Subjective cognitive decline risk may be higher in transgender vs cisgender adults

Transgender adults had a higher likelihood of experiencing subjective cognitive decline (SCD) and SCD-related functional limitations compared with their cisgender counterparts, according to a study presented at AAIC 2021.

“Transgender adults were 73 percent more likely to report SCD than cisgender adults. Among those with SCD, transgender adults were 2.3 times more likely to have an SCD-associated functional limitation than cisgender adults,” said study author Assistant Professor Ethan Cicero from Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, US.  

For this analysis, the researchers combined data from the CDC*-led annual cross-sectional 2015–2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys which included data on the health and health behaviours of non-institutionalized adults living in the US. The present analysis was based on information collected from 386,529 adults aged >45 years, of whom 1,302 and 385,227 identified as transgender and cisgender, respectively.

SCD** was more commonly reported by transgender than cisgender individuals (17.06 percent vs 10.64 percent; odds ratio, 1.73, 95 percent confidence interval, 1.44–2.08; p<0.0001). This corresponded to one in six transgender adults reporting SCD compared with one in 10 cisgender adults. [AAIC 2021, abstract 53902]

Transgender adults were also more likely to report SCD-related functional limitations (eg, inability to carry out day-to-day activities or interferences in ability to work, volunteer, or engage in social activities) compared with cisgender adults (64.71 percent vs 44.37 percent; p<0.0001).

Among respondents who reported SCD, transgender adults were younger than cisgender adults (mean 61.89 vs 65.15 years; p=0.0005) and were more likely to be from an ethnic or racial minority group (37.31 percent vs 19.53 percent; p<0.0001). Transgender adults were also more likely to be high school graduates or less (59.56 percent vs 43.42 percent; p=0.0003), have no insurance (17.04 percent vs 5.53 percent; p=0.0007), and have a depressive disorder (58.82 percent vs 45.74 percent; p=0.0028) than cisgender adults.

SCD is characterized by self-reported worsening in thinking or memory and may be one of the first clinical manifestations of Alzheimer’s disease and related dementia (ADRD), said Cicero. Prior research has shown a higher rate of SCD in LGBT vs non-LGBT adults, he said.

“Our findings suggest that transgender adults have unmet needs and may be of greater risk for developing ADRD,” he added.

According to Cicero, the reasons for the higher SCD incidence in transgender adults is uncertain at present. “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,” he noted.

He acknowledged the limitations presented by the study being a secondary analysis as well as the use of a subjective measure of cognitive impairment as the outcome of interest. 

“Additional studies are needed to further understand correlates and modifiable risk factors of cognitive impairment among transgender adults,” said Cicero.

“More research is [also] 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 concluded.