Transgender adults report greater cognitive and related functional challenges: Findings from the 2015‐2019 Behavioral Risk Factor Surveillance System

Abstract

AbstractBackgroundThere is limited research investigating cognitive impairment and Alzheimer’s disease and related dementia (ADRD) among transgender adults. Transgender adults experience more health disparities and psychosocial stressors, including high rates of depression, discrimination, and chronic health conditions, compared to cisgender adults. The inequities endured by transgender adults are linked to an increased risk of cognitive impairment in other marginalized groups. Subjective cognitive decline (SCD), a self‐reported experience of worsening memory or thinking, is one of the first clinical manifestations of ADRD.MethodCombined data from the 2015‐2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys, representing 33 states that used the SCD and gender identity modules, were analyzed to examine SCD and associated functional limitations among transgender and cisgender adults. BRFSS, an annual cross‐sectional telephone survey, collects data on the health and health behaviors of non‐institutionalized adults aged >18 living in the US. The sample included 386,529 adults aged >45 (transgender, N=1,302; cisgender, N=385,227). Logistic regression methods were used to determine the SCD and SCD‐associated functional limitations prevalences and test for differences in prevalence, demographic characteristics, and chronic health conditions among transgender and cisgender adults.ResultTransgender adults were 1.73x more likely to report SCD (17.06% vs 10.64%, 95% CL: 1.44‐2.08, P<0.001) and 2.30x more likely to report SCD‐related functional limitations (64.71% vs 44.37%, 95% CL: 1.62‐3.27, P=<0.0001) when compared to cisgender adults. Among those reporting SCD, transgender adults were younger (mean 61.89 vs 65.15 years, P=0.0005), more likely to be a racial/ethnic minority (37.31% vs 19.53%, P<0.0001), a high school graduate or less (59.56% vs 43.42%, P=0.0003), uninsured (17.04% vs 5.53%, P=0.0007), have a depressive disorder (58.82% vs 45.74%, P=0.0028).ConclusionAdditional studies are needed to further understand correlates and modifiable risk factors of cognitive impairment among transgender adults. This understanding is necessary for identifying and targeting of preventive intervention strategies for transgender adults who are at higher risk of cognitive impairment and ADRD, developing culturally relevant screenings, and shape policies to improve the health and well‐being of transgender adults.