Unpacking ADHD: Part 5 - The Long View: ADHD, Stimulants, and Aging

The Long Game: Neuroprotection and Unanswered Questions

Here's an intriguing and complex twist in recent research: the idea of "neuroprotection" in ADHD. Some recent analyses suggest that people with ADHD might experience less brain volume loss later in life (after age 60) compared to the typical aging brain (Dutta et al., 2022). These potential protective effects were found in key brain regions like the hippocampus and amygdala—areas where significant volume loss is usually linked to memory problems and diseases like Alzheimer's (Dutta et al., 2022).

This opens up a fascinating, unresolved question: Is ADHD itself somehow "neuroprotective," perhaps because the brain is constantly working harder or in unique ways, or are stimulant medications the ones providing this protection? (Dutta et al., 2022). It's a bit of a paradox: if ADHD itself offers a delay in brain degeneration later in life, and if medication "normalizes" brain changes in childhood, could that normalization, ironically, cancel out that potential long-term protective benefit? (Dutta et al., 2022). We still don't fully understand how long-term stimulant use might permanently change the brain throughout a person's life (Dutta et al., 2022). This highlights a profound and unresolved puzzle in ADHD treatment. While stimulants help children by normalizing brain structures and improving symptoms, their long-term effects on the brain's journey into old age are still a mystery and could be pretty complex. This challenges the simple idea of just "fixing" a disorder and opens up a crucial area for future research into the full, lifelong consequences of these brain-shaping interventions. Understanding this nuance is vital for making informed long-term treatment decisions and for talking responsibly with patients and their families. So, there's a real need for future studies that follow people over many years to truly understand how an ADHD diagnosis, stimulant treatment throughout life, and brain changes in old age all interact (Dutta et al., 2022).

Next, in Part 6, we'll explore what brain scans can (and can't) tell us about ADHD.

References

American Psychiatric Association. (2025, February 10). ADHD in adults: New research highlights trends and challenges. https://www.psychiatry.org/news-room/apa-blogs/adhd-in-adults-new-research-highlights

Cortese, S., & Castellanos, F. X. (2019). The neurobiology of ADHD: Still an enigma? Frontiers in Human Neuroscience, 13. https://doi.org/10.3389/fnhum.2019.00042

Cortese, S., Solmi, M., & Fusar-Poli, P. (2021). Neuroimaging of attention-deficit/hyperactivity disorder: A narrative review of recent findings. Current Opinion in Psychiatry, 34(2), 108–114. https://doi.org/10.1097/YCO.0000000000000674

Dutta, C. N., Christov-Moore, L., Ombao, H., & Douglas, P. K. (2022). Neuroprotection in late life attention-deficit/hyperactivity disorder: A review of pharmacotherapy and phenotype across the lifespan. Frontiers in Human Neuroscience, 16. https://doi.org/10.3389/fnhum.2022.938501

Kolar, A., & Cortese, S. (2019). The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know. Current Psychiatry Reports, 21(10), 96. https://doi.org/10.1007/s11920-019-1088-7

National Center for Biotechnology Information. (2020). Attention-Deficit Hyperactivity Disorder. In StatPearls. StatPearls Publishing.

Neuroimaging and ADHD: fMRI, PET, DTI findings, and methodological limitations. (2013). Journal of Attention Disorders, 17(6), 455–469. https://pubmed.ncbi.nlm.nih.gov/23682662/

Visser, J., van der Meer, S., van der Heijden, P. T., & de Jong, J. T. (2024). Unmet needs and priorities for stigma reduction in ADHD: A qualitative study with young adults, parents, teachers, and mental health care professionals. BMC Psychiatry, 24(1), 847. https://doi.org/10.1186/s12888-024-05459-y

Wang, S. Y. A., Manza, P., Tomasi, D., Volkow, N. D., Wang, G. J., & Zhang, Y. (2023). Shared and distinct neurobehavioral phenotypes of child obesity and ADHD. Translational Psychiatry, 13(1), 74. https://doi.org/10.1038/s41398-023-02359-x

Wu, F., Zhang, W., Ji, W., Zhang, Y., Jiang, F., Li, G., Hu, Y., Wei, X., Wang, H., Wang, S. Y. A., Manza, P., Tomasi, D., Volkow, N. D., Gao, X., Wang, G. J., & Zhang, Y. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. Neuropsychopharmacology.