The role of adverse childhood experiences and attachment in neuropsychiatric symptoms in dementia: a new hypothesis and systematic scoping review.

ObjectivesMost people living with dementia (~90%) will experience at least one neuropsychiatric symptom (NPS) such as agitation, aggression, and anxiety. NPS can be distressing, difficult to manage, and are associated with negative outcomes for people and their families. Emerging evidence suggests some NPS are related to post-traumatic stress disorder developed in adulthood. Whilst adverse childhood experiences (ACEs) have rarely been considered, we propose that they are especially relevant for people living with dementia and aimed to explore evidence for a link between NPS and ACEs. Methods We conducted a systematic scoping review searching four scientific databases. We included studies exploring the link between NPS and ACEs (physical, sexual, and emotional abuse; physical and emotional neglect; and household dysfunction (e.g. household violence, separation from parents). We also included insecure attachment style as a proxy for ACEs. ResultsFive papers were included. One described one relevant case of a person living with dementia whose NPS were perceived by healthcare staff as linked to his ACE (parental separation). Four papers explored links between attachment style and NPS with two showing a significant association and two showing no significant association.ConclusionThere is a substantial gap in the evidence base around ACEs and NPS. Methodological limitations and differences in sample characteristics across existing attachment studies make it difficult to draw conclusions. We propose that consideration of ACEs can offer a new approach to understanding and treating NPS, but more evidence needed. We recommend robust, longitudinal research into the association of ACE with NPS.