The Continuing Impact of Childhood Adversity across the Lifespan: Assessing the Relationship between Adverse Childhood Experiences and Subjective Cognitive Decline

Background and Purpose: The number of older adults with Alzheimer's disease and related dementia (ADRD) is rapidly increasing. By 2050, it is estimated that the number of older adults with ADRD will increase to 13.8 million, an 8.5 million rise from 2017 levels. Subjective cognitive decline (SCD) is a precursor to ADRD, a strong predictor of future ADRD diagnosis, and a commonly used indicator in survey research. Emerging research has focused on risk factors of developing ADRD, including linking early-life trauma and abuse with cognitive impairment. The few existing studies have found that 3 or more adverse childhood experiences (ACEs) are associated with increased risk of cognitive impairment. However, these studies have all used small samples, and none have looked at the relationship between ACEs and SCD.

Methods: Two logistic regressions were conducted to assess the relationship between ACEs and SCD using the 2011 Behavioral Risk Factor Surveillance System (BRFSS), in which questions on both ACEs and cognitive impairment were included. Seven ACEs were asked of respondents from California, Washington, and Wisconsin (n=5,898 aged 55 and older): physical abuse, emotional abuse, sexual abuse, parents separated/divorced, witnessed intimate partner violence, substance abuse in the household, and mental illness in the household. SCD was measured as experiencing “confusion or memory loss that is happening more often or is getting worse” in the prior 12 months.

Results: Due in part to how ACEs questions are asked in BRFSS, the sample reported a relatively high prevalence: 48.8% reported 0 ACEs, 23.7% reported 1 ACE, and 8.2% reported 4+ ACEs. Among the ACEs reported, emotional abuse was the most frequent (23.8%), followed closely by substance abuse in the household (22.8%). SCD was reported by 14.5% of respondents, more commonly at older ages (13.8% for 55-74 vs. 17.2% for 75+, p<.01). Respondents reporting more ACEs were more likely to have SCD, ranging from 9.3% SCD for respondents with 0 ACEs to 26.9% for respondents reporting 4 or more ACEs. Controlling for demographic characteristics, logistic regression results showed gradual increases with each additional ACE reported, up to 4.29 times the odds of SCD for 4+ ACEs compared to 0 ACEs. In a separate model of individual ACEs, those reporting physical abuse (OR=2.10) and sexual abuse (OR=1.84) had the greatest odds of SCD.

Conclusions and Implications: Findings from this large, multi-state sample demonstrate the association between childhood adversity and SCD, with the experience of child maltreatment placing individuals at greatest risk. Although survey responses for individuals with cognitive impairment must be treated with a degree of caution, the large increases to odds of SCD with higher ACE levels underscores the impact of these adverse experiences across the lifespan. These results implicate the importance of considering a lifespan perspective for work on childhood adversity and family violence, as well as the importance of considering ACEs and early-life experience when considering risk for cognitive impairment.