Dobrosavljevic Maja, Larsson Henrik, Cortese Samuele
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Expert Rev Neurother. 2023 Jul-Dec;23(10):883-893. doi: 10.1080/14737175.2023.2250913. Epub 2023 Sep 19.
There is a striking knowledge gap on ADHD in older adults, and the diagnosis as well as treatment for ADHD in this age group.
The authors first review the literature on the prevalence, functional impairment, and health comorbidities of ADHD across the lifespan. Next, they address the diagnostic criteria for ADHD in adults according to the DSM/ICD, available screening/diagnostic tools, differential diagnosis, and the validity of diagnostic criteria for ADHD in older adults. Finally, the authors focus on empirical evidence on the prevalence rates, medication response, and safety of pharmacological treatment of ADHD in older adults, and national and international clinical guidelines on the treatment of ADHD in this age group.
It is expected that future editions of the DSM and ICD will provide specifiers to the standard ADHD criteria, to better inform the diagnosis of ADHD in older adults. It is also expected that the increasing number of epidemiological studies will provide rigorous estimates on the prevalence, incidence, and burden of ADHD in older adults. One may expect an increasing number of RCTs assessing the efficacy/effectiveness and tolerability/safety of pharmacological as well as non-pharmacological interventions which will inform future guidelines on ADHD in older adults.
在老年人注意力缺陷多动障碍（ADHD）方面存在显著的知识空白，以及该年龄组ADHD的诊断和治疗。
作者首先回顾了关于ADHD在整个生命周期中的患病率、功能损害和健康共病的文献。接下来，他们根据《精神疾病诊断与统计手册》（DSM）/《国际疾病分类》（ICD）阐述了成人ADHD的诊断标准、可用的筛查/诊断工具、鉴别诊断以及老年人ADHD诊断标准的有效性。最后，作者聚焦于老年人ADHD患病率、药物反应和药物治疗安全性的实证证据，以及该年龄组ADHD治疗的国家和国际临床指南。
预计未来版本的DSM和ICD将为标准ADHD标准提供说明符，以便更好地指导老年人ADHD的诊断。预计越来越多的流行病学研究将对老年人ADHD的患病率、发病率和负担提供严谨的估计。人们可能期望有越来越多的随机对照试验（RCT）评估药物及非药物干预的疗效/有效性和耐受性/安全性，这将为未来老年人ADHD指南提供参考。
