADHD diagnosis, suggests they’re the kind of person who goes to the doctor in the first place.

Or else, maybe people with ADHD diagnoses are simply more likely to live long enough to develop dementia. Maybe their doctors catch other health problems earlier, before they lead to shorter lifespan?

“That is a great question, and those are exactly some of the issues we tried to address in our analyses. You are right that some people who likely have ADHD may never receive a diagnosis,” replied Douglas Teixiera Leffa, M.D., Ph.D., co-first author on the study, adding: “We tried to account for this … and the association remained present.”

That’s partly why the researchers also examined genetic susceptibility to ADHD.

They found an association with cognitive impairment even among people without ADHD diagnoses, making it less likely that these differences could explain the entire finding.

Still, maybe this is just me coping again, but even taking the findings seriously, I keep coming back to the actual percentages.

During the study’s observation period, 6.7 percent of participants with ADHD developed cognitive impairment, compared with 3.4 percent without ADHD. That’s a meaningful difference, certainly, but both are still fairly low numbers.

And they’re not estimates of anyone’s lifetime risk.

I asked point-blank: If a friend in their 50s or 60s with ADHD read this and called you, worried, what would you tell them?

“The first thing I would emphasize is that having ADHD does not mean that someone will develop dementia,” Leffa said. “Most individuals with ADHD in our study did not develop cognitive impairment, and our findings should not be interpreted as demonstrating that ADHD causes dementia.”

In the meantime, Leffa added, most of what any of us can do differently really consists of the same things we’d do for better brain health in general. Things like:

• Getting regular physical activity.

• Putting a focus on getting good sleep.

• Managing cardiovascular and metabolic risk factors.

• Not smoking and avoiding harmful substance use.

• Staying socially and cognitively engaged.

And my own addition: Maybe trying not to worry about things we can’t control.

Sounds like a good place to start.

I’ll begin right after just one more game of online chess.

Thank you for reading Understandably! If someone shared this with you, please sign up here for a free or paid subscription. I’m also grateful for one-off support (via Buy Me a Coffee) that helps me keep this whole thing going!

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Other things worth knowing …

• Axios: Stephen Miller, the new White House chief of staff starting today is unlike anyone who has occupied the powerful position in the modern era. He believes in almost limitless presidential power, considers the Democratic Party an extremist organization, and dreams of ruthless crackdowns on immigration and foreign adversaries. He puts the hard in hard-liner and understands how to pull the levers of power to get his way and make the U.S. government a MAGA machine. Miller’s appointment sets the stage for two years of partisan warfare.

• WSJ: With a vote on his impeachment looming next week, Defense Secretary Pete Hegseth is digging in his heels and vowing to stay at his Pentagon post for the rest of the Trump administration. If his congressional opponents vote to impeach him, Hegseth will seek to use the confrontation as a platform to aggressively defend his agenda, which includes the war with Iran, the ouster of senior military officers and rolling back past diversity policies. “He’s not going anywhere,” said Tim Parlatore, a special adviser to Hegseth. “He intends to serve the full four years.”

• Business Insider: Voters delivered a stern rebuke of data centers in 44 out of 45 ballot propositions across the country on Tuesday. The lone exception: Harwood, North Dakota, pop. 940, which shot down a measure that would have given residents a greater say in how large projects, such as AI data centers, are constructed in the town. A $3 billion AI data center equal in size to 17 football fields is currently under construction in the community’s backyard.

• Politico: Pope Leo XIV delivered a diplomatic but subtly strong critique of Argentine President Javier Milei’s austerity measures and libertarian agenda as he arrived Sunday in Argentina, insisting that political leaders must put people, not the economy, first. Leo used his first public speech in Argentina to lay out a vision of governance, democracy and society sharply at odds with Milei’s, exposing differences over spending cuts, social justice and artificial intelligence that the government had sought to play down ahead of the visit.

• NPR: It is something of a truism in the library world that, when economic conditions worsen, people use libraries more. Patrons and librarians across the U.S. tell NPR they’re seeing that pan out now. According to a Pew Research Center survey released in mid-October, 44% of Americans say they’ve struggled in the past year to afford at least one basic necessity. People start off with Audible and then a friend tells them, ‘Why are you paying for that? You can get that at the library if you’re a smidgen bit patient,’” said Jeremy Reeder, director of the Maricopa County Library District in Arizona.

• Yahoo News: While Mississippi waits to see if Scott Colom will become the state’s first Black senator since Reconstruction, Sen. Amy Klobuchar (D-Minn.) pointed out another bit of trivia: “When Scott Colom becomes the next Senator for Mississippi (and he will) there will be FOUR identical twins in the Senate Democratic Caucus,” the Minnesota governor-elect posted Sunday on X. The other three senators are Patty Murray (Washington), Brian Schatz (Hawaii) and Mark Kelly (Arizona).

• CNBC: Asador Etxebarri in Atxondo, Spain, is the world’s top restaurant, according to The World’s 50 Best Restaurants, which announced the results in Lima, Peru. Chef Gaggan Anand’s Gaggan in Bangkok took second place. Alchemist in Copenhagen, from head chef Rasmus Munk, came in third. Being “on the list,” many chefs and other restaurant-industry insiders have said, makes a huge difference for reservations and revenues. But, some top chefs have begun to criticize the contest and the time and energy it takes to get onto the list.

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Thanks for reading. Photo by Alonso Reyes on Unsplash. I wrote about some of this at Inc.com. See you in the comments!