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Late-Life Brain Effects of Childhood Adversity

The likelihood of cerebral infarcts in old age was greater with higher levels of emotional neglect in childhood.

Whether childhood adversity is associated with stroke in older people is understudied. These investigators addressed the question in a longitudinal neuropathologic study of 1040 nondemented individuals (age, 55) who were examined annually (mean follow-up, 3.5 years) and gave permission for autopsy.

Childhood adversity before age 18 was assessed with a self-report scale that covered emotional neglect, parental intimidation or violence, family turmoil, and financial need. Psychiatric evaluations were not conducted. Of the 257 participants who died, the brains of 192 consecutive cases (mean age, 88; 68% female) were autopsied and examined for gross and microscopic cortical and subcortical infarcts in six regions of one hemisphere.

Cerebral infarcts were found in 46% of autopsies. Likelihood of infarcts was significantly correlated with adversity scores (odds ratio, 1.1). In analyses by subscores, the association was limited to emotional neglect. Infarcts were 2.8 times more likely in people who had scored at the 75th percentile of emotional neglect than in those who had scored at the 25th percentile. Clinical stroke, present in 40 participants, was not associated with neuropathology. Findings remained significant after adjustment for numerous socioeconomic and cardiovascular risk factors.

Comment: Despite study limitations (e.g., autopsy of only one hemisphere), the findings are consistent with developmental differences found in institutionalized preschool children, who improved clinically and on neuroimaging after placement in emotionally enriched homes (JW Psychiatry Aug 20 2012). Shortened telomeres were associated with childhood adversity in the preschool study (JW Psychiatry Jun 13 2011), and, as a commentator suggests, shortened telomeres might also be a risk factor for stroke. An important clinical question is whether corrective environmental experiences, implemented during younger adulthood, could prevent old-age cerebral infarcts.

— Barbara Geller, MD

Published in Journal Watch Psychiatry September 19, 2012

Citation(s):

Wilson RS et al. Emotional neglect in childhood and cerebral infarction in older age. Neurology 2012 Oct 9; 79:1534. (http://viajwat.ch/OEAOXI)

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• Medline abstract (Free)

Barrett KM and Meschia JF. Cerebral infarction in older age: Nature or (lack of) nurture? Neurology 2012 Oct 9; 79:1524. (http://viajwat.ch/PzO5mw)

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• Medline abstract (Free)

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