J Psychiatr Pract. 2022 May 1;28(3):251-258. doi: 10.1097/PRA.0000000000000627.
Recent literature concerning attention-deficit/hyperactivity disorder (ADHD) underlines the persistence of this neurodevelopmental illness in older patients. Comorbidity with a neurodegenerative disease is thus possible. However, few studies have investigated this topic. To our knowledge, this is the first case report of such a possible association, which raises important questions about clinical presentation, symptoms, diagnosis, and treatment. A 72-year-old man, without any psychiatric history, presented with depression, subjective memory loss, and attention deficit and anxious symptoms, and was diagnosed with mild neurocognitive disorder due to Alzheimer's disease. However, the patient's attentional symptoms appeared to have been present since childhood. A formalized diagnostic interview assessing for ADHD did not allow for a clear diagnosis, possibly due to recall bias. The patient's anxiety symptoms also did not respond well to cognitive behavioral therapy coupled with different antidepressants. We hypothesized the presence of ADHD, with the symptoms balanced until now by the patient's high cognitive capacities, and we postulated that the onset of a neurogenerative process may have disrupted this balance. In this case report, we discuss symptom dimensionality, the interplay between neurodegenerative and neurodevelopmental diseases, and various treatment options. Attentional deficits and anxiety symptoms are frequent in mild neurocognitive disorders due to neurodegenerative illnesses. It is important to explore the time of onset of such symptoms since neurodegenerative processes can worsen neurodevelopmental conditions. Moreover, identification of a pre-existing neurodevelopmental condition can lead to alternative care and treatment options. In addition, the unexplained worsening of ADHD symptoms should prompt clinicians to assess for a neurodegenerative process.
最近关于注意力缺陷/多动障碍（ADHD）的文献强调了这种神经发育疾病在老年患者中的持续存在。因此，与神经退行性疾病并存是可能的。然而，很少有研究调查过这个课题。据我们所知，这是首例可能存在这种关联的病例报告，这就提出了关于临床表现、症状、诊断和治疗的重要问题。一名 72 岁的男子，没有任何精神病史，表现出抑郁、主观记忆丧失、注意力缺陷和焦虑症状，并被诊断为轻度阿尔茨海默病引起的认知障碍。然而，患者的注意力症状似乎从童年就已经存在。一项评估 ADHD 的正式诊断访谈无法明确诊断，可能是由于回忆偏差。患者的焦虑症状也没有很好地对认知行为疗法和不同的抗抑郁药产生反应。我们假设存在 ADHD，目前患者的高认知能力平衡了这些症状，我们推测神经退行性过程的发作可能破坏了这种平衡。在这个病例报告中，我们讨论了症状的维度、神经退行性和神经发育性疾病之间的相互作用以及各种治疗选择。注意力缺陷和焦虑症状在神经退行性疾病引起的轻度认知障碍中很常见。探索这些症状的发病时间很重要，因为神经退行性过程可能会使神经发育状况恶化。此外，识别出预先存在的神经发育状况可以为提供替代的护理和治疗选择。此外，ADHD 症状的不明原因恶化应促使临床医生评估神经退行性过程。
