The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults

Abstract

Background: Adverse childhood experiences (ACEs) are linked to higher risk of common conditions driving mortality in adulthood, but little evidence exists on whether ACEs are associated with risk of dementia, a leading cause of death in the USA.

Objective: To estimate the relationship between US adults' reported ACE scores and a positive screen for dementia.

Design: Cross-sectional analysis of a longitudinal, national population-based survey of US older adults.

Participants: Survey respondents aged ≥ 65 years with dementia screening data from the 2017 wave of the Panel Study of Income Dynamics (PSID) and ACE scores from the 2014 PSID Childhood Retrospective Circumstances Survey supplement (1,488 eligible participants unweighted).

Main measures: Dementia screening data was collected in the 2017 wave of the PSID using the 8-item informant interview to differentiate normal cognition and dementia (AD8). Mean change in AD8 score and probability of a positive dementia screen by ACE score were calculated using adjusted regression models with post-estimation. Analyses were stratified by age group. Measures were analyzed in 2020.

Results: Complete data were available for 1,223 (82%) participants, with a mean age of 73.4 years (SD 7.1, range 65 to 96 years). Adjusted estimated probability of a positive dementia screen increased with each additional adverse childhood experience reported. Older adults with ≥ 4 ACEs had higher rates of a positive dementia screen (AD8 score ≥ 2 points) compared to those with no ACEs (adjusted rate 26.6% versus 16.3%, p = 0.034). Compared to those with no ACE history, respondents with ≥ 4 ACEs had higher odds of a 1-point increase in AD8 score across all intervals of the AD8 scale (aOR 1.79, 95% CI 1.05-3.04). The ACE-positive dementia screen associations were strongest among those aged 65-75.

Conclusions: Greater exposure to ACEs is independently associated with higher probability of a positive dementia screen in older adulthood.

Keywords: adverse childhood experiences (ACEs); dementia; national survey data.