Association of Adverse Childhood Experiences with Later-Life Motoric Cognitive Risk Syndrome among Older Adults in China: Mediating Role of Depression and Chronic Pain

INTRODUCTION: Adverse childhood experiences (ACEs) may have long-term effects on cognitive and motor function in later life. This study examined the association between ACEs and motoric cognitive risk (MCR) syndrome among older adults in China and investigated whether depression and chronic pain mediate this relationship. METHODS: This cross-sectional study analyzed 3,983 adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). Twelve ACE indicators were assessed across conventional, expanded, and new categories. MCR was diagnosed based on cognitive complaints and slow gait speed. Depression was evaluated using the 10-item Center for Epidemiologic Studies Depression Scale, and chronic pain through standardized questionnaires. Multivariable logistic regression models and parallel mediation analyses examined associations between ACEs and MCR. RESULTS: The study included 3,983 older adults with a median age of 66 years (interquartile range: 63-71), of whom 59.3% were male. MCR was identified in 12.9% (n = 512) of participants, with emotional neglect (40.1%) and physical abuse (30.7%) being the most common ACEs. Participants with 1-3 ACEs (adjusted odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.05-1.93) and ≥4 ACEs (adjusted OR = 1.69, 95% CI: 1.19-2.43) showed significantly higher odds of MCR compared to those without ACEs. Depression and chronic pain mediated 14.3% and 21.4% of the total effect, respectively. CONCLUSION: ACEs demonstrated dose-dependent associations with MCR in Chinese older adults, partially mediated through depression and chronic pain. These findings suggest that screening for ACE exposure and addressing mental and physical health may be critical for preventing cognitive-motor decline in later life.