Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians

This was just sent by the RACP “Paediatric Pot-Pourri”. It continues the developing and worrying themes presented at the recent NBPSA and CCCH satellites days before the RACP Congress. I cannot see any reason to imagine that these same outcomes do not also apply to those children living anywhere in the world where ACE’s are flooding into their lives.

John Goldsmith

“All paediatricians, particularly those with an interest in child development, are aware of the Adverse Childhood Experiences studies that show a linear correlation between the number of significant adverse events in childhood and poor mental and physical health in adult life. As Australians who care about the health of Australian Aboriginal people we are also concerned about the gap in lifespan between Aboriginal and non-aboriginal adults. A ground breaking study by Professor Tony Broe and his team from the Aboriginal Health and Ageing Research Group shows that adverse childhood experiences in Aboriginal children have a correlation with later life dementia as well as a range of other mental health problems, including suicide attempts. Childhood trauma appears to be an important factor in the high dementia rates as well as the lifespan gap seen in Aboriginal people. This new work highlights the need for paediatricians to focus on Aboriginal child health in its broadest sense, looking at improving the lives as well as the health of these vulnerable children. A summary of the study is below. View the full study from The American Journal of Geriatric Psychiatry online.  Professor Kim Oates

Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians

Published with permission from Neuroscience Research Australia (NeuRA) & School of Medical Sciences, University of New South Wales, Sydney NSW Recent Australian studies show that both urban and remote Aboriginal people have high rates of late-life dementia – three to four times higher than the non-Indigenous population and amongst the highest in the world; dementia incidence is also high and onset occurs at an earlier age. Dementia types are the same as those found in studies of older people world-wide – most commonly Alzheimer's disease and secondly vascular brain disease - with other causes uncommon and alcohol related dementia rare (in contrast to stereotyped expectations). Increased dementia rates coincide with rapid ageing of Aboriginal populations (as with world populations generally) despite the persistence of the 10 year gap in life expectancy and high numbers of Aboriginal young people compared to non-Indigenous Australians. In the seminal Adverse Childhood Experiences (ACE) Study in the US, retrospectively reported child adversity was associated with poor mid-life mental (anxiety, depression, suicide) and physical health outcomes (cigarette use, stroke, heart disease, diabetes). These results have been replicated in numerous studies around the world, with mounting evidence that childhood adversity, particularly abuse and emotional neglect, affect early-life brain growth and development. Links between childhood adversity and late-life cognitive outcomes are also emerging, however primarily in relation to depressive symptoms and not for dementia diagnosis.  In this paper we examined potential risk factors for high dementia rates in the total 60 plus population from five representative NSW urban and rural Aboriginal Communities (n=336). We measured both standard bio-medical factors and early life factors, including childhood deprivation and trauma (using the Childhood Trauma Questionnaire (CTQ)). Childhood trauma was associated with all cause dementia and specifically Alzheimer's disease in Aboriginal Australians aged 60 to 92 years; childhood trauma was independently associated with anxiety, depression and stress disorder into late-life, as well as with previous attempted suicide. As expected standard mid-life biomedical risk factors examined were also associated with late-life dementia (stroke, head trauma, alcohol, etc.). CTQ scores were associated with other adverse childhood indicators including removal from family and poor childhood health; however there were no significant associations with late-life smoking, alcohol abuse, diabetes or cardiovascular risk factors.  Childhood trauma is likely to be important in the high dementia rates (and the lifespan gap) in Aboriginal Australians. This links to the role of social determinants of brain growth (parenting, education, social exclusion, emotional neglect) in life-long health disadvantage and the mounting evidence that childhood adversity affects early-life brain growth and development. Post-colonisation issues, ongoing cultural devastation and child removal, parenting and educational opportunities are factors which need to be examined and addressed to tackle poor Indigenous health and premature cognitive decline – as well as the commonly recognised mid-life biomedical risks.