This study aimed to examine how adverse childhood experiences (ACEs) and allostatic load (AL) are associated with patterns of cognitive decline in older Chinese adults, and whether AL mediates the association between ACEs and cognitive decline. Using data from the China Health and Retirement Longitudinal Study (CHARLS, Waves 1–4), we applied latent class growth analysis to identify four distinct classes of cognitive decline trajectories and examined the mediating role of AL using the Karlson–Holm–Breen method. Results showed that increased ACEs were associated with a higher likelihood of membership in less favorable classes of cognitive decline, particularly among those with ≥2 deprivation-related ACEs. However, AL was not associated with the patterns of cognitive decline trajectories and did not mediate the relationship between ACEs and cognitive decline trajectories. These findings underscore the importance of providing children with available resources and support to mitigate ACEs and prevent adverse cognitive decline in later life.
AbouelmagdM. E.AbdelMesehM.ElrosasyA.EldeebH. A.NabilY. (2024). Adverse childhood experiences and risk of late-life dementia: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 60(5), 1087–1098. https://doi.org/10.1007/s00127-024-02676-4
2.
BoothT.RoyleN. A.CorleyJ.GowA. J.Valdés Hernández MdelC.Muñoz ManiegaS.RitchieS. J.BastinM. E.StarrJ. M.WardlawJ. M.DearyI. J. (2015). Association of allostatic load with brain structure and cognitive ability in later life. Neurobiology of Aging, 36(3), 1390–1399. https://doi.org/10.1016/j.neurobiolaging.2014.12.020
3.
BrownM. J.KaurA.JamesT.AvalosC.AddoP. N. O.CrouchE.HillN. L. (2022). Adverse childhood experiences and subjective cognitive decline in the US. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 41(4), 1090–1100. https://doi.org/10.1177/07334648211058718
4.
D’AmicoD.AmestoyM. E.FioccoA. J. (2022). The mediating role of allostatic load in the relationship between early life adversity and cognitive function across the adult lifespan. Psychoneuroendocrinology, 141, 105761. https://doi.org/10.1016/j.psyneuen.2022.105761
5.
Fares-OteroN. E.OJ.SpiesG.WomersleyJ. S.GonzalezC.AyasG.MossieT. B.Carranza-NeiraJ.Estrada-LorenzoJ. M.VietaE.SchalinskiI.SchnyderU.SeedatS. (2023). Child maltreatment and resilience in adulthood: A protocol for a systematic review and meta-analysis. European Journal of Psychotraumatology, 14(2), 2282826. https://doi.org/10.1080/20008066.2023.2282826
6.
FinlayS.RothC.ZimsenT.BridsonT. L.SarnyaiZ.McDermottB. (2022). Adverse childhood experiences and allostatic load: A systematic review. Neuroscience & Biobehavioral Reviews, 136, 104605. https://doi.org/10.1016/j.neubiorev.2022.104605
7.
GeoffroyM. C.Pinto PereiraS.LiL.PowerC. (2016). Child neglect and maltreatment and childhood-to-adulthood cognition and mental health in a prospective Birth cohort. Journal of the American Academy of Child & Adolescent Psychiatry, 55(1), 33–40. https://doi.org/10.1016/j.jaac.2015.10.012
8.
GoldA. L.MezaE.AckleyS. F.MungasD. M.WhitmerR. A.MayedaE. R.MilesS.EngC. W.GilsanzP.GlymourM. M. (2021). Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: Results from the kaiser healthy aging and diverse life experiences study baseline. BMJ Open, 11(2), e042125. https://doi.org/10.1136/bmjopen-2020-042125
9.
GuidiJ.LucenteM.SoninoN.FavaG. A. (2021). Allostatic load and its impact on health: A systematic review. Psychotherapy and Psychosomatics, 90(1), 11–27. https://doi.org/10.1159/000510696
10.
HardtJ.RutterM. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(2), 260–273. https://doi.org/10.1111/j.1469-7610.2004.00218.x
11.
Hayes-LarsonE.GradwohlN. M.FongJ.KobayashiL. C.GilsanzP.WhitmerR. A.GlymourM. M.BarnesL. L.KoenenK. C.DeCarliC.FletcherE.MungasD.MayedaE. R. (2025). Childhood adversity and late-life cognitive and brain health in a diverse cohort. Alzheimer's and Dementia: The Journal of the Alzheimer's Association, 21(1), e14388. https://doi.org/10.1002/alz.14388
12.
HongweiW.FangY.KolanowskiA. (2008). Caring for aging Chinese: Lessons learned from the United States. Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society, 19(2), 114–120. https://doi.org/10.1177/1043659607312971
13.
HooperD.CoughlanJ. P.MullenM. R. (2008). Structural equation modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6(1), 53–60. https://doi.org/10.21427/D7CF7R
14.
HuY.RuizM.BobakM.MartikainenP. (2021). Four-year trajectories of episodic memory decline in mid-late life by living arrangements: A cross-national comparison between China and england. Journal of Epidemiology & Community Health, 75(9), 881–889. https://doi.org/10.1136/jech-2020-215567
15.
JiaL.DuY.ChuL.ZhangZ.LiF.LyuD.LiY.LiY.ZhuM.JiaoH.SongY.ShiY.ZhangH.GongM.WeiC.TangY.FangB.GuoD.WangF.JiaJ. (2020a). Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: A cross-sectional study. The Lancet Public Health, 5(12), e661–e671. https://doi.org/10.1016/s2468-2667(20)30185-7
16.
JiaL.QuanM.FuY.ZhaoT.LiY.WeiC.TangY.QinQ.WangF.QiaoY.ShiS.WangY. J.DuY.ZhangJ.ZhangJ.LuoB.QuQ.ZhouC.GauthierS.JiaJ.Group for the Project of Dementia Situation in China. (2020b). Dementia in China: Epidemiology, clinical management, and research advances. The Lancet Neurology, 19(1), 81–92. https://doi.org/10.1016/s1474-4422(19)30290-x
17.
JusterR. P.McEwenB. S.LupienS. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 35(1), 2–16. https://doi.org/10.1016/j.neubiorev.2009.10.002
18.
KobayashiL. C. (2024). Adverse childhood experiences and later-life cognitive aging: Persistent methodological challenges limit the evidence base. The journals of gerontology. Series A, Biological sciences and medical sciences, 79(8), glae138. https://doi.org/10.1093/gerona/glae138
19.
KohlerU.KarlsonK. B.HolmA. (2011). Comparing coefficients of nested nonlinear probability models. STATA Journal: Promoting communications on statistics and Stata, 11(3), 420–438. https://doi.org/10.1177/1536867x1101100306
20.
KortenN. C.PenninxB. W.PotA. M.DeegD. J.ComijsH. C. (2014). Adverse childhood and recent negative life events: Contrasting associations with cognitive decline in older persons. Journal of Geriatric Psychiatry and Neurology, 27(2), 128–138. https://doi.org/10.1177/0891988714522696
21.
LambertH. K.KingK. M.MonahanK. C.McLaughlinK. A. (2017). Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence. Development and Psychopathology, 29(3), 929–940. https://doi.org/10.1017/s0954579416000584
22.
LianJ.KielyK.M.CallaghanB.L.EramudugollaR.MortbyM.AnsteyK.J. (2024). No association found: Adverse childhood experiences and cognitive impairment in older Australian adults. The Journal of Prevention of Alzheimer’s Disease, 11(6), 1818–1825. https://doi.org/10.14283/jpad.2024.133
23.
LinL.CaoB.ChenW.LiJ.ZhangY.GuoV. Y. (2022). Association of adverse childhood experiences and social isolation with later-life cognitive function among adults in China. JAMA Network Open, 5(11), e2241714. https://doi.org/10.1001/jamanetworkopen.2022.41714
24.
LinglongY.LeiQ.Shia Ben-Change. a. (2021). Heterogeneous growth trajectories of cognitive function and influencing factors forElderly adults. ChineseJournal ofHealthStatistics, 38(02), 183–187.
25.
LorY.GeorgeK. M.GilsanzP.MeunierC. C.PetersonR. L.Hayes-LarsonE.BarnesL. L.MungasD.WhitmerR. A. (2023). What is the association between adverse childhood experiences and late-life cognitive decline? Study of healthy aging in african Americans (STAR) cohort study. BMJ Open, 13(11), e072961. https://doi.org/10.1136/bmjopen-2023-072961
26.
McLaughlinK. A.SheridanM. A.LambertH. K. (2014). Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience. Neuroscience & Biobehavioral Reviews, 47, 578–591. https://doi.org/10.1016/j.neubiorev.2014.10.012
27.
MengQ.WangH.StraussJ.LangaK. M.ChenX.WangM.QuQ.ChenW.KuangW.ZhangN.LiT.WangY.ZhaoY. (2019). Validation of neuropsychological tests for the China health and retirement longitudinal study harmonized cognitive assessment protocol. International Psychogeriatrics, 31(12), 1709–1719. https://doi.org/10.1017/s1041610219000693
28.
MenkesD. L.BuchmanA. S.ShahR. J.BoyleP. A.BennettD. A. (2010). Kidney function is associated with the rate of cognitive decline in the elderly. Neurology, 74(20), 1656–1657. https://doi.org/10.1212/WNL.0b013e3181d8a4ef
29.
MisiakB.StańczykiewiczB.PawlakA.Szewczuk-BogusławskaM.SamochowiecJ.SamochowiecA.TyburskiE.JusterR. P. (2022). Adverse childhood experiences and low socioeconomic status with respect to allostatic load in adulthood: A systematic review. Psychoneuroendocrinology, 136, 105602. https://doi.org/10.1016/j.psyneuen.2021.105602
30.
MudaligeD.GuanD. X.BallardC.CreeseB.CorbettA.PickeringE.HampshireA.RoachP.SmithE. E.IsmailZ. (2025). Early life factors and dementia risk: A study of adverse childhood experiences and later-life cognition and behaviour. Public Health, 242, 172–178. https://doi.org/10.1016/j.puhe.2025.02.008
31.
O'SheaB. Q.DemakakosP.CadarD.KobayashiL. C. (2021). Adverse childhood experiences and rate of memory decline from mid to later life: Evidence from the English longitudinal study of ageing. American Journal of Epidemiology, 190(7), 1294–1305. https://doi.org/10.1093/aje/kwab019
32.
PatelP.OremusM. (2023). The association between adverse childhood experiences and late-life cognition: A systematic review of cross-sectional and case-control studies. The Gerontologist, 63(6), 1087–1103. https://doi.org/10.1093/geront/gnac041
33.
RaymondC.MarinM. F.MajeurD.LupienS. (2018). Early child adversity and psychopathology in adulthood: HPA axis and cognitive dysregulations as potential mechanisms. Progress in neuro-psychopharmacology & biological psychiatry, 85, 152–160. https://doi.org/10.1016/j.pnpbp.2017.07.015
34.
RitchieK.JaussentI.StewartR.DupuyA. M.CourtetP.MalafosseA.AncelinM. L. (2011). Adverse childhood environment and late-life cognitive functioning. International Journal of Geriatric Psychiatry, 26(5), 503–510. https://doi.org/10.1002/gps.2553
35.
RogoschF. A.DackisM. N.CicchettiD. (2011). Child maltreatment and allostatic load: Consequences for physical and mental health in children from low-income families. Development and Psychopathology, 23(4), 1107–1124. https://doi.org/10.1017/s0954579411000587
36.
SchäferJ. L.McLaughlinK. A.ManfroG. G.PanP.RohdeL. A.MiguelE. C.SimioniA.HoffmannM. S.SalumG. A. (2023). Threat and deprivation are associated with distinct aspects of cognition, emotional processing, and psychopathology in children and adolescents. Developmental Science, 26(1), e13267. https://doi.org/10.1111/desc.13267
37.
SouthwickS. M.BonannoG. A.MastenA. S.Panter-BrickC.YehudaR. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), 25338. https://doi.org/10.3402/ejpt.v5.25338
38.
SteinC. R.SheridanM. A.CopelandW. E.MachlinL. S.CarpenterK. L. H.EggerH. L. (2022). Association of adversity with psychopathology in early childhood: Dimensional and cumulative approaches. Depression and Anxiety, 39(6), 524–535. https://doi.org/10.1002/da.23269
39.
TjoelkerF. M.JeuringH. W.AprahamianI.NaardingP.MarijnissenR. M.HendriksG. J.RhebergenD.LugtenburgA.LammersM. W.van den BrinkR. H. S.Oude VoshaarR. C. (2022). The impact of a history of child abuse on cognitive performance: A cross-sectional study in older patients with a depressive, anxiety, or somatic symptom disorder. BMC Geriatrics, 22(1), 377. https://doi.org/10.1186/s12877-022-03068-6
40.
van der NestG.Lima PassosV.CandelM.van BreukelenG. J. P. (2020). An overview of mixture modelling for latent evolutions in longitudinal data: Modelling approaches, fit statistics and software. Advances in Life Course Research, 43, 100323. https://doi.org/10.1016/j.alcr.2019.100323
41.
WangY.ChenX.HuY. (2023). Relationship between social support and 7-year trajectories of cognitive decline: Results from the China health and retirement longitudinal study. Journal of Epidemiology & Community Health, 77(9), 578–586. https://doi.org/10.1136/jech-2022-219733
42.
WellerB. E.BowenN. K.FaubertS. J. (2020). Latent class analysis: A guide to best practice. Journal of Black Psychology, 46(4), 287–311. https://doi.org/10.1177/0095798420930932
43.
XieJ.FanX.YinP.GuJ.YangC. (2022). Association between childhood friendship and cognitive ageing trajectory in later life: Evidence from the China health and retirement longitudinal study (CHARLS). BMC Geriatrics, 22(1), 494. https://doi.org/10.1186/s12877-022-03181-6
44.
YeX.HeP. (2022). The association between the community SARS exposure and allostatic load among Chinese older adults. Journal of the American Geriatrics Society, 70(2), 352–362. https://doi.org/10.1111/jgs.17516
45.
ZhangK.WangY.SunY.GaoL.LuY.WangN. (2024). Self-reported childhood adversity, unhealthy lifestyle and risk of new-onset chronic kidney disease in later life: A prospective cohort study. Social Science & Medicine, 341, 116510. https://doi.org/10.1016/j.socscimed.2023.116510
46.
ZhangK.ZhangW. (2022). Adverse childhood experiences and mild cognitive impairment in later life: Exploring rural/urban and gender differences using CHARLS. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 41(5), 1454–1464. https://doi.org/10.1177/07334648211064796
47.
ZhangT.KanL.JinC.ShiW. (2023). Adverse childhood experiences and their impacts on subsequent depression and cognitive impairment in Chinese adults: A nationwide multi-center study. Journal of Affective Disorders, 323, 884–892. https://doi.org/10.1016/j.jad.2022.12.058
48.
ZhaoY.HuY.SmithJ. P.StraussJ.YangG. (2014). Cohort profile: The China health and retirement longitudinal study (CHARLS). International Journal of Epidemiology, 43(1), 61–68. https://doi.org/10.1093/ije/dys203
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