Intimate Partner Violence and Dementia Risk: Applying Lifecourse and Gender Analysis - PROJECT SUMMARY/ABSTRACT By 2060, the burden of Alzheimer’s disease and related dementias (ADRD) in the U.S. is expected to double to 13.9 million, with women being overrepresented among cases. However, many powerful aspects of women’s lives–including exposure to gender-based violence–have received almost no attention in ADRD research. Women’s exposure to gender-based violence, particularly intimate partner violence (IPV), is pervasive; nearly 30% of older women have experienced IPV in their lifetime. Preliminary evidence suggests that IPV is associated with accelerated biological aging and decreased cognitive functioning, but samples are often highly selected, sample sizes are limited, and studies lack longitudinal assessments. Stress sensitization models also suggest that the impact of trauma, such as IPV, may be larger in some subgroups, since trauma and stress in early life are hypothesized to increase sensitivity to stressful and/or traumatic experiences in later life, but such models have not been extended to neurologic aging outcomes such as cognitive decline. However, data sources that contain robust measures on IPV and longitudinal cognition are limited and often not population representative, limiting the external validity of study results. Modern transportability methods from causal inference may provide novel opportunities to extrapolate study results across populations, improving external validity at the population level. The overall goal of this proposal is to investigate a long-term, aging-related health consequence of IPV among cis-gender women–cognitive decline–an early indicator of ADRD risk using data from longitudinal subcohorts of the Nurses’ Health Study II (NHS2) and the Health and Retirement Study (HRS). This work will be achieved through three specific aims: to estimate (aim 1) the effect of experiences of IPV on trajectories of cognitive functioning in midlife, to evaluate (aim 2) whether experiences of childhood trauma modify the effect of experiences of IPV on trajectories of cognitive functioning in midlife, and to address (aim 3) the non- representative nature of the NHS2 cohort by utilizing novel transportability methods developed in causal inference to estimate the population effect of experiences of IPV on trajectories of cognitive functioning in midlife using HRS. This work will address critical public health questions on the lifecourse consequences of IPV among cis-gender women, bringing analysis of lifecourse and gender into ADRD research, and will provide methodologic contributions to ADRD research to address sample limitations frequent in this field. Further, this fellowship will provide individualized training in gender-based violence, social relationships and networks, cognitive functioning, and methods for causal transportability alongside direct mentorship from an exceptional team of researchers. This work is poised to contribute both substantively and methodologically to the literature on ADRD and may help reveal how lifecourse social experiences of women influence ADRD risk.
