Adverse Childhood Experiences and Cognitive Disability Across Adulthood: Associations with ACE Burden, Specific Adversities, and Age

Background and Objective: Adverse childhood experiences (ACEs) are associated with adverse health outcomes across the life course, but associations with adult cognitive disability remain incompletely characterized. We examined associations between individual ACEs, cumulative ACE burden, and cognitive disability and assessed whether associations varied by age. Methods: We conducted a cross-sectional analysis of 2020–2024 Behavioral Risk Factor Surveillance System data from 329,392 adults from 27 states, the District of Columbia, Puerto Rico, and U.S. Virgin Islands that administered the ACE module. Survey-weighted logistic regression estimated associations between individual and cumulative ACE exposure and self-reported cognitive disability, adjusting for demographic, socioeconomic, behavioral, and health characteristics. Results: Cognitive disability was reported by 11.3% of participants. Several individual ACEs were associated with cognitive disability, with the strongest association being observed for living with someone who was depressed, mentally ill, or suicidal (adjusted odds ratio [aOR], 2.00; 95% CI, 1.87–2.13). Cognitive disability prevalence increased from 6.4% among adults reporting 0 ACE types to 30.0% among those reporting ≥5 ACE types. The association between cumulative ACE burden and cognitive disability differed by age (p for interaction < 0.0001), with stronger associations observed among younger adults. Among adults aged ≥45 years, greater cumulative ACE exposure was associated with higher odds of initial cognitive difficulties and several related cognitive and functional concerns, with the strongest and most consistently elevated associations being observed among those reporting ≥5 ACE types. Conclusions: ACEs were associated with adult cognitive disability, with stronger associations being observed with the increase in ACE burden and among younger adults. Among adults aged ≥45 years, greater ACE burden was also associated with several self-reported cognitive-related difficulties. Longitudinal research is needed to clarify the mechanisms underlying these associations.