[ADHD IN THE AGING POPULATION: A NEW DIFFERENTIAL DIAGNOSIS?]

INTRODUCTION: During midlife and aging, subjective reports regarding cognitive decline increase in frequency. Age-associated cognitive impairment, mild cognitive impairment and dementia, increase in prevalence and are frequently diagnosed. Background medical conditions and risk factors are often regarded as contributing to the cognitive decline. The contribution of prior undiagnosed ADHD (Attention Deficit Hyperactive Disorder) is seldom considered. The aim of the current study was to examine whether childhood or adult ADHD should be considered relevant in the differential diagnosis of cognitive complaints during midlife and aging. METHODS: Thirty-six subjects, aged 50-70 years, diagnosed with probable ADHD (pADHD) and 29 controls participated in the present study. The pADHD group included 12 individuals self-referred due to self-complaints regarding cognitive decline or memory impairment, previously undiagnosed with ADHD (ADHD-A) but with lifelong symptomatology of ADHD and fulfilling ADHD criteria and 24 individuals, parents of diagnosed ADHD children and reporting ADHD symptoms (ADHD-B) , without complaints regarding recent cognitive decline. The neuropsychological evaluation included the Conners' Adult ADHD Rating Scale-SL, Beck Depression Inventory, and the following cognitive tests: logical memory subscale (LM- WMS), California Verbal study was conducted at the Cognitive Neurology Clinic - Rambam Health Care Campus and was granted the approval of the local IRB committee. RESULTS: ADHD-A were impaired on attention parameters while memory and executive functions were intact. ADHD-B did not present measurable attention or other neuropsychological deficits as compared to the control group. Neither group fulfilled criteria for MCI or dementia. CONCLUSIONS: ADHD should be considered as a new/additional entity in the differential diagnosis of subjective cognitive complaints among middle-aged and older persons. The recognition of the specific cognitive and behavioral profiles of ADHD should contribute to the ability to reach optimal differentiation from pre-dementia conditions in order to tailor appropriate therapies. The pathophysiology and future trajectory of the emerging ADHD symptomatology in older patients fulfilling lifelong ADHD symptomatology remains to be clarified. When examining older adults, ADHD should be considered as a differential diagnosis.

Empathic Embarrassment Accuracy in Autism Spectrum Disorder.

Empathic accuracy refers to the ability of perceivers to accurately share the emotions of protagonists. Using a novel task assessing embarrassment, the current study sought to compare levels of empathic embarrassment accuracy among individuals with autism spectrum disorders (ASD) with those of matched controls. To assess empathic embarrassment accuracy, we compared the level of embarrassment experienced by protagonists to the embarrassment felt by participants while watching the protagonists. The results show that while the embarrassment ratings of participants and protagonists were highly matched among controls, individuals with ASD failed to exhibit this matching effect. Furthermore, individuals with ASD rated their embarrassment higher than controls when viewing themselves and protagonists on film, but not while performing the task itself. These findings suggest that individuals with ASD tend to have higher ratings of empathic embarrassment, perhaps due to difficulties in emotion regulation that may account for their impaired empathic accuracy and aberrant social behavior.

Brain asymmetry in emotional processing in Asperger syndrome.

The role of brain asymmetry in emotional processing in Asperger syndrome (AS) is still largely unknown. Although the valence hypothesis predicts that positive emotions are processed preferentially by the left hemisphere and negative emotions by the right hemisphere, reports concerning laterality of emotion point to a left hemisphere advantage for complex emotion versus a right hemisphere advantage for basic emotions (the "type hypothesis"). In this study, we investigated the lateralization of basic versus complex (negative and positive) eye expressions in adults with AS in 2 consecutive experiments: in the first experiment, the performance of AS and healthy controls were compared in a divided visual field task. In the second experiment, the ability of participants with AS to identify eye expressions varying in valence and type was compared with that of patients with localized lesions in either the right or the left hemispheres. Controls were better in recognizing negative emotions presented to the left visual field and positive emotions presented to the right visual field, whereas individuals with AS failed to show this interaction effect. Lateralization of basic versus complex emotions was less evident although indeed controls identified better basic emotions presented to the right visual field. Furthermore, participants with AS exhibited a similar pattern of recognition of negative versus positive emotions to that of patients with left hemisphere damage. It is suggested that the pattern of performance of individuals with AS resembles that of patients with left hemisphere dysfunction.

The relationship between theory of mind and autobiographical memory in high-functioning autism and Asperger syndrome.

The relationship between theory of mind (ToM) and autobiographical memory (AM) in high-functioning autism (HFA) and Asperger syndrome (AS) has never been investigated. Here, we show that ToM abilities could be predicted by levels of AM in HFA and AS as compared to controls, suggesting that difficulties in AM are closely related to ToM impairments in HFA and AS.