Pathways from Adverse Childhood Experiences to Later-Life Cognition in China

BACKGROUND AND OBJECTIVES: Dementia prevalence is rising dramatically in China. Adverse Childhood Experiences (ACEs) are linked to cognitive function in later life but the specific pathways underlying this connection are not well understood. Drawing on the chain-of-risk model and the Dimensional Model of Adversity and Psychopathology, this study tested whether 11 individual ACEs are associated with later-life cognition directly or indirectly through 13 modifiable dementia risk factors identified by the Lancet Commission, and whether threat, deprivation, and household-disruption ACEs operate through theoretically distinct pathways. RESEARCH DESIGN AND METHODS: We utilized data from 20,010 adults aged 40 years or more from the China Health and Retirement Longitudinal Study and its 2014 Life History Survey. Structural equation modeling was employed to simultaneously test the direct paths from individual ACEs to a latent global cognition factor and the indirect paths through dementia risk factors (e.g., less education, depression), controlling for covariates. RESULTS: Emotional abuse and community violence showed significant direct negative associations with later-life cognition that persisted after mediators were included. Physical neglect and parental divorce or death showed significant indirect negative effects, operating through less education, depression, and untreated vision loss. Emotional neglect and household violence showed unexpected positive direct associations. DISCUSSION AND IMPLICATIONS: ACEs reach later-life cognition through qualitatively distinct routes. Effective intervention requires both upstream social-determinants policies and clinical attention to ACE history as a marker of cognitive risk.