Adverse Childhood Experiences and Subjective Cognitive Decline in the US

Abstract

Objective

The aim of this study was to determine the association between adverse childhood experiences (ACEs) and subjective cognitive decline (SCD) among a representative sample of the adult US population.

Methods

Data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 82,688, ≥45 years). Adverse childhood experiences included sexual, physical/psychological and environmental ACEs, and a score. Multivariable logistic regression was used to determine the association between ACEs and SCD, and SCD-related outcomes.

Results

Sexual (adjusted OR (aOR: 2.83; 95% CI: 2.42–3.31)), physical/psychological (aOR: 2.05; 95% CI: 1.83–2.29), and environmental (aOR: 1.94; 95% CI: 1.74–2.16) ACEs were associated with SCD in the past year. There was also a dose-response relationship between ACE score and SCD.

Conclusion

ACEs were associated with SCD. Interventions to maximize cognitive health in aging and prevent future cognitive impairment should consider the potential role of ACEs among affected populations.

Keywords

abuse and neglect cognition epidemiology mental health quantitative methods

Introduction

Adverse childhood experiences (ACEs) have been shown to be associated with poorer objective cognition (Gold et al., 2021; O’Shea et al., 2021), but there has been limited research examining ACEs and subjective cognition. Subjective cognitive decline (SCD) refers to the perception of worsening cognitive function or more frequent confusion or memory loss, albeit normal performance on standardized cognitive tests (Jessen et al., 2014; Studart & Nitrini, 2016). Due to the slow, progressive development of cognitive impairment in aging, SCD is often the first indicator of incipient cognitive decline and a potential precursor of Alzheimer’s disease (AD) (Jack et al., 2018; Jessen et al., 2014; Sperling et al., 2011). Due to the increased risk for cognitive decline among individuals who have experienced ACEs, it is important to investigate relationships between ACEs and SCD in aging. In the current study, we examine these relationships in a nationally representative sample of US adults. This study might be useful for policymakers and program developers as they consider designing and implementing trauma-informed interventions geared toward addressing SCD in aging.

Adverse Childhood Experiences

Adverse childhood experiences are defined as the negative events to which a child is exposed, and can be potentially traumatic (Centers for Disease Control and Prevention, 2020b). They can include direct and environmental events. Direct events may consist of sexual, physical, and psychological abuse, and physical and emotional neglect, while environmental events tend to describe those events that may not be directed toward the child, such as witnessing parental violence, living with someone with psychopathology or who had been incarcerated, or experiencing parental separation or divorce (Brown & Cohen, 2013).

Adverse childhood experiences have been linked to a variety of adverse physical and mental health outcomes such as diabetes (Deschênes et al., 2018), cancer (Alcalá et al., 2017; Brown et al., 2013); HIV/STIs (Brown et al., 2017); depression (Brown et al., 2017; Brown, Perera, et al., 2015; Dagnino et al., 2020), substance abuse (Brown et al., 2017; Brown, Perera, et al., 2015; Leza et al., 2021), and posttraumatic stress disorder (PTSD) (Brown et al., 2017; Brown, Perera, et al., 2015). They are also associated with negative behavioral outcomes such as increased health care utilization (Alcalá et al., 2018), earlier age at sexual debut (Brown, Masho, et al., 2015), HIV risk behavior (Fang et al., 2016; VanderEnde et al., 2018), and intimate partner violence victimization (Thulin et al., 2021) and perpetration (Brown, Masho, et al., 2015). In addition, ACEs have been positively associated with subjective health complaints (Kovács-Tóth et al., 2021) and negatively associated with subjective well-being (Kelifa et al., 2021).

Subjective Cognitive Decline

Among adults aged 45 and older, 11% report SCD (Taylor et al., 2018), and its prevalence increases with age (Brown et al., 2020). Subjective cognitive decline may also be linked to a variety of negative outcomes, including depression (Brown et al., 2020), cognitive and functional decline (Ismail et al., 2021), poorer life satisfaction (Brown & Patterson, 2020a), and higher mortality risk (Luck et al., 2015). Although declines in objective cognition (i.e., deficits detected by clinical assessments of cognition) precede a diagnosis of Alzheimer’s disease, older adults often report the subjective perception of cognitive problems (i.e., SCD) much earlier in the trajectory of decline, a prime opportunity for interventions to maximize cognitive and functional outcomes.

Adverse Childhood Experiences and Cognition

Prior research examining the association between ACEs and cognition found that experiences such as parental death were associated with worse cognition among adults aged 65 and older in Northern California (Gold et al., 2021). Among a sample of participants aged 54 and older, individuals who had lived in foster care were more likely to score lower on baseline memory but not memory decline (O’Shea et al., 2021). Previous research has found that having three or more ACEs was linked to having an increased risk of dementia (Tani et al., 2020). Early and chronic levels of stress such as ACEs are associated with mid-life stress, and structural and physiological changes in the brain such as the hippocampus and the prefrontal cortex (Gheorghe et al., 2021), which are then linked to poorer cognition and dementia. Moreover, social cognitive abilities may mediate the association between ACEs and psychopathology later in life (Rokita et al., 2018). However, previous studies were limited to the associations between ACEs and objective cognition. The influence of ACEs on subjective cognition is yet to be studied, but is crucial to consider given the links between SCD and cognitive decline risk as individuals age (Parfenov et al., 2020). These findings can help us identify individuals at risk for poor cognitive outcomes earlier in the aging trajectory, when interventions can have the largest impact on preventing or delaying cognitive and functional decline (Livingston et al., 2020).

Rationale and Aims

Although the impact and stress of experiencing ACEs may result in cognitive challenges later in life, to our knowledge, no study has examined the relationship between ACEs and SCD using a representative sample of US adults. The aim of this study was to examine the association between direct and environmental ACEs, and SCD and SCD-related outcomes. Findings from this study may inform cognitive intervention programs among affected populations.

Methods

Data Source and Study Population

Data for the current study were obtained from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a national survey established by the Centers for Disease Control and Prevention that collects data on health behaviors, chronic conditions, and healthcare service use. Twenty states asked the ACEs and SCD modules and are included in the study. The SCD module was only asked of participants aged 45 and older. More details on the BRFSS can be found here (Centers for Disease Control and Prevention, 2020a).

Measures

Primary variables

Operationalization of SCD and SCD-related outcomes can be found in Table 1 and operationalization of ACEs can be found in Table 2. The ACEs questions have been validated and shown to be reliable in measuring adverse childhood events irrespective of their self-reported nature (Dube et al., 2004; Hardt et al., 2010). Validation studies took place among individuals receiving care within the Kaiser Permanente’s Health Appraisal Center (Dube et al., 2004) and among longitudinal cohorts from child development studies (Hardt et al., 2010). In addition, the scale can delineate differing scores or rates of ACEs among varying subgroups (Zarse et al., 2019). ACEs were operationalized as sexual, physical/psychological and environmental due to previous research using principal component analysis using BRFSS data (Brown et al., 2013), and each was assigned a score (1, 2, 3, 4 or more) (Gold et al., 2021; Koball et al., 2021; Lacey et al., 2020; Meadows et al., 2019).

Table 1.

Operationalization of SCD and SCD-Related Outcome Variables.

SCD/SCD-Related Outcome	Operationalization
During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?	Yes versus no
During the past 12 months, as a result of confusion or memory loss, how often have you given up day-to-day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills?	Always/usually/sometimes versus rarely/never
As a result of confusion or memory loss, how often do you need assistance with these day-to-day activities?	Always/usually/sometimes versus rarely/never
When you need help with these day-to-day activities, how often are you able to get the help that you need?	Always/usually/sometimes versus rarely/never
During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home?	Always/usually/sometimes versus rarely/never
Have you or anyone else discussed your confusion or memory loss with a health care professional?	Yes versus no

Note. SCD = subjective cognitive decline.

Table 2.

Operationalization of Adverse Childhood Experiences.

Adverse Childhood Experiences	Operationalization
1) Did you live with anyone who was a problem drinker or alcoholic?	Yes versus No
2) Did you live with anyone who used illegal street drugs or who abused prescription medications?	Yes versus No
3) Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility?	Yes versus No
4) Were your parents separated or divorced?	Yes versus No
5) How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up?	Once/More than once versus Never
6) Not including spanking, (before age 18), how often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way?	Once/More than once versus Never
7) How often did a parent or adult in your home ever swear at you, insult you, or put you down?	Once/More than once versus Never
8) How often did anyone at least 5 years older than you or an adult, ever touch you sexually?	Once/More than once versus Never
9) How often did anyone at least 5 years older than you or an adult, try to make you touch them sexually?	Once/More than once versus Never
10) How often did anyone at least 5 years older than you or an adult, force you to have sex?	Once/More than once versus Never

Note. SCD = subjective cognitive decline.

Confounders

Potential confounders considered were age, gender, race/ethnicity, income, education, employment, diabetes, and depression. Previous studies have shown that there are statistically significant differences in SCD by age (Brown et al., 2020; Ju et al., 2021), gender (Brown & Patterson, 2020b; Ju et al., 2021), and racial differences (Reed et al., 2019) where older, male, and racial/ethnic minority populations report more SCD compared to younger, female and White populations. Populations who earn less income (Brown et al., 2020; Ju et al., 2021), who have lower educational attainment (Brown et al., 2020; Ju et al., 2021), are unemployed (Brown et al., 2020; Ju et al., 2021; Zullo et al., 2021) and have diabetes (Brown et al., 2020) tend to report more SCD compared to those who earn a higher income, have higher educational attainment, are employed and do not report diabetes. Hypertension has been linked to cognitive decline (Haring et al., 2016; McDonald et al., 2017; Tadic et al., 2016). Depression is also a significant factor in SCD (Brown et al., 2020; Ju et al., 2021; Kim et al., 2021; Zullo et al., 2021) and SCD-related functional outcomes (Brown et al., 2020; Ju et al., 2021).

Sociodemographic characteristics and certain chronic diseases have also been linked to ACEs. Statistically significant differences by gender, age, and level of education have been found in the number of ACEs experienced. Women, younger adults, and those with lower educational attainment were more likely to report a higher number of ACEs (Lietzén et al., 2021). In addition, employment status, race/ethnicity and income (Racine et al., 2021) have also been shown to be correlated with ACEs, where employed (Brown et al., 2017; Hardcastle et al., 2018), racial/ethnic minority individuals (Brown et al., 2017; Chu & Chu, 2021), and those with lower income tend (Brown et al., 2017) to report more ACEs. Adverse childhood experiences have also been linked to depression (Kapoor et al., 2021; Racine et al., 2021; Sahle et al., 2021) and hypertension (Su et al., 2015), and diabetes (Chu & Chu, 2021; Ittoop et al., 2020) in prior research.

Analytic Approach

Crude and adjusted logistic regression models adjusting for age, gender, race/ethnicity, income, education, employment, diabetes, hypertension, and depression were used to determine the association between ACE types (sexual, physical/psychological, and environmental), ACE score (1, 2, 3, ≥4) and SCD, and SCD-related outcomes. All analyses considered the weighting strategy used in BRFSS, the multiple datasets for each module, and were conducted in SAS version 9.4 (SAS Institute Inc., Cary, NC).

Results

Sixty-two percent (62%) of respondents reported being exposed to ACEs, while 11% reported experiencing SCD in the past year (data not shown). Table 3 shows the sociodemographic characteristics of the study population and also by ACEs and SCD status. There were statistically significant differences in ACEs by age, race/ethnicity, income, education, employment, and depression status. Respondents reporting ACEs tended to be younger, Black, earn less than $50,000, have less than a high school or some college education, be unemployed, and have depression. There were also statistically significant differences in SCD by age, income, education, employment, diabetes, hypertension and depression status. Respondents reporting SCD in the past year tended to be older (80 years old and older), earn less than $50,000, have a high school education or less, be unemployed, or have diabetes, hypertension or depression.

Table 3.

Distribution of Sociodemographic Characteristics and Adverse Childhood Experiences and Subjective Cognitive Decline Status.

	%	ACEs (n = 44,478)	No ACEs (n = 31,669)	p-Value	SCD (n = 9429)	No SCD (73,259)	p-Value
Age
45–59	40.5	45.4	32.5	<.001	39.8	40.6	<.001
60–69	28.7	29.7	28.9		27.1	28.9
70–79	19.3	16.8	23.2		19.3	19.3
80+	11.5	8.0	15.3		13.8	11.2
Gender
Female	53.6	54.0	53.6	.617	54.9	53.4	.156
Male	46.4	46.0	46.4	.617	45.1	46.6	.156
Race/Ethnicity
Black, non-Hispanic	11.3	11.9	8.5	<.001	12.0	11.2	.076
Other, non-Hispanic	4.8	3.7	3.4		5.4	4.7
White, non-Hispanic	76.5	77.9	82.0		73.9	76.8
Hispanic	7.4	6.5	6.2		8.6	7.3
Income
<$15,000	9.7	10.5	7.6	<.001	20.7	8.3	<.001
$15,000–<$50,000	40.9	41.7	40.5		50.4	39.7
≥$50,000	49.4	47.8	51.9		28.9	52.0
Education
<High school	12.4	12.8	10.2	<.001	21.4	11.3	<.001
High school	30.5	31.2	32.1		32.5	30.2
Some college	28.9	30.7	27.6		27.4	29.1
College graduate	28.2	25.3	30.1		18.7	29.4
Employment
Employed	44.5	45.5	42.3	<.001	24.5	47.1	<.001
Unemployed	19.4	22.1	14.3		39.6	16.8
Retired	36.1	32.4	43.4		35.9	36.1
Diabetes
Yes	18.9	19.4	18.8	.250	29.4	17.6	<.001
No	81.1	80.6	81.2	.250	70.6	82.4	<.001
Hypertension
Yes	49.4	50.8	50.0	.233	59.5	48.1	<.001
No	50.6	49.2	50.0	.233	40.5	51.9	<.001
Depression
Yes	18.1	24.4	9.8	<.001	46.3	14.5	<.001
No	81.9	75.6	90.2	<.001	53.7	85.5	<.001

Bolded estimates are statistically significant at p < .05.

Note. ACE = adverse childhood experiences; SCD = subjective cognitive decline.

Table 4 shows the association between ACEs and SCD. After adjusting for age, gender, race/ethnicity, income, education, employment, diabetes, hypertension and depression, sexual (adjusted OR (aOR: 2.83; 95% CI: 2.42–3.31)), physical/psychological (aOR: 2.05; 95% CI: 1.83–2.29) and environmental (aOR: 1.94; 95% CI: 1.74–2.16) ACEs were associated with SCD in the past year. There was also a dose-response relationship between ACE score and SCD; as the number of ACEs increased, the odds of SCD also increased. This finding was also confirmed by correlational analysis (ACE = 1: r = 0.031, p < 0.001; ACE = 2: r = 0.075, p < 0.001; ACE = 3: r = 0.107, p < 0.001; ACE = ≥4: r = 0.187, p < 0.001). Respondents who were exposed to four or more ACEs were twice as likely to experience SCD in the past year (aOR: 1.98; 95% CI: 1.71–2.30).

Table 4.

Association between Adverse Childhood Experiences and Subjective Cognitive Decline.

	Crude OR (95%CI)	Adjusted OR^a (95% CI)
Sexual	3.97 (3.53–4.46)	2.83 (2.42–3.31)
Physical/psychological	2.69 (2.45–2.95)	2.05 (1.83–2.29)
Environmental	2.63 (2.40–2.88)	1.94 (1.74–2.16)
1	1.15 (1.02–1.30)	1.14 (0.99–1.31)
2	1.64 (1.44–1.85)	1.39 (1.20–1.61)
3	2.31 (1.99–2.67)	1.81 (1.50–2.19)
≥4	3.09 (2.77–3.44)	1.98 (1.71–2.30)

Bolded estimates are statistically significant at p < .05.

^aAdjusted estimates controlled for age, gender, race/ethnicity, income, education, employment, diabetes, hypertension, and depression.

Table 5 shows the association between ACEs and SCD-related outcomes. After adjusting for age, gender, race/ethnicity, income, education, employment, diabetes, hypertension, and depression, respondents who reported specific types of ACEs were more likely to give up chores due to confusion or memory loss: sexual (aOR: 1.57; 95% CI: 1.19–2.08), physical/psychological (aOR: 1.38; 95% CI: 1.08–1.76), and environmental (aOR: 1.31; 95% CI: 1.04–1.66). Respondents who were exposed to sexual (aOR:1.46; 95% CI: 1.08–1.96) and physical/psychological abuse (aOR:1.30; 95%CI: 1.02–1.66) were also more likely to report that confusion or memory loss interfered with their ability to work, volunteer, or engage in social activities outside the home. In addition, experiencing four or more ACEs was associated with giving up chores due to memory loss or confusion (aOR: 1.38; 95% CI: 1.06–1.80) or memory loss or confusion interfering with the ability to work, volunteer or engage in social activities outside of the home (aOR: 1.41; 95% CI: 1.09–1.82).

Table 5.

Association between Adverse Childhood Experiences and Subjective Cognitive Decline-Related Outcomes.

	Given up chores		Need assistance with day-to-day activities		Did not get help with day-to-day activities		Interfered with ability to work, volunteer or engage in social activities		Discussed with a health care professional
	Crude OR (95%CI)	Adjusted^a OR (95% CI)	Crude OR (95%CI)	Adjusted^a OR (95% CI)	Crude OR (95%CI)	Adjusted^a OR (95% CI)	Crude OR (95%CI)	Adjusted^a OR (95% CI)	Crude OR (95%CI)	Adjusted^a OR (95% CI)
Sexual	2.69 (2.16–3.36)	1.57 (1.19–2.08)	1.95 (1.53–2.47)	0.95 (0.72–1.25)	1.30 (0.77–2.20)	1.18 (0.66–2.09)	2.94 (2.31–3.74)	1.46 (1.08–1.96)	1.80 (1.45–2.23)	1.13 (0.88–1.46)
Physical/psychological	2.07 (1.72–2.51)	1.38 (1.08–1.76)	1.68 (1.38–2.05)	1.11 (0.87–1.40)	1.37 (0.86–2.18)	1.10 (0.67–1.81)	2.43 (1.98–2.97)	1.30 (1.02–1.66)	1.52 (1.28–1.82)	1.08 (0.88–1.33)
Environmental	2.10 (1.74–2.53)	1.31 (1.04–1.66)	1.78 (1.46–2.16)	1.07 (0.85–1.36)	1.25 (0.78–2.02)	1.00 (0.58–1.72)	2.30 (1.88–2.81)	1.16 (0.91–1.48)	1.64 (1.37–1.95)	1.15 (0.94–1.41)
1	0.79 (0.63–0.99)	0.75 (0.53–1.06)	0.85 (0.67–1.08)	0.80 (0.57–1.12)	1.53 (0.89–2.65)	1.31 (0.79–2.16)	0.86 (0.67–1.10)	0.81 (0.57–1.15)	1.00 (0.79–1.25)	0.99 (0.76–1.30)
2	0.90 (0.70–1.15)	0.99 (0.74–1.32)	1.02 (0.79–1.32)	1.21 (0.89–1.64)	1.09 (0.64–1.85)	1.08 (0.57–2.05)	1.25 (0.97–1.60)	1.14 (0.84–1.55)	1.44 (1.15–1.82)	1.22 (0.94–1.58)
3	1.27 (0.93–0.73)	1.05 (0.76–1.45)	1.21 (0.87–1.69)	0.95 (0.69–1.30)	1.55 (0.87–2.76)	1.76 (0.96–3.22)	1.21 (0.91–1.62)	0.97 (0.70–1.35)	1.28 (0.95–1.73)	1.02 (0.75–1.39)
≥4	2.00 (1.63–2.46)	1.38 (1.06–1.80)	1.51 (1.21–1.88)	0.95 (0.73–1.23)	1.59 (1.05–2.41)	1.35 (0.86–2.12)	2.31 (1.87–2.86)	1.41 (1.09–1.82)	1.70 (1.40–2.08)	1.10 (0.86–1.40)

Bolded estimates are statistically significant at p < .05.

^aAdjusted estimates controlled for age, gender, race/ethnicity, income, education, employment, diabetes, hypertension, and depression.

Discussion

To our knowledge, no study has examined the relationship between ACEs and SCD using a representative sample of the US. Prior research examined the relationship between ACEs and objective cognition (Gold et al., 2021; O’Shea et al., 2021), which suggests that adverse experiences in early life contribute to poorer cognitive outcomes as people age. Furthermore, SCD may be an early indicator of cognitive problems and is therefore important to consider in the context of aging and AD risk. Typical cognitive screenings are only sensitive enough to capture impairment at the point when it starts to impact daily function, and are only conducted with a small percentage of adults. Reports of SCD may be clinically meaningful, and our findings suggest that individuals with a history of ACEs may be more likely to experience SCD than those without a history of ACEs.

We found that the prevalence of ACEs was higher among middle-aged adults than older age groups. It is possible that there is a retrospective memory effect where younger adults tend to remember more ACEs compared to older adults (recall bias). However, studies have shown that the impact of ACEs may last into older adulthood (Ege et al., 2015; O’Shea et al., 2021; Tani et al., 2020). It is also possible that this finding is due to a cohort effect, with a higher prevalence of ACEs among younger cohorts (Logan-Greene et al., 2014). Nevertheless, previous research has shown that the impact of ACEs on adverse health outcomes is not affected by social changes among birth cohorts in the 20th century (Dube et al., 2003). It is also possible that there might be decreased stigma and shame about reporting these events among younger cohorts compared to older populations.

Older adults had a higher prevalence of SCD, in line with previous research (Brown et al., 2020). This impact could be due to the effects of normal aging or non-normative changes at later ages (such as the earliest symptoms of AD). While cognitive decline can occur as individuals age, memory loss in performing routine tasks is not considered “normal aging” and may affect an individual’s independence (Centers for Disease Control and Prevention, 2019). The questions about SCD in the current study asked specifically about memory loss and memory loss affecting functioning, which may go beyond the cognitive decline associated with normal aging.

The main findings of this study were that sexual, physical/psychological, and environmental ACEs were associated with SCD in mid-to-older adulthood (45 years and older) after adjusting for sociodemographic characteristics, diabetes, hypertension and depression. There was also a dose-response relationship between ACE score and experiencing SCD in the past year. Depending on the type and score, ACEs were also associated with giving up chores (sexual, physical/psychological, environmental and ≥4) and interference with the ability to work, volunteer, or engage in social activities outside the home due to cognitive problems (sexual, physical/psychological and ≥4). These findings have important implications for identifying individuals at risk for cognitive decline as they age, particularly in an understudied area: experiences in early life. These findings also suggest that adverse childhood events should also be considered in measures/proxies of cognitive reserve as a potential factor that reduces reserve.

Previous research has shown that ACEs may be associated with objective cognition. Parent’s remarriage, which may be a proxy for parental separation, and parental death were associated with worse cognition as measured by the Spanish and English Neuropsychological Assessment Scales (SENAS) among adults aged 65 years and older in Northern California (Gold et al., 2021). This study did not examine the impact of direct ACEs such as sexual or physical/psychological abuse. Nevertheless, other environmental ACEs such as witnessing domestic violence or substance abuse were not associated with cognition. In comparison to the current study, these disparate findings may be due to the way cognition was measured (objective vs. subjective) and the different ways in which ACEs were operationalized (using established components from PCA vs. examining separately). Another study that focused on older adults in rural South Africa found that environmental ACEs such as living with someone with psychopathology (substance abuse or mental health challenges) was linked with lower memory scores (Kobayashi et al., 2020), which is in line with our current findings.

Gold et al., found no relationship between ACE count and cognition, which conflicts with the current study. We found that an ACE score of at least one was associated with SCD; however, a score of at least four was linked to giving up chores and interference with the ability to work, volunteer or engage in social activities outside the home due to cognitive problems. The higher the number of ACEs, the more stress an individual may experience. Previous work has found that early-life stress is associated with a delay in cognitive functioning before age 20 (Oh et al., 2018), and chronic stress influences brain health throughout the aging process (Lupien et al., 2018). The results in the current study suggest that the impact of ACEs on cognitive functioning may extend into later adulthood.

The potential pathway between early-life stress and cognition in later adulthood has been elucidated in prior research. Kalia and Knauft found that ACEs decreased cognitive flexibility, which describes specific activity in the prefrontal cortex. They also found that perceptions of chronic stress in adulthood mediated the relationship between ACEs and cognitive flexibility (Kalia & Knauft, 2020). A comparison between experiencing ACEs and recent negative events found that individuals exposed to ACEs showed a faster decline in cognition, potentially through biological and/or psychological vulnerability (Korten et al., 2014). ACEs have also been linked to impaired intellectual ability and performance, decreased cerebral and hippocampus volume, and disruption of memory in childhood (Pechtel & Pizzagalli, 2011), which may be related to SCD in adulthood.

There are some limitations to consider when interpreting the study’s findings. Data were self-reported, which may result in social desirability bias. Therefore, ACEs and SCD may be underreported. Subjective cognitive decline as operationalized, though we were able to examine related functional limitations, did not include some factors that are found in the operationalization of SCD plus such as the onset of SCD in the past 5 years; worries associated with SCD or comparison to peers; informant confirmation or inclusion of the APOE ɛ4 genotype data (Jessen et al., 2014; Sanchez-Benavides et al., 2018). Recent research suggests that SCD plus is a better indicator of cognitive decline risk compared to SCD alone. Furthermore, the ACEs and SCD modules were not asked by all states; therefore our study may not be generalizable to all areas of the US. In addition, the selection of confounders was based on the literature and not a specific theory. Trauma-related confounders such as PTSD, anxiety disorders, substance use disorders and attentional disorders were not included in the survey from which our data were drawn; therefore, we were unable to examine their effects in our analysis. Additionally, the specific age at which ACEs were experienced and for how long were not available in the survey. Future research should consider this in more detail as age of ACEs has been shown to impact mental health (Kerker et al., 2015).

Nevertheless, the study had multiple strengths. Although cross-sectional, the temporal sequence was established as ACEs occurred before 18 years old and SCD occurred within the past year among respondents aged 45 and older. In addition, the large sample size (N = 82,688) and representation of 20 states are substantially more representative than previous research on ACEs and early cognitive change in aging. Furthermore, prevalence estimates and measures of effect were weighted and obtained from a population-based sample, further enhancing generalizability. Adjusted analyses controlled for sociodemographic covariates, diabetes, hypertension, and depression, which may alter the association between ACEs and SCD, and SCD-related outcomes.

Conclusion

Adverse childhood experiences were associated with SCD, giving up chores and interference with the ability to work, volunteer, or engage in social activities outside the home due to cognitive problems. The impact of ACEs on cognition may extend from childhood and young adulthood to later life, and this may be noticeable by those affected earlier than when objective deficits are noted on cognitive tests. Intervention programs targeting cognitive health, albeit among older adults, may include addressing ACEs. Future research should examine if the relationship between ACEs and SCD is moderated by sociodemographic characteristics such as age, gender, or race/ethnicity and is mediated by trauma-related variables such as PTSD.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication was made possible in part by Grant Number K01MH115794 from the National Institute of Mental Health awarded to MJB and T32-GM081740 from NIH-NIGMS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIMH, NIGMS, or NIH.”

ORCID iD

Monique J. Brown

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