Cumulative ACE Burden Drives Cognitive Decline Among Low-Income Seniors

Minoritized populations experience higher incidence of cognitive impairment and dementia. Adverse childhood experiences (ACEs) are associated with increased risk for cardiometabolic disease and cognitive decline in adulthood, yet the relationship between ACEs and subjective cognitive functioning (SCF) remains poorly characterized. We used community-engaged research strategies (i. e. , community advisory board and community champion-led recruitment) to evaluate low-income seniors (n=65; 57% Female; 72% ≤ 25K income annually), living independently, for ACE and subjective cognitive decline. We examined the association between cumulative ACE burden and SCF using validated instruments: ACE and Cognitive Failures (CFQ), and an Instrumental Activities of Daily Living (IADL) question. For IADL, we asked how often the individual failed to perform routine activities (i. e. , cooking, driving, or paying bills) due to confusion or memory loss over the past year. Any reported impairment was categorized as IADL decline. We used linear regression and Pearson chi-square test to examine associations between ACE (no ACEs, 1-3 ACEs, or ≥4 ACEs) and cognition factors. While the highest burden ACE participants tended to be younger and had higher educational attainment, they had worse reported cognition. Compared with individuals reporting no ACEs, those with ≥4 had higher CFQ scores (β = 19. 3, 95% CI: 8. 3–30. 4). CFQ memory subscale analysis produced similar results, indicating that the observed association reflects memory-specific cognitive failures rather than distraction or stress-related inattention. IADL impairment also increased with higher ACE exposure. Higher ACE exposure was associated with poorer CFQ scores independent of race, education, and age. Our findings suggest a dose-response pattern of cumulative adversity between ACE exposure and later life brain health. Understanding ACE exposure may help identify individuals at elevated risk for dementia.