Childhood Adversities, Race, and Late-life Cognition: Socio-behavioral pathways

Background Alzheimer’s Disease and Related Dementia (ADRD) poses a significant public health burden, with pronounced racial disparities in its prevalence. Adverse Childhood Experiences (ACEs) have been implicated as predictors of later-life cognitive decline, potentially contributing to these disparities. However, the pathways linking ACEs to cognition in later life, and how these pathways vary by race, remain understudied. Methods This study utilized data from the Health and Retirement Study (HRS), focusing on a cohort of 9,894 U.S. adults aged 50 and older who participated in the 2008 and 2010 Enhanced Face-to-Face interviews. An innovative structural equation modeling (SEM) approach assessed the cumulative cognitive impact of 23 ACEs by estimating a single overall impact parameter and differentially weighting ACEs to identify the most and least harmful. This was integrated within a race-stratified mediation framework to evaluate the mediating roles of education, smoking, depressive symptoms, and physical activity for Whites and Blacks. Results In the overall model, cumulative ACEs were linked to lower education, increased smoking, higher depressive symptoms, and lower physical activity, all of which contributed to lower cognitive function. In race-stratified models, education emerged as the most significant mediator for Black participants, with depressive symptoms as a secondary mediator, together fully mediating the ACE-cognition relationship. For Whites, all mediators played a role in the ACE-cognition link, with education remaining the most important. A direct association between ACEs and cognition persisted for Whites even after accounting for mediators. The study also highlighted race-specific differences in ACE significance, with parental risky behaviors more impactful for Whites and physical disabilities for Blacks. Grade retention and learning problems were impactful ACEs for both groups. Conclusion This study highlights the complex, race-specific socio-behavioral pathways linking ACEs to cognitive decline in later life. Education plays a crucial mediating role, particularly for Black individuals, while White individuals are influenced by a broader set of factors. These findings suggest the need for targeted public health interventions that address the unique experiences of different racial groups. Future research should continue to explore these pathways to better understand and mitigate racial disparities in ADRD.