Depression, subjective cognitive decline common among transgender, nonbinary adults
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Adults in the U.S. who identify as transgender or gender nonbinary more often reported worsening memory and thinking, functional limitations and depression than cisgender adults.
Researchers presented results of two studies that assessed cognition among transgender and gender nonbinary adults at the Alzheimer’s Association International Conference.
“We know far too little about Alzheimer’s, dementia and cognitive well-being among transgender and gender nonbinary individuals,” Carl V. Hill, PhD, MPH, chief diversity, equity and inclusion officer of the Alzheimer’s Association, said in a press release. “As we learn more about dementia in this population, there is a great need for health care that is culturally competent and delivered with humility to address the needs of aging transgender individuals and their loved ones.”
Subjective cognitive decline more common among transgender than cisgender adults
Ethan Cicero, PhD, RN, assistant professor at Emory University’s Nell Hodgson Woodruff School of Nursing, and colleagues analyzed data on subjective cognitive decline and related functional limitations, such as giving up daily activities or interferences with ability to work, volunteer or partake in social activities, among transgender and cisgender adults. They obtained data via the 2015 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), a large annual health behavior survey headed by the CDC.
Results showed reports of subjective cognitive decline among 17% of transgender adults and 10.6% of cisgender adults. Transgender adults who reported subjective cognitive decline were 2.3 times more likely to report related social and self-care limitations compared with cisgender adults. Further, transgender adults with subjective cognitive decline were approximately 3 years younger and more likely to be in an underrepresented racial/ethnic group, to be uninsured and to have depression.
One-third of transgender adults who reported worsening memory problems and half of transgender adults with related social and self-care limitations were unable to see a doctor due to cost.
“We are not certain what may be causing the elevated subjective cognitive decline rates among transgender adults,” Cicero said in the release. “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 health care and age. 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.”
Transgender, gender nonbinary adults have higher rates of depression, cognitive disability
In a separate study presented at AAIC, Nickolas H. Lambrou, PhD, assistant scientist in the division of geriatrics and gerontology at the University of Wisconsin School of Medicine and Public Health, and colleagues investigated links between health conditions, cognitive disability and gender identity. They obtained data via the 2019 BRFSS of 231,414 adults, of whom 955 identified as transgender or gender nonbinary.
Results showed significantly higher depression prevalence among transgender and gender nonbinary adults (37%) than among cisgender adults (19.2%). Transgender and gender nonbinary adults also had significantly higher reports of cognitive disability compared with cisgender adults (24.7% vs. 10.5%, respectively). Gender nonbinary adults had the highest proportion of depression (49.6%) and cognitive disability (30.5%) compared with all other gender groups. Men, whether transgender or cisgender, more often reported cognitive disability associated with depression compared with other groups; however, cisgender men had the lowest proportions of depression (14%) and cognitive disability (9.4%) compared with all other gender identity groups.
“These rates are concerning because cognitive disability may be a risk factor or early indicator of Alzheimer’s or other dementia,” Lambrou said in the release. “Further research is needed; it is critical that researchers include measures to identify [transgender or gender nonbinary] participants so we have an accurate representation of their health and health behaviors.”
References:
Alzheimer’s Association. Transgender adults more likely to experience subjective cognitive decline, depression. https://alz.org/aaic/releases_2021/transgender-adults-cognition.asp?_gl=1*1balofb*_ga*MTM5NTI1NjQ4OC4xNjI3MzA0Mzcx*_ga_9JTEWVX24V*MTYyNzQ5NzM4My40LjAuMTYyNzQ5NzM4My4w&_ga=2.53164456.107383584.1627488104-1395256488.1627304371. Accessed July 28, 2021.
Cicero E, et al. Transgender adults report greater cognitive and related functional challenges: Findings from the 2015-2019 Behavioral Risk Factor Surveillance System. Presented at: Alzheimer’s Association International Conference; July 26-30, 2021 (virtual meeting).
Lambrou NH, et al. Prevalence of modifiable risk factors for Alzheimer’s disease and related dementias, and association with cognitive disability among transgender and gender nonbinary adults in the U.S.; BRFSS 2019. Presented at: Alzheimer’s Association International Conference; July 26-30, 2021 (virtual meeting).
Perspective
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This is important work because it indicates that individuals who are transgender or who identify as nonbinary experience higher rates of subjective cognitive decline. Subjective cognitive decline includes self-reported experiences of confusion, memory loss or problems of cognition that worsen over time. We already know that there are differences between different populations in terms of their risk profiles. Women, African Americans and Hispanics are at higher risk for developing dementia. It is important for us to look at transgender populations to understand their risk for subjective cognitive decline. This sets the scene for further studies to look at risk for dementia in future years.
Health care professionals should consider the individual and use a holistic approach that incorporates a patient’s identity and experience. As we've seen with other at-risk groups, part of this risk may be underlined by differences in health disparities and differences in other risk factors. These studies highlighted increased rates of depression and depression being a risk factor for cognitive decline and dementia. It is important for health care professionals to be looking at the individual as a whole and at their environment, and then bearing in mind other risk factors that could be occurring at the same time as well.
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