The Long Arm of Adversity: Examining the Role of Adverse Life Events on Mid- to Late-Life Cognitive Functioning
Creators: name: Johnson, Kimson
Publisher: name: My University
Year: 2023
Subjects: subject: adverse childhood events
subject: aces
subject: cognitive functioning
subject: aging over the life course
subject: Alzheimer's disease and related dementias (AD/ADRD)
subject: Public Health
subject: Health Sciences

description: As the number of Americans living with Alzheimer’s disease and related dementias (AD/ADRD) continues to grow rapidly, there has been a concerted effort to better understand what potential modifiable risk factors account for ADRD across the life course. Despite the growing literature on modifiable risk factors for dementia, minimal research has focused on how exposure to adversity in early and midlife can affect cognitive functioning and dementia risk over the life course. More research is needed to identify how the long arm of adversity in childhood and adulthood affects cognitive functioning trajectories after age 50. The broad goal of this research is to examine the association between exposure to adverse life events in childhood and adulthood and cognitive functioning outcomes after age 50. This dissertation aims to (1) identify the relationship between household adverse childhood experiences (household ACEs) and mid- to late-life cognitive functioning, (2) identify the relationship between adverse adult experiences (AAEs) and cognitive functioning in mid-to late life over five waves of data (2010–2018), and (3) determine how the relationship between adverse life events (ALEs) in both childhood and adulthood impacts cognitive functioning over five waves of data (2010–2018). Previous research has paid particular attention to how two of the three categories of ACEs (i.e., abuse and neglect) impact physical and mental health outcomes. Few studies have explored how a third category of ACEs—household dysfunction—impacts cognitive health in later life. In addition to the additive effect of exposure to household ACEs and AAEs on cognitive functioning after age 50. The outcomes examined in this research are two indicators of cognitive functioning: the Langa-Weir classification of cognitive function (i.e., normal; cognitively impaired, not dementia (CIND); and dementia) and total recall (indicator of cognitive decline). Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2018 tracker file; the Cross-Wave 2015–2017 Life History Mail Survey (LHMS): Harmonized and Aggregated Public Data Resource; the Cross-Wave Childhood Health and Family Aggregated Data; and the Langa-Weir Classification of Cognitive Function (1995–2018). The empirical chapters use two statistical analysis approaches. Multinomial logistic regression is used to examine the relative risk for cognitive decline. Latent growth curve modeling is used to observe individual-level patterns of cognitive functioning trajectories and change over time. Results from the second chapter show that exposure to one household ACE was not statistically significantly associated with a higher relative risk for CIND, while exposure to two or more household ACEs was significantly associated with a higher relative risk for CIND. Exposure to one ACE and two or more household ACEs was significantly associated with a higher relative risk for dementia. The third chapter reports that exposure to one or more household ACEs is associated with statistically significantly lower cognitive functioning over an eight-year period (across five waves of data). As discussed in the fourth chapter, exposure to one or more AAEs is significantly associated with lower cognitive functioning over an eight-year period (across five waves of data). Exposure to one or more adverse life events (ALES) is associated with significantly lower cognitive functioning over an eight-year period (across five waves of data). Understanding how ALEs influence cognitive functioning over the life course can inform the development of interventions that could potentially mitigate this impact among individuals who have experienced ALEs.