What are your concerns regarding long term stimulant use in geriatric patients with ADHD?

I agree with @Dr. First Last; however, I had a patient in their mid-70s with small vessel disease (Parkinsonism) who had a gait disturbance, cognitive, and organizational problems. He was a lawyer who was trying to close his practice, and I gave him 10-20 mg of dextroamphetamine ER. It helped him co...

That's a good question - there are several concerns, but these are the top (on my list).

• Cardiovascular risk [most concerning]: HTN, tachycardia, CAD, and tachyarrhythmias of all kinds (SVT, Aflutter, AFib, VTach, Vfib...)
• Drug interactions: risk of hypertensive crisis with MAOIs, risk of serotonin...

I have found that minimal doses of methylphenidate can be helpful in elderly patients, especially after a stroke, balance problems, and cognitive decline.

Most of the time, mood, motor, and cognitive function improve significantly, and so far, at 2.5 mg to 5 mg doses, I have not observed any side ef...

I would wean the stimulant off, the reason being that the risk of exacerbation of hypertension, as well as precipitation of dysrhythmia in the context of CAD, outweighs the benefit. Other options, if the ADHD does still in fact require pharmacological intervention, should be investigated.