Prospective Studies of Childhood Trauma and Mid to Late Life Neighborhood Deprivation with Cognitive Trajectories and Dementia Outcomes
- Lee, Adrienne
- Advisor(s): LaCroix, Andrea Z
Abstract
Background: Given that the burden of Alzheimer’s Disease and Related Dementias (AD/ADRD) is expected to double by the year 2050 affecting 14 million Americans aged ≥65, understanding the risk factors that accumulate throughout the life course is imperative to reduce modifiable risk factors and slow the progression of disease. Childhood trauma is an early life psychosocial risk factor that may precipitate worse conditions later in the life course, such as neighborhood socioeconomic disadvantage, both of which have been independently shown to be associated with adverse cognitive outcomes in later life. However, associations between childhood trauma and neighborhood disadvantage in mid-to-late life have never been examined, and there is limited prospective research examining these risk factors with longitudinal cognitive outcomes in later life among a nationally representative cohort. Methods: This dissertation uses longitudinal data from the Health and Retirement Study, a U.S.-based aging cohort representative of adults aged ≥50. In Aim 1 (n=9,022), we investigated associations between childhood trauma and mid-to-late life neighborhood socioeconomic disadvantage. In cognitively intact adults aged ≥50, we investigated associations between baseline neighborhood socioeconomic disadvantage (Aim 2; n=26,728) and childhood trauma (Aim 3; n=8,051) with cognitive performance trajectories and algorithmically classified dementia outcomes. Differences by gender, race/ethnicity, and early life socioeconomic adversity were explored in all aims. Results: In Aim 1, family structure disruption was associated with living in neighborhoods with less disadvantage in Black and Hispanic/Latino adults, while parental/sibling death was associated with living in higher disadvantaged areas in the absence of childhood financial adversity. In Aim 2, among over 25,000 cognitively intact adults aged ≥50, living in neighborhoods with high versus low disadvantage was associated with worse cognitive performance and faster declines, as well as increased risk for cognitive impairment/no dementia (CIND) and probable dementia primarily in White/non-Hispanic adults. Last, in Aim 3, we found that childhood trauma –particularly parental/sibling death – was associated with worse cognitive performance and faster declines, as well as increased risk of CIND and probable dementia within subgroups of the population. Conclusion: While complex, we demonstrate that childhood trauma influences mid-to-late life neighborhood disadvantage, and both factors were associated with faster cognitive performance decline and risk of dementia. These findings underscore the role of social and structural determinants on adverse cognitive outcomes in later life.