Cognition research in LGBTQIA+ groups: What’s it mean for Alzheimer’s research?

Abstract

AbstractBackgroundOlder adults who are members of sexual and gender minoritized (SGM) communities, including lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identity (LGBTQIA+) groups, are at high risk of cognitive problems and caregiving deficits. Sexual orientation is a social and structural determinant of health (SSDOH), impacting cognitive health and medical management as members of SGM groups encounter social and structural barriers that could be impacting cognition directly and indirectly, and research is needed to understand pathways that lead to those elevated risks. So, what type of cognition research is being conducted with LGBTQIA+ groups and how does it herald inclusion of these groups in Alzheimer’s studies?MethodsWe conducted a broad search of Pubmed, Embase, and PsychINFO (ProQuest platform) databases for January 2000 to December 2020 using search key terms for constructed related to: LGBTQIA, cognition, and Alzheimer’s disease and related dementias (AD/ADRD). Abstracts were analyzed to identify studies reporting on medical conditions. We report summary statistics to describe the topics, conceptual frameworks, sample characteristics, and methods in those studies with a focus toward the relevance of that information in Alzheimer’s research.ResultsIn the past 20 years, 173 publications reported results from studies with samples identified as LGBTQIA+, suggesting about six studies per year are published on cognition topic‐related biomedical literature on these populations. The bulk of the empirical articles focused on sexual risk‐taking (n = 56) with a few addressing specific medical conditions: HIV (n = 37), AD/ADRD (n = 3), and cervical cancer (n = 1). Eight articles discussed cognition, with 5 of them reporting on cognitive measures.ConclusionsBiomedical research on cognition with LGBTQIA+ populations remains focused on sexual behavior. Understanding how sexual orientation influences cognitive health and medical management requires advancing a conceptual framework of how other social and structural determinants of health operate on LGBTQIA+ identities. Investigations, for example, that help advance what is known about cognition – risks, resilience, and function, in members of SGM groups that are impacted by barriers to quality healthcare, employment instability, and experience daily discrimination. This type of framework may facilitate LGBTQIA+ inclusion in cognition studies and research priorities.