Mudalige Dinithi, Guan Dylan X, Ballard Clive, Creese Byron, Corbett Anne, Pickering Ellie, Hampshire Adam, Roach Pamela, Smith Eric E, Ismail Zahinoor
University of Calgary, AB, Canada.
University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, AB, Canada.
Public Health. 2025 May;242:172-178. doi: 10.1016/j.puhe.2025.02.008. Epub 2025 Mar 17.
Adverse childhood experiences (ACE) are associated with brain alterations and cognitive decline. In later life, cognitive impairment and mild behavioural impairment (MBI) are associated with greater dementia risk. We investigated whether more severe ACE are cross-sectionally associated with worse later-life cognitive and behavioural symptoms.
Cross-sectional study.
Data are from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT). Measures included the Childhood Trauma Screener (CTS-5), neuropsychological testing, Everyday Cognition (ECog)-II scale, and MBI Checklist (MBI-C). Linear regressions modelled associations between ACE severity and neuropsychological test scores. Multivariable negative binomial regressions (zero-inflated, if appropriate) modelled associations between ACE severity and ECog-II and MBI-C scores. All models controlled for age, sex, education, and ethnocultural origin. Clinical diagnoses of depression and/or anxiety were explored as covariates or mediators.
In adjusted analyses, higher ACE scores were associated with worse performance on Trail-Making B (standardized b = 0.10, q = 0.003), Switching Stroop (b = -0.08, q = 0.027), Paired Associates Learning (b = -0.08, q = 0.049), and Digit Span (b = -0.08, q = 0.029). Higher ACE scores were also associated with higher ECog-II (b = 1.08, q = 0.029) and MBI-C (b = 1.20, q < 0.001) scores; these associations were neither mediated by affective symptoms (ECog p = 0.16; MBI p = 0.13) nor moderated by sex (ECog p = 0.09; MBI p = 0.46).
Older adults with a history of more severe ACE show greater cognitive and behavioural risk markers for dementia that cannot be explained by previous psychiatric history. Further research into ACE as an early modifiable risk factor for dementia is warranted.
儿童期不良经历（ACE）与大脑改变和认知衰退有关。在晚年，认知障碍和轻度行为障碍（MBI）与更高的痴呆风险相关。我们调查了更严重的ACE是否与更差的晚年认知和行为症状存在横断面关联。
横断面研究。
数据来自加拿大在线研究平台，以调查老年人的健康、生活质量、认知、行为、功能和照护情况（CAN-PROTECT）。测量指标包括儿童创伤筛查量表（CTS-5）、神经心理学测试、日常认知（ECog）-II量表和MBI清单（MBI-C）。线性回归模型用于分析ACE严重程度与神经心理学测试分数之间的关联。多变量负二项回归（如适用则为零膨胀模型）用于分析ACE严重程度与ECog-II和MBI-C分数之间的关联。所有模型均对年龄、性别、教育程度和种族文化背景进行了控制。探讨了抑郁和/或焦虑的临床诊断作为协变量或中介变量。
在调整分析中，较高的ACE分数与连线测验B表现较差（标准化β = 0.10，q = 0.003）、色词转换测验（β = -0.08，q = 0.027）、成对联想学习（β = -0.08，q = 0.049）和数字广度（β = -0.08，q = 0.029）相关。较高的ACE分数还与较高的ECog-II（β = 1.08，q = 0.029）和MBI-C（β = 1.20，q < 0.001）分数相关；这些关联既不受情感症状介导（ECog p = 0.16；MBI p = 0.13），也不受性别调节（ECog p = 0.09；MBI p = 0.46）。
有更严重ACE病史的老年人表现出更大的痴呆认知和行为风险标志物，且无法用既往精神病史来解释。有必要进一步研究ACE作为痴呆的早期可改变风险因素。
