Approved Research

Mediation Effects of Sexually Transmitted Infections on Neurodegeneration, Dementia, and Alzheimer's Disease among Adult Survivors of Childhood Sexual Violence: Evidence from the UK Biobank

Lay summary

The main aim is to investigate whether and to what extent sexually transmitted infections influence the effects of childhood sexual violence on neurodegeneration in mid-life (ages 45-69) and late-life (age 70 and above). To achieve this, the study will explore the direct and indirect relationships between exposure to sexual violence in childhood, sexually transmitted infections into and throughout adulthood, and neurodegeneration outcomes over the life course.

The study will focus on adults from the UK Biobank cohort. Using statistical methods for epidemiology in analyzing cohort studies, we will quantify the effects of sexually transmitted infections on neurodegeneration in mid- and late-life among adults exposed and unexposed to childhood sexual violence. We will also consider other factors that might influence sexually transmitted infections and neurodegeneration, such as gender, age, race, ethnicity, socioeconomic status, and other types of child maltreatment. Neurodegeneration measures will include a range of key biomarkers, and dementia and Alzheimer's disease diagnoses.

One major reason for this study is that a Lancet Commission identified 12 evidence-based factors that affect the likelihood of dementia. However, childhood sexual violence and sexually transmitted infections have not been considered in this context before. Both of these factors can impact the immune system and inflammation in the body, which can contribute to neurodegeneration, and in turn, dementia, and Alzheimer's disease. By examining these relationships, the study aims to provide valuable insights at the intersections of child maltreatment, infectious diseases, brain health in mid- and late-life, and health disparities.

The research holds significant public health importance. Dementia and Alzheimer's disease impose serious health, social, and economic consequences on individuals, families, and communities in the UK and globally. Women, in particular, are affected by dementia and Alzheimer's disease disproportionately. Similarly, childhood sexual violence and sexually transmitted infections are more prevalent among girls and women. By understanding better the pathways between childhood sexual violence, sexually transmitted infections, and neurodegeneration, the study will inform biobehavioral, community-based, public health, clinical and molecular research and interventions to mitigate and prevent risks of and improve protective factors against neurodegenerative conditions. These findings can especially benefit women and girls in structurally underserved communities. Ultimately, this research aims to shed light on new ways to address the complex relationships between early-life adversities, infections, brain health in aging, and health equity.