Priya Patel1, Mark Oremus1. 1. School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: 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? RESEARCH DESIGN AND METHODS: 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 one 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 risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS. RESULTS: 20 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 non-significant, and many were unlikely to be clinically important. DISCUSSION AND IMPLICATIONS: 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.
BACKGROUND AND OBJECTIVES: 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? RESEARCH DESIGN AND METHODS: 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 one 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 risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS. RESULTS: 20 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 non-significant, and many were unlikely to be clinically important. DISCUSSION AND IMPLICATIONS: 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.