Adverse childhood experiences and subjective cognitive decline: An analysis of the Behavioral Risk Factor Surveillance System

Background: Cognitive functioning plays a crucial role in maintaining a healthy, active, and independent lifestyle. A 2017 study found the total net cost of care for an individual with dementia was 175% more than a person without dementia.¹  With an aging population and increasing rates of dementia in the U.S., improved etiology of cognitive decline is pertinent to establishing preventative measures, and therefore slowing increasing rates. The aim of this study was to determine the association between domains of Adverse Childhood Experiences(ACEs), and subjective cognitive decline (SCD) in a representative sample of the US adult population.

Methods: Data was obtained from the 2019 and 2020 Behavioral Risk Factor Surveillance Survey (N=18,096; > 45 years). ACEs were summed and categorized into 0, 1-2, and 3+ for ACE accumulation analysis. Among individuals reporting one ACE, domains of adversity (Family Mental Illness, Family Substance Abuse, Family Incarceration, Parental Divorce, Intimate Partner Violence, Emotional Abuse, Physical Abuse, and Sexual Abuse) were compared to those reporting 0 ACEs. We estimated prevalence of ACEs among individuals responding to the SCD questions within BRFSS and used multivariate logistic regression to determine the association between ACE domains and SCD.

Results: Our sample included 178,441 respondents representing a population estimate of 38,215,839. Among respondents aged 45 and over, 10.14% (n = 18,096; N = 3,960,992) reported experiencing cognitive decline. Mean ACE scores among participants reporting cognitive decline were 2.61 compared to an ACE score of 1.44 in participants not reporting cognitive decline, a statistically significant difference (P<.001).

Compared to individuals reporting 0 ACEs, individuals reporting 1-2 ACEs were more likely to report frequently experiencing memory loss (OR: 1.59; 95%CI 1.43-1.76) and even greater among those reporting 3 or more ACEs (OR: 3.58; 95%CI: 3.23-3.96). Individuals reporting 3 or more ACEs were also significantly more likely to report frequent difficulties with ADLs, needing assistance with ADLs, and experiencing social limitations due to cognitive decline compared to individuals with no ACEs. Further those with higher ACEs scores were significantly less likely to have spoken with a healthcare provider about their cognitive decline.

Among individuals reporting 1 ACE of family mental illness, family substance abuse, family incarceration, emotional abuse, and physical abuse had significantly greater odds of reporting memory loss compared to individuals with no ACEs. Individuals with 1 ACE of parental divorce were less likely to get help with ADLs when needed, and individuals reporting 1 ACE of sexual abuse were significantly less likely to experience social limitations compared to those with no ACEs.

Conclusions: Having multiple ACEs was significantly associated with higher odds of cognitive decline and associated limitation of social activity and inversely associated with getting help when it is needed. Further, many ACE domains were associated with SCD—a novel addition to the literature and the methodology used herein. Interventions focused on improving cognitive health and preventing cognitive decline should consider the potential role of ACEs among affected populations.