Adverse childhood experiences and cognitive outcomes among older adults in low-income and middle-income countries: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not provided for pooled analysis

• Effect Size: Not quantified - narrative synthesis only

• Primary Outcome: Cognitive impairment and cognitive function in older adults

• Nnt Or Sensitivity: 10 of 14 studies (71%) reported significant associations between ACEs and poorer cognitive outcomes

• Confidence Interval: Not provided

Clinical Application

Limited by lack of standardized ACE assessment tools and cognitive screening protocols in many LMIC healthcare systems Limited direct applicability to Australian practice given focus on LMIC populations, though may inform care of migrants from LMIC backgrounds and highlight importance of childhood trauma screening Adults aged 40+ in LMIC settings, particularly those with history of childhood adversity

Abstract

OBJECTIVES: While adverse childhood experiences (ACEs) have been consistently linked to poorer cognitive outcomes in later life, far less is known about ACEs' contribution to dementia and cognitive ageing risk in low-income and middle-income countries (LMICs), despite their growing and disproportionate share of global Alzheimer's disease and related dementias (ADRD) burden. This study aimed to systematically review existing evidence on the association between individual ACEs and cognitive outcomes among adults aged 40 years and older in LMIC settings. DESIGN: Systematic review and narrative synthesis. DATA SOURCE: We searched Medline, Embase, PsycINFO and CINAHL from the inception of each database to January 2026. ELIGIBILITY CRITERIA: Observational studies examining the association between individual ACEs and cognitive outcomes among adults aged 40 and older in LMICs. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened each record, assessed risk of bias using the Joanna Briggs Institute critical appraisal tool and extracted data. Results were illustrated using descriptive forest plots and a narrative synthesis. RESULTS: Our systematic review included 14 studies, primarily from upper-middle-income countries, that assessed the relationship between individual ACEs and cognitive impairment (n=4) and function (n=10). 10 studies reported significant associations between ACEs and poorer cognitive function and increased risk of cognitive impairment. No study assessed the association between ACEs and ADRD. Parental death, neglect and mental health issues in the family showed consistent associations with cognitive outcomes, whereas experiencing hunger and poor health in childhood showed inconsistent associations. CONCLUSIONS: Our review corroborated evidence from high-income countries that exposure to ACEs is associated with a long-term risk of poorer cognitive outcomes among older populations in LMICs. However, the available literature remains limited, with most studies originating from upper-middle-income countries, few examining cognitive impairment and none assessing ADRD. These findings underscore substantial gaps in knowledge and highlight the need for research across diverse LMIC settings to clarify the role of broader psychosocial and contextual childhood experiences in shaping cognitive ageing and dementia risk. PROSPERO REGISTRATION NUMBER: CRD42024501816.

References

1. 1.Ngwa, C. H., Abdulrahim, S., Nehme, R., Saad, M., Kabalan, M., Lteif, M. R., Yazbek, Y., Chaaya, M., & Elbejjani, M. (2026). Adverse childhood experiences and cognitive outcomes among older adults in low-income and middle-income countries: a systematic review. BMJ Open, 16(4), e112648. https://doi.org/10.1136/bmjopen-2025-112648