The association between adverse childhood events and later-life cognitive function and dementia risk

Early life factors and dementia risk: A study of adverse childhood experiences and later-life cognition and behaviour

OBJECTIVES

Adverse childhood experiences (ACE) are associated with brain alterations and cognitive decline. In later life, cognitive impairment and mild behavioural impairment (MBI) are associated with greater dementia risk. We investigated whether more severe ACE are cross-sectionally associated with worse later-life cognitive and behavioural symptoms.

STUDY DESIGN

Cross-sectional study.

METHODS

Data are from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT). Measures included the Childhood Trauma Screener (CTS-5), neuropsychological testing, Everyday Cognition (ECog)-II scale, and MBI Checklist (MBI-C). Linear regressions modelled associations between ACE severity and neuropsychological test scores. Multivariable negative binomial regressions (zero-inflated, if appropriate) modelled associations between ACE severity and ECog-II and MBI-C scores. All models controlled for age, sex, education, and ethnocultural origin. Clinical diagnoses of depression and/or anxiety were explored as covariates or mediators.

RESULTS

In adjusted analyses, higher ACE scores were associated with worse performance on Trail-Making B (standardized b = 0.10, q = 0.003), Switching Stroop (b = -0.08, q = 0.027), Paired Associates Learning (b = -0.08, q = 0.049), and Digit Span (b = -0.08, q = 0.029). Higher ACE scores were also associated with higher ECog-II (b = 1.08, q = 0.029) and MBI-C (b = 1.20, q < 0.001) scores; these associations were neither mediated by affective symptoms (ECog p = 0.16; MBI p = 0.13) nor moderated by sex (ECog p = 0.09; MBI p = 0.46).

CONCLUSION

Older adults with a history of more severe ACE show greater cognitive and behavioural risk markers for dementia that cannot be explained by previous psychiatric history. Further research into ACE as an early modifiable risk factor for dementia is warranted.

Cognitive impairment and dementia-Are they linked to childhood health and socioeconomic status? A systematic review

BACKGROUND

Dementia is a major public health concern, with its incidence rising as the population ages. Recent studies suggest links between childhood health, socioeconomic status, and later-life cognitive impairment and dementia, though findings remain inconclusive. This systematic review evaluates the influence of childhood health and socioeconomic status on cognitive impairment and dementia.

METHOD AND FINDINGS

A systematic search conducted in MEDLINE, CiNAHL, and PsycINFO in December 2024 identified 44 studies matching our inclusion criteria. Findings are presented under five key themes: (1) childhood health, (2) childhood educational attainment, (3) family socioeconomic and educational factors, (4) childhood experiences, and (5) childhood reading habits and social interactions.

CONCLUSION

Our results highlight the need for further longitudinal studies to establish causal relationships between early-life risk factors and later cognitive decline. Policymakers should prioritize early childhood development programs that integrate health, nutrition, education, and social support to help mitigate cognitive impairment and dementia in later life.

Effect of childhood trauma on cognitive function in individuals with major depressive disorder and healthy controls

BACKGROUND

Individuals with major depressive disorder (MDD) exhibit cognitive impairment, while childhood trauma (CT) is associated with an elevated risk of both MDD and cognitive dysfunction. The effect of CT on cognitive function in MDD patients and healthy controls (HCs) is unclear.

METHODS

MDD patients and HCs were enrolled between December 2013 and December 2016. The Childhood Trauma Questionnaire (CTQ) was used to assess CT. Depressive symptoms and cognitive function were assessed at baseline and after 8-week acute-phase treatment with selective serotonin reuptake inhibitors (SSRIs) in MDD patients.

RESULTS

A total of 909 people were included in the analysis. The interaction between MDD and CT had a main effect on Digit Symbol-Coding Test (DSCT), Stroop Color Test (SCT), and Stroop Color-Word Test (SCWT) scores. The effect of CT on cognitive function disappeared after adjusting for MDD diagnosis and years of education. Neglect could predict poor performance on SCT and SCWT in the HC group. After acute-phase treatment with SSRIs, CT did not significantly predict changes in cognitive function or depressive symptoms.

LIMITATIONS

The CTQ assessment might cause recall bias, and the cross-sectional design could not establish the causal link between CT and cognitive function.

CONCLUSION

The effect of CT on cognitive function was modulated by MDD diagnosis and years of education. CT did not predict changes in depressive symptoms or cognitive function after acute-phase treatment with SSRIs. The direct influence of CT on cognitive function in MDD patients may be over-estimated.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02023567; registration date: December 2013.

The Impact of Life and Adverse Childhood Events on Help-Seeking Behaviours-A Cross-Sectional Survey of School-Age Adolescents in Jordan

Traumatic life and childhood events are associated with adverse health outcomes, particularly for adolescents, who are vulnerable to such events and exhibit distinct health behaviours and needs. Nevertheless, the influence of exposure to these events on their help-seeking behaviour remains largely unexplored, especially in the Eastern Mediterranean region. This study aims to estimate the prevalence of adverse events among adolescents in Jordan and examine how adverse events shape the help-seeking behaviours.

METHODS

A national cross-sectional survey of 4407 school-age (12-18 years) adolescents living in Jordan was conducted between December 2022 and April 2023 using multi-state stratified cluster sampling. The study utilised self-report questionnaires as well as validated tools. These were adapted to ensure cultural relevance and sensitivity and translated to Arabic.

RESULTS

The prevalence of at least one adverse event is around 16%, while that of four or more ACEs stands at around 41% in our population. The most commonly reported event was being infected or having a family member infected with COVID-19 at 60.3%. Specific individual characteristics and traumatic events appeared to shape their help-seeking behaviour, particularly family affluence and smoking status as well as exposure to COVID-19.

CONCLUSIONS

The study underscores the need to understand help-seeking patterns among school-age adolescents in light of exposure to traumatic events. Based on this study's findings, special attention should be paid to the impact certain events have on adolescents' mental health and their help-seeking behaviours. Positive help-seeking behaviours that resonate with adolescents' beliefs, emphasising contextual factors in mental health coping, should be promoted.

Sex Differences in the Associations Among Early Life Adversity, Inflammation, and Cognition

Early life adversity (ELA) has long been recognized to negatively impact a variety of health outcomes, with increasingly recognized long-term implications for neurocognitive function. ELA may affect the brain through multiple mechanisms, including chronic inflammation. One potential moderator of the pathway from ELA to neuroinflammation to cognitive dysfunction is sex. ELA may leave females potentially even more vulnerable to cognitive impairment in later life. This review discusses the influence of ELA on cognitive function across much of the lifespan, how inflammation is implicated in this process, and the current state of knowledge regarding sex differences in these relationships. We conclude with a discussion of unanswered questions and suggestions for future research, including the incorporation of genetic data.

Childhood maltreatment, cognitive performance, and cognitive decline in middle-aged and older adults with chronic disease: A prospective study

OBJECTIVES

Childhood maltreatment (CM) may increase the risk for cognitive deficits and dementia later in life. However, most research has been cross-sectional in nature, has typically focused on specific types of CM, and rarely examined individual differences. The objectives are to evaluate 1) if CM predicts poorer cognitive performance and greater cognitive decline over a 5-year follow-up in older men and women with coronary artery disease (CAD) or other non-cardiovascular (non-CVD) chronic disease, and whether 2) sex and CAD status influence these relations.

METHODS

Men and women (N = 1254; 39.6 % women; 65.6 ± 7.0 years old) with CAD or other non-CVD chronic diseases completed the Childhood Trauma Questionnaire Short Form (CTQ-SF). The Montreal Cognitive Assessment (MoCA) was administered twice at 5-year intervals. Main analyses included bivariate correlations, hierarchical analyses and moderation analyses controlling for sociodemographic and health parameters.

RESULTS

CM was experienced by 32 % of the sample, while scores suggestive of cognitive deficits were obtained by 32.7 % and 40.2 % at study onset and follow-up, respectively. CM was associated with significantly lower MoCA scores at study onset (b = -0.013, p = 0.020), but not with change in MoCA over time (b = -0.002, p = 0.796). While MoCA scores did differ as a function of sex and CAD status, the latter did not influence the relations between maltreatment and MoCA.

CONCLUSIONS

CM predicted poorer cognitive functioning among older individuals with chronic diseases but did not play a role in any further cognitive decline over the follow-up period. Further research is needed to help understand the mechanisms implicated.

Gender differences in the associations of psychosocial trauma and acute medical stressors with immune system activation and dementia risk

Objective: The purpose of this article is to provide a narrative review synthesizing the literature on differences between women and men in relationships among certain stressors associated with immune system activation and their relationship to cognitive dysfunction and dementia. Method: We review the cycle of stress leading to neuroinflammation via cortisol and neurochemical alterations, cell-mediated immune system activation, and pro-inflammatory cytokines, and how this is implicated in the development of dementia. We follow this by discussing sex differences in stress physiology and immune function. We then review the work on early life adversity (ELA) and adverse childhood experiences (ACEs), post-traumatic stress disorder, acute medical stressors, and their associations with cognitive dysfunction and dementia. Throughout, we emphasize women's presentations and issues unique to women (e.g. trauma disorder prevalence). Conclusions: There is a need for more mechanistic and longitudinal studies that consider trauma accumulation, both physical and emotional, as well as a greater focus on traumas more likely to occur in women (e.g. sexual abuse), and their relationship to early cognitive decline and dementia.

Associations and Mediating Pathways Between Childhood Adversity and Risk of Dementia: A Cohort Study in the UK Biobank

BACKGROUND

While childhood adversity (CA) is known to be associated with multiple adverse outcomes, its link with dementia is an area with limited exploration and inconsistent agreement. The study aimed to examine the longitudinal associations of CA with incident all-cause dementia and to quantify the potential mediating pathways.

METHODS

Data from the UK Biobank. CA, encompassing neglect and abuse, was evaluated retrospectively by an online mental health questionnaire. Physical performance, psychological factors, lifestyles, and biological indicators assessed at baseline were considered potential mediators. Incident all-cause dementia was defined by International Classification of Diseases, Tenth Revision codes obtained through self-reported medical conditions, primary care, hospital admission, and death registrations. Cox proportional hazard models were applied to estimate the longitudinal associations. Mediation analyses were conducted on potential mediators to examine their contribution.

RESULTS

This cohort study comprised 150 152 nondemented individuals (mean [SD] age, 55.9 [7.7] years) at baseline (2006-2010). Compared to individuals who did not experience CA, those exposed to any CA exhibited a 30.0% higher risk of dementia (hazard ratio = 1.300, 95% confidence interval [CI]: 1.129-1.496). Each additional CA was associated with a 15.5% (95% CI: 8.8%-22.5%, pfor trend < .001) increased dementia risks. Depression, smoking, and low grip strength explained 8.7%, 2.4%, and 0.9% of the associations, respectively. Biomarkers involving inflammation, erythrocytes, liver, and kidney function mediated the associations by 0.6%-1.4%.

CONCLUSIONS

The study revealed the detrimental effects of CA on dementia and identified some potential mediators, namely depression, smoking, low grip strength, and several targeted biomarkers. In addition to calling more attention to CA, the findings underscore the importance of interventions targeting modifiable mediators in preventing dementia.

Adverse childhood experiences (ACEs), resilience, and outcomes in older adulthood: A scoping review

BACKGROUND

Previous research has demonstrated a dose-response relationship between exposure to adverse childhood experiences (ACEs) and adverse outcomes in adulthood. Despite widely known associations, previous reviews have primarily focused on outcomes in younger and middle-aged adults exposed to ACEs to the exclusion of older adults and do not consider the potential role of resilience for understanding outcomes in older adulthood.

OBJECTIVE

The present scoping review aimed to examine the extent and nature of existing literature on the influence of ACEs and resilience on the cognitive, physical, mental, and social health outcomes among older adults.

METHODS

We conducted a search of five electronic databases (CINAHL, MEDLINE, PsycINFO, AgeLine, Scopus) using the following keywords: adversity, resilience, aging, and older adults. We limited our inclusion criteria to works published in English or French after 1998 as Felitti et al. published the first study describing ACEs in this year.

RESULTS

Of the 4926 studies screened, 27 studies met the inclusion criteria. Overall, results from the included studies indicated that exposure to adversity during childhood was associated with worse outcomes in older adulthood. Additionally, we found that resilience and resiliency-related factors (e.g., problem-focused coping strategies) mitigated or reduced harms associated with ACEs to improve outcomes in older adulthood.

CONCLUSIONS

Exposure to ACEs is associated with reduced functioning in later adulthood. Findings from this review indicate a need for further exploration into the role of ACEs, and the potential effects of resilience, on health outcomes in older adults to develop better individual- and population-level interventions for this group.

A lifetime perspective on risk factors for cognitive decline with a special focus on early events

Both Alzheimer's disease and vascular dementia are the result of disease processes that typically develop over several decades. Population studies have estimated that more than half of the risk for dementia is preventable or at least modifiable through behavioral adaptations. The association between these lifestyle factors and the risk of dementia is most evident for exposure in midlife. However, habits formed in middle age often reflect a lifetime of behavior patterns and living conditions. Therefore, individuals who, for example, are able to maintain healthy diets and regular exercise during their middle years are likely to benefit from these cognition-protective habits they have practiced throughout their lives. For numerous adult diseases, significant risks can often be traced back to early childhood. Suboptimal conditions during the perinatal period, childhood and adolescence can increase the risk of adult diseases, including stroke, heart disease, insulin resistance, hypertension and dementia. This review aims at summarizing some of the evidence for dementia risks from a life-time perspective with the goal of raising awareness for early dementia prevention and successful aging.

Frontal cortical volume deficits as enduring evidence of childhood abuse in community adults with AUD and HIV infection comorbidity

Background

Childhood abuse is an underappreciated source of stress, associated with adverse mental and physical health consequences. Childhood abuse has been directly associated with risky behavior thereby increasing the likelihood of alcohol misuse and risk of HIV infection, conditions associated with brain structural and functional deficits. Here, we examined the neural and behavioral correlates of childhood trauma history in alcohol use disorder (AUD), HIV infection (HIV), and their comorbidity (AUD+HIV).

Methods

Occurrence of childhood trauma was evaluated by retrospective interview. Cortical (frontal, temporal, parietal, and occipital), subcortical (hippocampus, amygdala), and regional frontal volumes were derived from structural MRI, adjusted for intracranial volume and age. Test scores of executive functioning, attention/working memory, verbal/visual learning, verbal/visual memory, and motor speed functional domains were standardized on age and education of a laboratory control group.

Results

History of childhood abuse was associated with smaller frontal lobe volumes regardless of diagnosis. For frontal subregional volumes, history of childhood abuse was selectively associated with smaller orbitofrontal and supplementary motor volumes. In participants with a child abuse history, poorer verbal/visual memory performance was associated with smaller orbitofrontal and frontal middle volumes, whereas in those without childhood abuse, poorer verbal/visual memory performance was associated with smaller orbitofrontal, frontal superior, and supplemental motor volumes.

Conclusions

Taken together, these results comport with and extend the findings that childhood abuse is associated with brain and behavioral sequelae in AUD, HIV, and AUD+HIV comorbidity. Further, these findings suggest that sequelae of abuse in childhood may be best conceptualized as a spectrum disorder as significant deficits may be present in those who may not meet criteria for a formal trauma-related diagnosis yet may be suffering enduring stress effects on brain structural and functional health.

Childhood Maltreatment and Dementia Risk Factors in Midlife: A Prospective Investigation

BACKGROUND

Previous studies have linked childhood adversities to dementia risk, yet most studies are cross-sectional in design and utilize retrospective self-reports to assess childhood experiences. These design characteristics make it difficult to establish temporal order and draw firm conclusions.

OBJECTIVES

Using a longitudinal design, we sought to determine whether childhood maltreatment predicts dementia risk factors in middle adulthood.

METHODS

Data have been obtained from a prospective cohort design study of children with documented cases of childhood maltreatment (ages 0-11 years at case identification) and demographically matched controls who were followed up and interviewed in middle adulthood. Outcomes were assessed through a medical examination and interview, and 807 of the cases that included blood collection at mean age 41. Dementia risk were investigated using 11 potentially modifiable risk factors.

RESULTS

Compared to controls, individuals with histories of childhood maltreatment had a higher risk of low educational attainment, low social contact, smoking, and clinical depression, and a higher total number of dementia risk factors. In general, childhood maltreatment predicted a higher risk of dementia for females, males, and Black and White participants. Black maltreated participants had a greater risk for traumatic brain injury compared to Black controls. Physical abuse, sexual abuse, and neglect, each predicted a higher number of dementia risk factors in mid-life.

CONCLUSION

These findings provide evidence that childhood maltreatment increases the risk for dementia in mid-life and has a demonstrable impact lasting over 30 years. Reducing the prevalence of mid-life dementia risk factors could reduce the risk of later-life dementia.

Childhood adverse events and BDNF promoter methylation in later-life

Studies have shown that the effects of early-life stress and trauma can be enduring, with long-term negative effects on health. Epigenetics, including DNA methylation, have been implicated as a potential mechanism for these effects. Brain-derived neurotropic factor (BDNF) is a neurotransmitter involved in learning and memory, and altered BDNF promoter methylation measured in peripheral tissue has been found with early-life stress. However, whether such methylation differences remain stable into later life, is unknown. This study aimed to investigate the association between childhood adversity and BDNF promoter methylation in adults aged 65 years and over. Data came from a large study of older community-dwelling individuals in France (ESPRIT). Information on three major childhood adverse events, namely abuse/maltreatment, war/natural disaster, and financial difficulties/poverty, was obtained by retrospective reporting from participants of ESPRIT study. BDNF promoter I and IV methylation was assessed in blood and buccal tissue. Linear regression analysis was performed, adjusting for age, sex, education, depression, and morbidity. Among 927 participants, there was no strong evidence that childhood abuse/maltreatment or financial difficulties/poverty were associated with BDNF methylation in older individuals. For war/natural disaster, differential methylation at four of twenty-nine CpG sites was observed, however, these would not have remained significant after correction for multiple testing. Together, these findings do not support a long-term association between adverse childhood events and BDNF methylation in older age, but further large prospective studies are needed, which do not target specific genes, but consider DNA methylation across the genome.

Prolonged Maternal Separation Reduces Anxiety State and Increases Compulsive Burying Activity in the Offspring of BALB/c Mice

BACKGROUND

The elevated plus maze (EPM) and the marble burying (MB) tests are common behavioral tests used for behavioral phenotyping in mouse models for neurodevelopmental disorders. However, the behavioral effects of maternal separation (MS), a standard paradigm for early life stress in animals, in both the EPM and MB tests remain incompletely known.

OBJECTIVES

This study aimed to investigate the behavioral effects of prolonged MS in the offspring of mice using the EPM and MB tests.

METHODS

Male BALB/c mice were isolated from their mothers for 4 h each day during the first 30 days after birth. On day 50 postnatal, groups of separated and non-separated mice (n = 18/each group) were subjected to the EPM and MB tests for comparative behavioral evaluations. In addition, the locomotor activity of mice was evaluated using the actophotometer test.

RESULTS

The findings of the EPM test revealed that separated mice exhibited anxiolytic-like behaviors, as evidenced by a significant increase in the latency to closed arms and the time spent in the open arms compared with non-separated mice. Separated mice also showed compulsive burying activity in the MB test, as determined by a significant increase in the number of buried marbles. The results of the actophotometer test did not show any significant change in locomotor activity.

CONCLUSIONS

Prolonged MS caused the adult offspring of mice to exhibit a decrease in anxiety state and increased compulsive burying activity, which were not associated with a change in locomotor activity. Further investigations with validated tests are needed to support these findings.