When It’s Not Alzheimer’s: Recognizing the Cognitive Overlap Between Vascular Dementia and ADHD

The most common form of dementia is Alzheimer’s, accounting for between 60 - 80% of age related dementia. So most people, clinicians included, default to treating any dementia as if it’s Alzheimer’s.

• Alzheimer’s primarily affects memory storage—the memories are gone.

• Fronto-subcortical dementia affects memory retrieval and regulation—the memories are in there, but hard to access without cues.

• ADHD is a neurodevelopmental cousin to fronto-subcortical disorders—sharing executive function deficits and similar behavioral patterns.

In today’s newsletter, I discuss how I realized that my father’s vascular dementia often looks more similar to my ADHD than Alzheimer’s. And how that information helps me understand him, and myself, better.

🔬 Alzheimer’s vs. Vascular Dementia and ADHD

After my father’s symptoms first developed 16 years ago, we assumed it was Alzheimer’s. The doctor started him on Alzheimer’s medication and his symptoms subsided.

Case closed? Or so I thought.

We had a problem to prepare for so I did what I always do:

I studied. I watched. I prepared.

Alzheimer’s is cruel but tends to follow a predictable and painful path.

I expected:

• The slow unraveling of memory.

• The confusion.

• The fading of his personality.

• The eventual loss of recognition (that was what I dreaded the most).

But those signs never came. In hindsight, his symptoms resolved because his initial mild stroke was resolving—not because of the medication.

What I saw instead?

There was a distinct difference between before and after his second stroke but after the first few months, he was mostly himself but with glimpses of me.

Mistakes I know intimately. Habits I fight daily. Expectations I am unable to meet.

Cognitively complicated traits that looked a lot like my own experience with AuDHD. 

All the things that drove him crazy when he was his younger “old self” and he thought that I could do better if I just tried harder.

I will never forget the day when he apologized to adult me for not understanding my undiagnosed ADHD. He saw my “potential” and was frustrated that I didn’t execute consistently.

Finally he understood. Oh how I wish he never had to.

When Dementia Looks Like ADHD: What My Father’s Stroke Taught Me About My Own Brain

We were preparing for Alzheimer’s. We braced for the long goodbye. We created a lifestyle conducive to caregiving.

But his symptoms didn’t match the script.

His long-term memory? Sharp.

His short-term memory? Spotty but cuable.

His stories? Still intact just shuffled.

It wasn’t until a full neuropsychological evaluation that we got clarity: Vascular dementia not consistent with Alzheimer’s.

And the area of his brain most affected? The fronto-subcortical region - the same region that lights up differently in people with ADHD.

That’s when I realized: His brain didn’t look like it was fading.

🧭 The Twist: His Brain Looked Like Mine…Cognitively Complicated But Intact.

🧠 Here Are Six Ways Vascular Dementia and ADHD Overlap:

1. Working Memory Gaps

   He couldn’t hold multi-step instructions in his head. Neither can I. The biggest challenge for my parents came around meal time when following a recipe became challenging and supper wouldn’t get finished until bed time.
   
   Even today, his physical therapist reminded me that I need to give him cues one step at a time. “move your left foot, move your right foot, do the Hokey Pokey, turn yourself around, etc.”
   

2. Needs Cueing to Recall His Stories

   My father has always used Echolalia to communicate. The right word, song, memory. The memories are still there—but inaccessible without prompting and cueing. I know my father’s greatest hits by heart so I can fill in the blanks of his stories. I’d offer a detail, and he’d light up and can finish the story as if he’s telling it for the first time.
   
   That’s how my brain works too: I don’t forget and then remember—I misfile and then recall them all at once.

3. Task Initiation Paralysis

   Once interrupted—usually by one of his frequent bathroom breaks or other distractions—he wouldn’t pick back up where he left off. The momentum was gone. Starting again felt impossible because we do not remember - we reconstruct or recall.

   Same for me. That’s not laziness—it’s executive function shutting down midstream. Hurrying us or interrupting us does not make the story get told faster…it means you have to start from scratch because we don’t remember where we were…we reconstruct from the beginning.

4. Emotional Reactivity

   He gets overwhelmed quickly, his emotions are labile and often insensitive or inconsistent.

   Even when his words miss the mark, his empathy never leaves. He may say something that stings, but he feels the sting too—deeper and longer than I do. He just can’t always regulate the gap between what he feels and what he expresses.
   
   I have to guard my reactions because if he hurts my feelings, he is devastated for days. He can’t remember what happened…just that I was upset and it was his fault.
   
   ADHD isn’t just hyperactivity—it’s hypersensitivity. He and I both ride a fast emotional elevator.
   

5. Impulse-Driven Speech

   He’d repeat phrases, talk over others, or interrupt without meaning to. When he has a thought on his mind, it’s easiest to let him say it. He will not remember and his ability to track the give and take of a conversation is often sidetracked by his brilliant thought that popped into his mind/mouth at the same time.
   
   So do I. It’s not rudeness—it’s cognitive urgency, and it’s hard to pause when your mind moves fast.
   

6. Inconsistent Attention

   He can spend days perseverating over an idea and then just as quickly, it’s gone. Multiple calls to ask the same question but once he hears the answer, he accepts it…until he forgets and calls again. Hyperfocus and distractibility aren’t opposites. They’re twins.
   
   The reason I am more patient than most would be is that I know the feeling. Each time I ask the same question, it’s the first time for me…even if my husband has already answered it 10 times.
   

Recognition Changes Everything

Realizing we were dealing with fronto-subcortical dementia, not Alzheimer’s, gave me an advantage: I was already fluent in this kind of cognitive complication.

It made it easier to care for my dad because I understood his brain. After 58 years of living as a cognitively complicated conundrum, I know what works for me.

And I found many of the same strategies and frameworks worked for him too.

This is how cognitively complicated caregiving begins: With recognition.

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