A new study led by University of Pittsburgh School of Medicine researchers finds that adults with attention-deficit/hyperactivity disorder (ADHD) face a significantly higher risk of developing dementia or mild cognitive impairment later in life. The research, published today in JAMA Psychiatry , also found that people who carry a higher genetic risk for ADHD face a greater chance of cognitive decline even absent a documented diagnosis.
Researchers analyzed health records and genetic data from more than 187,000 adults aged 50 and older enrolled in the National Institutes of Health's All of Us Research Program and found that 6.7% of participants with ADHD developed dementia or cognitive impairment, compared with 3.4% of those without ADHD. After accounting for factors like age, sex and other health conditions, researchers found that people with ADHD had more than four times the risk of developing cognitive impairment over time.
The researchers also calculated each participant's genetic risk score for ADHD, a measure that reflects how much a person’s common genetic variants are associated with ADHD, regardless of whether they were ever formally diagnosed. People with the highest genetic risk had a 35% greater chance of developing dementia than those with the lowest risk.
“This doesn’t prove that ADHD causes dementia, but seeing the same pattern show up independently in medical records and in people's genes gives us greater confidence that the association is not simply an artifact of how ADHD gets diagnosed,” said senior author Tharick A. Pascoal, M.D., Ph.D., associate professor of psychiatry and neurology at Pitt. “Two different kinds of evidence are pointing in the same direction.”
The study also found that ADHD compounded the burden of living with dementia. Among participants who developed cognitive impairment, those with a comorbid ADHD diagnosis reported worse mental health, lower quality of life and less social satisfaction than those with dementia alone. They also used about 20% more health care overall in the year following diagnosis.
“We’re replicating a pattern that's been observed in other countries, now in a large U.S. sample, and adding genetic evidence on top of it,” said Douglas Teixiera Leffa, M.D., Ph.D., who recently completed his psychiatry residency at UPMC. “That combination gives us more confidence that ADHD deserves a closer look as a potential factor in cognitive aging.”
One possibility is that early, undetected dementia symptoms are sometimes mistaken for ADHD before a formal cognitive diagnosis is made. However, the association remained statistically significant even when the team required at least eight years to pass between an ADHD diagnosis and the onset of cognitive impairment, making that explanation less likely to account for the full effect.
Several questions remain unanswered, including whether ADHD medications, such as stimulants, might lower dementia risk over time, and whether managing cardiovascular health — already linked to both ADHD and dementia — could help.
“Analyzing genetic information alongside years of health records allows us to identify patterns that might not be visible in a smaller or more traditional study,” said Guilherme Bauer-Negrini, Ph.D., co-first author and postdoctoral associate in biomedical data science at Pitt. “With this kind of data, we can start to investigate what may be driving this association and whether any of those factors could be modified to support healthier cognitive aging."
The findings build on years of related work from the Pascoal lab, including a 2022 study that first linked ADHD genetic risk to Alzheimer's-related brain changes in cognitively unimpaired older adults. The new study is the largest and most comprehensive to date to combine clinical diagnoses and genetic data within the same population.
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Co-authors include Pamela C. L. Ferreira, Ph.D., Bruna Bellaver, Ph.D., Guilherme Povala, Ph.D., Marina S. Medeiros, M.D., Firoza Z. Lussier, M.S., Brooke S. G. Molina, Ph.D., and Dana L. Tudorascu, Ph.D., all of Pitt; Samuele Cortese, M.D., Ph.D., of the University of Southampton; and Luis Augusto Rohde, M.D., Ph.D., of Hospital de Clínicas de Porto Alegre.
This research was supported by the National Institute on Aging (R01 AG073267, R01 AG075336), the Alzheimer’s Association (AARF-D-23-1150249, AARFD-22-923814, AARFD-22-974627, 24AARFD-1243899), the U.K. National Institute for Health and Care Research (NIHR303122, NIHR203684, NIHR203035, NIHR130077, NIHR128472, RP-PG-0618-20003), and the European Research Executive Agency (101095568 HORIZONHLTH- 2022-DISEASE-07-03).
JAMA Psychiatry
10.1001/jamapsychiatry.2026.3165
Attention-Deficit/Hyperactivity Disorder and Late-Life Cognitive Impairment
7-Oct-2026