Adverse childhood experiences (ACEs) are associated with a greater risk for many common conditions that contribute to mortality in adulthood, but limited evidence examines whether ACEs correlate with risk for dementia, a leading cause of morbidity and mortality in the United States, according to Heather B. Schickedanz, MD. “Extensive work has been done to understand the science of ACEs and the effects of toxic stress on the development of the brain, as well as the impact on chronic conditions throughout one’s life,” Dr. Schickedanz says. “International studies have linked childhood trauma to the risk for dementia and one study showed that a composite measure of ACEs was positively associated with the development of dementia. However, additional research is needed to understand the ACE-dementia relationship.”

For a paper published in the Journal of General Internal Medicine, Dr. Schickedanz and colleagues sought to examine the association between ACE scores and a positive screen for dementia. In a cross-sectional analysis of a longitudinal, national population-based survey of older adults, the researchers examined data that covered four generations of American families and examined a host of health and demographic information. “We specifically looked at data from participants aged 65 and older who were administered the 8-item information interview to differentiate normal cognition from dementia (AD8),” she says, adding that dementia screening data were also derived from the 2017 wave of the Panel Study of Income Dynamics (PSID) and ACE scores from the 2014 PSID Childhood Retrospective Circumstances Survey supplement. Complete data were available for 1,223 (82%) participants.

Higher Number of ACEs Linked With Dementia Later in Life

“Our research supports the growing science of ACEs by demonstrating that like many chronic diseases linked to ACEs, the risk for dementia may be affected by early life stress,” Dr. Schickedanz says. “Our findings align with current research and build upon existing evidence tying major drivers of mortality to the life course effect of trauma—in this case, to dementia in later life.”

The study team found that a higher number of ACEs was associated with an increased probability of a positive screen for dementia. “This link was strongest in adults aged 65-74 and in those with four or more ACEs,” Dr. Schickedanz notes. “Older adults with childhood experiences of emotional abuse, sexual abuse, exposure to intimate partner violence, or a parent’s mental illness had the greatest likelihood of a positive screening for dementia,” she says. “The AD8 indicated that increasing ACE scores were most strongly linked to changes in thinking and memory and shifts in remembering appointments.” She adds that differences in chronic conditions, including hypertension, diabetes, cardiovascular disease, prior stroke or myocardial infarction, severe mental illness, and alcohol use did not mediate the association between ACEs and positive screen for dementia.

Weaker Association Between ACEs & Dementia in Oldest Group

Examining the association between a positive AD8 dementia screen and ACE score by age range, the relationship was observed primarily for respondents aged 65-74, with little association found between ACEs and a positive dementia screen for those 75 and older, notes Dr. Schickedanz (Table). “The heightened incidence of dementia in adults older than 75 demonstrates it is possible that the oldest adults in our sample were less likely to reliably recall ACEs,” she says. “This could explain the weaker association between ACEs and dementia risk in the oldest age group.”

The connection between ACEs and dementia risk indicates an accelerated neurocognitive decline in learning and memory, which may begin with adaptations to early life stress, Dr. Schickedanz explains. “Therefore, pediatricians and behaviorists should develop networks and resources to identify and address ACEs and promote resilience by ensuring early intervention with appropriate mental, behavioral, and educational therapies,” she says.

Dr. Schickedanz and colleagues agree that further studies are needed to investigate the potential benefits of screening for ACE and risk-based cognitive assessment. “While our study did not examine protective factors, frequency, or severity of ACE exposure, or whether childhood adversity affects midlife antecedents of later complications of dementia, these topics are ripe for future research,” she says.