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States-of-Mind

ADHD and death

ADHD and risk of premature death

I have written several articles about ADHD and its symptoms.

In addition to hallmark difficulties concentrating or staying on task, some other common traits of ADHD include impulsive behaviour, risk taking, increased likelihood of substance abuse and a reduced ability to foresee consequences of actions.

Some of these characteristics seem to lead to an increase in risk for accidents and injuries among those with ADD. Studies have shown, for example, that those with the condition are more likely to get in motor vehicle accidents.

One study in Denmark has shown those diagnosed with ADHD have twice the risk of premature death and a lower life expectancy than those without ADHD.

This study, published in The Lancet, examined the health records of 1.92 million people born in Denmark between 1981 and 2011 and followed until 2013.

Roughly 32,000 of them were diagnosed with ADHD. During the study, just over 5,000 people died – 107 with ADHD.

The mortality rate for those with ADHD was twice the average mortality rate and accidents were the most common cause of death (42 of the 107 deaths).

Mortality was higher for girls and women as well as for those diagnosed in adulthood. Co-existing oppositional disorder, conduct disorder or substance use further increased the mortality risk.

Researchers in the study said that although overall risk of death was still low in this study, the results point to the importance of early diagnosis and proper management of ADHD.

Although certainly important, death is not usually the first concern to cross the mind when dealing with ADHD.

Children and adults living with this condition usually experience lost opportunities and difficulty functioning in school, work and relationships because of their symptoms.

ADD affects roughly five per cent of the population. It is a condition that starts in childhood and often continues throughout life. It is not the result of diet, poor parenting or a weak character, but results from differences in the brain.

Treatment strategies including education about the condition, behavioural techniques and medication can all help individuals with ADD to reach their goals in life.

If you think you or your child are experiencing ADHD, speak with your doctor to arrange for an assessment by a qualified mental health professional.





Work protects memory

Research suggests a challenging work environment does more than keep you engaged or stress you out from day to day – it may have a protective effect on your brain as it ages. 

A German study published in the journal Neurology tested the memory and thinking skills of 1,054 people over the age of 75 and followed them every 18 months for eight years. 

Results showed those whose work history required more speaking, strategy development, conflict resolution and managerial tasks had better protection against memory and thinking decline as they aged.

Work tasks over the course of a career were more strongly linked to later brain function than education (which is known to affect risk of dementia).

In the study, work tasks were separated into executive, verbal and fluid. Those whose careers involved high levels of all three fared the best in terms of thinking and memory function over time. 

A theory about why this kind of work is protective likens challenging work tasks to a form of training for the brain.

Similar to athletes conditioning their bodies for specific sports accomplishments and building muscle reserve, challenging the brain can build up a long-term, mental reserve that is helpful as we age.

Although challenging the brain seems to be healthy, it should still be noted that a stressful work environment may not be good for mental health. We also have a lot of data on the harmful effects of prolonged elevated stress to mental and physical health. 

It is likely important to strike a balance between finding work that is stimulating and mentally challenging without it also being overly demanding or stressful. 

Of course, not everyone is able to find work that is mentally challenging, but that doesn’t mean it is impossible to find ways to train the brain and challenge it using some of the same principles outside of a work environment. 

Executive, verbal and fluid tasks are often integral to household management, community involvement, advocacy and volunteer work as well and all of these activities present opportunities for giving your brain a workout to build up that mental reserve.



Mortality and mental illness

Mental illness can shorten your life.

We’ve known for a long time that people living with mental illness have a higher likelihood of other serious health conditions such as heart disease. We also know mental illness seems to hamper or slow recovery from some medical conditions.

Recent meta-analysis of data from 203 studies conducted in 29 countries around the world has shed light on the bigger picture of mortality and mental illness. This analysis found people with mental illness have a mortality rate that is 2.22 times higher than the general population and their lives are shortened by an average of about 10 years.

While mental illness is directly responsible for death in some cases, many people with mental illness die from other medical conditions and at a higher rate than in the general population.

More than two thirds of deaths among the mentally ill in this analysis were from natural causes. This, of course, raises questions and concerns about medical care and prevention among the mentally ill.

Interestingly, this study found the mortality gap has gotten bigger in recent years — studies beginning in the 1990s showed higher mortality than those beginning in the 1970s. Researchers say it appears people with mental illness are not experiencing the increased life expectancy enjoyed by the general population.

Increased mortality could be occurring for a variety of reasons. It is well known that many psychiatric conditions are associated with higher prevalence of unhealthy behaviours such as smoking and substance abuse, which could increase general mortality and cause lower overall health.

Access to quality healthcare is also a concern as are social determinants of health such as poverty and social connectedness. We know that people with mental health conditions often do not receive preventive health care such as immunizations or cancer screenings, they are less likely to get tobacco counseling and tend to receive a lower quality of care for chronic medical conditions.

All of this information gives us a roadmap toward ensuring better care for those living with mental illness.

Of course, we need to continue working to prevent events such as suicide, but this is also an excellent reminder that mentally ill individuals are whole people with more than one aspect to their health.

Sometimes symptoms of mental illness can overshadow everything else because of how debilitating they can be, but we should not neglect proper diagnosis and management of other chronic health issues or illness prevention in this population.

If you or a loved one are living with mental illness and are concerned about the quality of your general medical care, talk with your healthcare professional about your concerns.





Predicting Alzheimer's pace

A diagnosis of Alzheimer’s disease is a frightening prospect.

We’ve likely all heard what the later stages of this condition are like, and thinking of an inevitable decline is daunting.

One of the more anxiety-inducing parts is the unpredictability of the condition.

Cognitive degeneration in Alzheimer’s can be quite varied. For some, decline happens rapidly and others seem to plateau for relatively long periods with little noticeable change in functioning.

For patients and their loved ones, not knowing how much time is left can be stressful.

A study published in the Canadian Journal of Psychiatry examined risk factors for disease progression in Alzheimer’s disease. For this study, data from 488 individuals with mild to moderate Alzheimer’s disease was examined.

Over a one-year study period, nearly half of study participants experienced clinically meaningful deterioration.

Using readily available clinical information, researchers identified several risk factors, which seem to predict disease progression. Patients who were older at age of onset had significantly increased risk of decline than those of a younger age.

Other studies have supported this finding and it could be due to other factors associated with old age such as the likelihood of additional medical issues.

Interestingly, some research has also shown the opposite result, although in that study, the overall age of study participants was younger, suggesting the impact of age on decline may depend on sample selection.

In this study, patients represented average Alzheimer’s patients in Canada.

Being female was also associated with a significant risk of decline — women had a 1.68-fold increase in their risk of decline in this study.

Hormonal differences and psychosocial issues may play a role in this discrepancy between the sexes.

Apart from age and sex, some of the other risk factors related to disease progression include:

  • lower cognitive function at study start
  • genetic differences (those with epsilon 4 allele of the apolipoprotein E gene see more decline)
  • education
  • language difficulty (aphasia)
  • visuospatial processing
  • psychiatric symptoms.

Although there is little we can do to slow or stop the progression of Alzheimer’s disease at this point, it is still helpful to be able to estimate disease course.

Patients who are identified as high risk can be more closely monitored and they can be given some idea of what to expect.

Alzheimer’s is the most common dementia and is expected to increase dramatically as our population ages. Research into disease progression, prevention and treatment is critical.

At Okanagan Clinical Trials, we regularly conduct studies for investigational treatments of Alzheimer’s disease. We also have a memory clinic offering comprehensive cognitive assessments.

Contact our office at (250) 862-8141 for more information.



More States of Mind articles

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About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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Follow us on Twitter: @OCT_ca



The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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