New Research Reveals Cognition Disparities Among Transgender and Non-Binary Adults

New research presented at this year's Alzheimer's Association International Conference suggests that trans and non-binary people suffer higher rates of both depression and subjective cognitive decline (SCD).

One paper, by Ethan Cicero, Ph.D., RN, et al., was titled "Transgender Adults Report Greater Cognitive and Related Functional Challenges: Findings from the 2015-2019 Behavioral Risk Factor Surveillance System." The other, by Nickolas H. Lambrou, Ph.D. et al., was "Prevalence of modifiable risk factors for Alzheimer's disease and related dementias, and association with cognitive disability among transgender and gender non-binary adults in the U.S.; BRFSS 2019."

The new papers show two key findings, which an AAIC release summarized:

"Transgender adults – individuals who identify with a gender different than the one assigned to them at birth – were nearly twice as likely to report SCD and more than twice as likely to report
SCD-related functional limitations, such as reduced ability to work, volunteer or be social."

Also: "Prevalence of depression was significantly higher for transgender and gender nonbinary adults (individuals who identify outside the male/female binary) (37%) compared to cisgender adults (19.2%). Additionally, reports of cognitive disability, a surrogate for SCD, were significantly higher in transgender and nonbinary adults (24.7%) compared to cisgender adults (10.5%)."

Past studies have shown the members of the LGBTQ community suffer disparities in terms of health care access, health care outcomes, and elevated risk factors such as alcohol and tobacco use, obesity, and other factors that are thought to be associated with minority stress.

"We've seen a lot of health disparities, as well as discrimination that exists in these populations," Dr. Rebecca Edelmayer, the Senior Director, Scientific Engagement for the Alzheimer's Association, told EDGE, "so we certainly do think that it's possible that these types of experiences for individuals could contribute to their stress across their life course."

Dr. Edelmayer added: "So many of those things are also considered to be risk factors for any individual of any sexual orientation or gender expression. However, these individuals also are experiencing greater rates of discrimination, which is also a known barrier to access and quality health care."

The papers presented at the conference narrowed the focus in a new way: Dr. Edelmayer noted that the new research comprises "some of the first-ever studies that are looking at cognition specifically in transgender and gender non-binary individuals."

The release explained that for the results reported in the paper by Dr. Ethan Cicero, et al., researchers "examined data on SCD and associated functional limitations" as self-reported by members of the transgender and gender nonbinary communities, finding that about "17% of transgender adults (1 in 6) reported SCD, which is significantly higher than the 10.6% rate for cisgender adults (roughly 1 in 10)."

Additionally, the data showed that "[a]mong those reporting SCD, transgender adults were 2.3 times more likely to report associated social and self-care limitations when compared to cisgender adults," the release said. "Among those reporting SCD, transgender adults were about three years younger and more likely to be a racial/ethnic minority, to be uninsured and to have depression."

While the new research does not focus specifically on possible links between depression and cognitive decline, Dr. Edelmayer noted that "there's some evidence to suggest that individuals that are living with untreated or lifelong experience of depression can be at a greater risk for developing cognitive impairment, and potentially even dementia."

Interestingly, the release noted that the paper by Dr. Nickolas H. Lambrou, et al, reported that "men, whether transgender or cisgender, were more likely to report cognitive disability associated with depression compared to other groups.

"However," the release added, "it is important to note that cisgender men also reported the lowest proportions of depression (14%) and cognitive disability (9.4%) compared to all other gender identity groups."

Dr. Edelmayer pointed out that it seems to be the case that the majority of those living with Alzheimer's – more than two-thirds in the U.S. – "are actually identifying as women."

The results raise new questions about how mental function, stress factors, health care disparities, and gender identity might be interrelated.

"We need to continue to do more inclusive research, and we need to make sure that that research is going to be able to be helpful to all individuals across all these communities," Dr. Edelmayer told EDGE. "The association has a partnership with SAGE, which is the advocacy and services for LGBT elders to help support LGBT people living with Alzheimer's or other dementias, as well as LGBT-identified caregivers," Dr. Edelmayer added.

The release pointed out that the partnership has led to the creation of "an issues brief that offers recommendations for working with LGBT people living with Alzheimer's or other dementias, as well as supporting LGBT-identified caregivers for people living with dementia. Among those recommendations is using gender-affirming language."