LGBT Americans report increased rates of memory loss and confusion — two early signs of dementia — compared to their heterosexual and cisgender counterparts, a large survey has found. The observations present new risk factors to consider for Alzheimer’s disease, the most common form of dementia, and raise questions about the potential influence of social stressors.
“This idea that LGBT people might have more … subjective cognitive impairment is a very interesting one,” said Yaakov Stern, a professor of neuropsychology at Columbia University College of Physicians and Surgeons. Stern was not involved in the research but said colleagues undertaking a small pilot study of cognition in the LGBT community around the New York area have “very similar findings.”
Researchers from the University of California, San Francisco, based their analysis on 2015 data collected by the Centers for Disease Control and Prevention across nine states in a random phone survey. The survey included questions about memory loss and confusion in the past 12 months and gender identity and sexual orientation. Responses from 44,403 adults age 45 or older were included in the analysis, with 3% identifying as LGBT and the remainder saying they were heterosexual and cisgender, or people whose gender identity matches the sex that they were assigned at birth. One in seven, or 14%, of people in sexual and gender minorities reported memory problems that got worse over the past year. This contrasts with 1 in 10, or 10%, of heterosexual and cisgender people reporting the same problems. After adjusting for characteristics such as age, gender, race and ethnicity, marital status, and income, the researchers found that LGBT individuals were 29% more likely to report cognitive impairment compared to their counterparts. The observations are being presented Sunday at the 2019 Alzheimer’s Association International Conference in Los Angeles. Jason Flatt, an assistant professor at UCSF and lead author of the study, also noted the LGBT individuals had more problems with daily activities, such as cooking and cleaning, compared to heterosexual and cisgender individuals.
Previous studies have found a correlation between self-reported cognitive impairment and dementia. People with subjective cognitive decline are three times more likely to have future cognitive decline, Flatt said.
Dr. Victor Henderson, a professor of health policy and of neurology at Stanford University, cautioned that the age group the researchers were looking at included relatively young individuals. Dementia is rare below age 60.
“Subjective cognitive decline in the younger population may not have the same meaning as it would for someone who was in his or her 70s or 80s or 90s,” he said. Henderson was not involved in the study. “I think it’s an important observation that’s been made, but the actual interpretation in relation to an impending dementia remains to be determined.” Exactly why there might be a higher risk of memory loss and confusion among LGBT people is unclear. It could be due to challenges such as depression or stress in social situations, according to Stern and Henderson. Flatt noted that as LGBT individuals get older, they are less likely to have strong social support networks, such as a partner or children, and may end up living where people might not accept who they are.
The survey results don’t mean LGBT people will necessarily have higher incidence of Alzheimer’s disease, Flatt noted, but instead, they show a concerning trend that needs additional attention.
“The community really needs greater support, education, screening for their memory, and opportunity to talk to their doctor about these problems,” said Flatt. Additional research is also needed, and he advocated for the inclusion of questions asking about sexual orientation and gender identity in national surveys. Otherwise, “how are we going to see how the community does over time?” he asked.
LGBT people are underrepresented in research on cognitive impairment, said Erin Dunn, an assistant professor of psychiatry at Harvard Medical School who was not involved in the study. “I think it’s a critical question that should be addressed.”