'Alarming' Data on Early Cognitive Decline in Transgender Adults

Megan Brooks

July 29, 2021

DENVER — Transgender adults are more likely to experience subjective cognitive decline than their cisgender peers, and at an earlier age, new research shows.

Investigators found transgender adults — individuals who identify with a gender different than the one assigned to them at birth — were nearly twice as likely to report subjective cognitive decline (SCD) and more than twice as likely to report SCD-related functional limitations — such as reduced ability to work, volunteer, or be social — than cisgender adults.

"Trans populations are disproportionately impacted by health disparities and also risk factors for dementia. Putting these pieces together, I wasn't surprised by their greater risk of cognitive decline," study investigator Ethan Cicero, PhD, RN, with Emory University Nell Hodgson Woodruff School of Nursing in Atlanta, Georgia, told Medscape Medical News.

The findings were presented here at the Alzheimer's Association International Conference (AAIC) 2021.

"Alarming" Finding

SCD is a self-reported experience of worsening memory or thinking and is one of the first clinical manifestations of Alzheimer's disease and related dementia (ADRD). Yet there is limited research into cognitive impairment among transgender adults.

The researchers examined SCD and associated functional limitations among transgender and cisgender adults older than age 45 years who provided health and health behavior data as part of the Behavioral Risk Factor Surveillance System (BRFSS) surveys (2015-2019). 

The sample included 386,529 adults of whom 1302 identified as transgender and 385,227 as cisgender.

Roughly 17% of transgender adults reported SCD, which is significantly higher than the 10.6% rate for cisgender adults (P < .001).

Compared with cisgender adults reporting SCD, transgender adults reporting SCD were younger (mean age 61.9 vs 65.2 years, P = .0005), more likely to be in a racial/ethnic minority group (37.3% vs 19.5%, P < .0001), have a high school degree or less (59.6% vs 43.4%, P = .0003), be uninsured (17% vs 5.5%, P = .0007) and have a depressive disorder (58.8% vs 45.7%, P = .0028).

Cicero told Medscape Medical News the fact that transgender people who reported SCD were about 3 years younger than cisgender people who reported SCD is "somewhat alarming and a red flag to ask middle-aged trans adults about their brain health and not just older or elderly trans adults."

The study also showed that transgender adults reporting SCD were 2.3 times more likely to report related social and self-care limitations when compared with cisgender adults reporting SCD.

The findings align with a study reported at AAIC 2019, which showed that sexual or gender minorities (SGM) are almost 30% more likely to report subjective cognitive decline compared with the non-SGM population, as reported by Medscape Medical News.

Cause Unclear

"We are not certain what may be causing the elevated subjective cognitive decline rates among transgender adults. We postulate that it may be in part due to anti-transgender stigma and prejudice that expose transgender people to high rates of mistreatment and discrimination where they live, work, learn, seek healthcare and age," Cicero said in a statement.

"More research is needed to identify and target preventive intervention strategies, develop culturally relevant screenings, and shape policies to improve the health and well-being of the transgender population," he added.

Weighing in on the study for Medscape Medical News, Rebecca Edelmayer, PhD, senior director of scientific engagement at the Alzheimer's Association, said "researchers have only just started to explore the experiences of dementia within the lesbian, gay, and bisexual community, but this is the first time we are seeing some specific research that's looking at cognition in transgender individuals and gender nonbinary individuals."

"We don't know exactly why transgender and gender nonbinary individuals experience greater rates of subjective cognitive decline, but we do know that they have greater rates of health disparities that are considered risk factors for dementia, including higher rates of cardiovascular disease, depression, diabetes, tobacco and alcohol use, and obesity," Edelmayer said. 

"Alzheimer's and dementia do not discriminate. Neither can we," Maria C. Carrillo, PhD, chief science officer for the Alzheimer's Association, said in a statement.

"The Alzheimer's Association advocates for more research to better understand the cognitive and emotional needs of transgender and nonbinary individuals so that our nation's healthcare providers can offer them culturally sensitive care," said Carrillo.

The study had no specific funding. Cicero, Carrillo, and Edelmayer have disclosed no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2021. Abstract Poster 53902. Presented July 28, 2021.

For more Medscape Psychiatry news, join us on Facebook and Twitter


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.