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Lifecourse Traumatic Events and Cognitive Aging in the Health and Retirement Study

  • Rebecca C. Stebbins
    Correspondence
    Address correspondence to: Rebecca C. Stebbins, PhD, Social, Genetic, & Developmental Psychiatry Centre, King's College London, 8 Memory Lane, London SE5 8AF, United Kingdom.
    Affiliations
    Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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  • Joanna Maselko
    Affiliations
    Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Y. Claire Yang
    Affiliations
    Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Sociology, College of Arts and Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Brenda L. Plassman
    Affiliations
    Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina

    Department of Neurology, Duke University School of Medicine, Durham, North Carolina
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  • Jessie K. Edwards
    Affiliations
    Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Allison E. Aiello
    Affiliations
    Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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      Introduction

      Much of the heterogeneity in the rate of cognitive decline and the age of dementia onset remains unexplained, and there is compelling data supporting psychosocial stressors as important risk factors. However, the literature has yet to come to a consensus on whether there is a causal relationship and, if there is, its direction and strength. This study estimates the relationship between lifecourse traumatic events and cognitive trajectories and predicted dementia incidence.

      Methods

      Using data on 7,785 participants aged ≥65 years from the Health and Retirement Study, this study estimated the association between lifecourse experience of 10 traumatic events (e.g., losing a child) and trajectories of Telephone Interview for Cognitive Status from 2006 to 2016 using linear mixed-effects models and predicted incident dementia from 2006 to 2014 using cumulative incidence functions (data analysis was in 2020–2022). Inverse probability weights accounted for loss to follow-up and confounding by sex, education, race/ethnicity, and age.

      Results

      Experiencing 1 or more traumatic events over the lifecourse was associated with accelerated decline compared with experiencing no events (e.g., β= −0.05 [95% CI= −0.07, −0.02] Health and Retirement Study-Telephone Interview for Cognitive Status units/year; 1 vs 0 events). In contrast, experiencing traumatic events was associated with better cognitive function cross-sectionally. Furthermore, the impact of trauma on cognitive decline was of greater magnitude when it occurred after the age of 64 years. However, the magnitude and direction of association varied by the specific traumatic event. There were no associations with predicted incident dementia.

      Conclusions

      These results suggest that researchers and clinicians should not aggregate traumatic events for understanding the risk of accelerated cognitive decline.
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