LOS ANGELES—Sexual and gender minorities (SGM) are 29 percent more likely than those who are not in those groups to report that they have experienced subjective cognitive decline in the past year, according to results from a cross-sectional telephone survey presented here at the Alzheimer's Association International Conference.
SGM is an umbrella term comprising individuals who are lesbian, gay, bisexual, and transgender as well as those whose sexual orientation or reproductive development varies from traditions and norms.
Researchers at the University of California, San Francisco—who conducted the study using data from nine states included in the Behavioral Risk Factor Surveillance System—said the findings on point to the need for further exploration of the early signs of cognitive decline among sex and gender minorities.
Subjective cognitive decline—the self-perception that one has experienced more frequent or worsening confusion or memory loss in the past year—puts people at three times greater risk for later cognitive decline; 2 to 7 percent of those who report this perception progress to Alzheimer's disease annually.
"The hope is that this raises awareness of the need for screening for the community," said Jason Flatt, PhD, MPH, assistant professor of public health at the University of California, San Francisco. "Nationally we're seeing a huge demographic shift, with the population getting older and older. So likely we need to really think about this community in terms of Alzheimer's and other dementia prevention. There are a lot of things we could be doing."
Dr. Flatt pointed to an array of challenges facing members of this community that make it especially imperiled when dementia symptoms arise. They are less likely to be married or have children, they are twice as likely to live alone, and they have little to no caregiver support, he said. The community also struggles with stigma, discrimination, and trauma and tends to be reluctant to seek medical care.
The study analyzed data on 44,400 adults—about 1,300 in the sexual and gender minority community—ages 45 and older in Nevada, Minnesota, Wisconsin, Illinois, Ohio, West Virginia, Virginia, Georgia, and Hawaii. Those in the SGM group were significantly less likely to be married, more likely to be a racial or ethnic minority, had significantly fewer years of education, were significantly more likely to be unemployed, and significantly more likely to be in a low-income group and to be uninsured.
One in seven SGM adults reported subjective cognitive decline, compared to one in 10 non-SGM participants. After accounting for personal background characteristics such as age and income, researchers found, SGM adults were 29 percent more likely to report subjective cognitive decline. They were also more likely to report giving up day to day activities (p=.003) and more likely to report needing help with household tasks (p=.01).
The researchers found no difference in the percentage of SGM and non-SGM participants who reported symptoms to the doctor. More than half in both groups had not done so.
Dr. Flatt acknowledged that the questions asked in the survey amount to a screen, and are not diagnostic, and that the confusion and memory loss reported could be due to other health issues that are not dementia-related, such as depression or trouble sleeping.
He and his group are continuing to analyze data, which will eventually encompass 24 states.
"This requires further study really to think about the key pieces. Do they need more social support? Do they need greater prevention, or an opportunity to get screening for cognition?"
Holly E. Hinson, MD, MCR, FAAN, associate professor of neurology at Oregon Health & Science University, said it's encouraging to see research in this area expanding since sexual and gender minorities were designated as a health care disparity population by the National Institutes of Health a few years ago.
"I'm thrilled to see people are following that up and really paying attention," she said.
This study, she said, had "a very large sample size and it represented a nice cross-section of geography across the US, which is a huge benefit to the work that they did and I think distinguishes it from previous work in this area."
The subjective nature of the data calls for caution in interpreting it, however, she said.
"I'd be very interested to see in the future how this result would stack up against something a little bit more objective," Dr. Hinson said. "But it's really thought-provoking."
Drs. Flatt and Hinson reported no disclosures.
Link Up for Related Information
Flatt JD, Johnson JK, Karpiak SE, et al. Correlates of subjective cognitive decline in lesbian, gay, bisexual, and transgender older adults. J Alzheimers Dis 2018;64(1):91–102.