School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada.
Gerontologist. 2023 Jul 18;63(6):1087-1103. doi: 10.1093/geront/gnac041.
Adverse childhood experiences (ACEs) are a recognized risk factor for unfavorable health outcomes. No prior systematic review has explored the association between ACEs and cognition in late life, a critical period for cognitive fluctuation. The objective of this review is to address the following research question: What is the association between ACEs and late-life cognition?
Articles were obtained from PubMed, PsycINFO, and Scopus. The last search was performed in May 2021. Eligible articles examined the association between exposure to at least 1 ACE and the outcome of late-life cognition, measured either by cognitive testing or the presence/absence of a neurocognitive disorder. Data were synthesized narratively using the synthesis without meta-analysis guidelines, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS.
Twenty articles representing 18 unique studies were included in the narrative synthesis. Associations with lower late-life cognition were reported for: childhood maternal death, parental divorce, physical neglect, emotional neglect, physical abuse, and combinations of ACEs. However, most results were statistically nonsignificant, and many were unlikely to be clinically important.
We found an association between ACEs and late-life cognition. However, the direction and magnitude of association varied between and within types of ACEs and measures of cognitive function. Most included articles had a moderate risk of bias. This review is the first attempt to synthesize the literature on this topic and it outlines the next steps to improve the evidence base in the area.
不良的童年经历（ACEs）是导致不良健康结果的公认危险因素。以前没有系统的综述探讨 ACEs 与晚年认知之间的关系，而晚年是认知波动的关键时期。本综述的目的是解决以下研究问题：ACEs 与晚年认知之间存在什么关联？
文章从 PubMed、PsycINFO 和 Scopus 中获取。最后一次搜索是在 2021 年 5 月进行的。符合条件的文章研究了至少经历 1 次 ACE 暴露与晚年认知结果之间的关联，认知测试或是否存在神经认知障碍来衡量。使用无荟萃分析指南的综合方法进行叙述性综合，使用纽卡斯尔-渥太华量表（NOS）和适应的 NOS 评估偏倚风险。
有 20 篇文章代表了 18 项独特的研究，纳入了叙述性综合。与晚年认知能力较低相关的因素包括：儿童期母亲死亡、父母离婚、身体忽视、情感忽视、身体虐待以及 ACEs 的组合。然而，大多数结果在统计学上无显著意义，且许多结果不太可能具有临床意义。
我们发现 ACEs 与晚年认知之间存在关联。然而，ACEs 的类型和认知功能的测量之间的关联方向和程度存在差异。大多数纳入的文章存在中度偏倚风险。这是首次尝试综合该主题的文献，并概述了在该领域提高证据基础的下一步措施。
