Correlates of Subjective Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender Older Adults

Flatt, Jason D.; Johnson, Julene K.; Karpiak, Stephen E.; Seidel, Liz; Larson, Britta; Brennan-Ing, Mark

doi:10.3233/jad-171061

Cited by 55 publications

(56 citation statements)

References 79 publications

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“…In the present study, Cronbach's alpha for the 8-item Cognition Function-Short Form was 0.90. SCD was assessed categorically via questions about memory complaints because an impaired memory is the most frequently reported complaint in research on SCD (e.g., [1,41,42]) and because previous cross-sectional research has utilised similar approaches to classifying SCD (e.g., [43,44]). Participants answered the following question: "Do you have memory complaints?".…”

Section: Methodsmentioning

confidence: 99%

Repetitive negative thinking is associated with subjective cognitive decline in older adults: a cross-sectional study

et al. 2020

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Background In the absence of a cure or effective treatment for dementia, attention has shifted towards identifying risk factors for prevention. Subjective Cognitive Decline (SCD) describes self-perceived worsening of cognition despite unimpaired performance on neuropsychological tests. SCD has been associated with an increased dementia risk and steeper memory decline. Repetitive negative thinking (RNT) is a transdiagnostic process that manifests across several mental health disorders associated with increased vulnerability to dementia. RNT has thus been proposed as a candidate marker of risk for dementia and, relatedly, could contribute to the manifestation of SCD. We aimed to investigate the relationship between SCD and RNT alongside other proposed psychological risk/protective factors for dementia and cognitive decline. Methods In a cross-sectional online survey, 491 older adults (mean = 64.9 years, SD = 4.2; 63.1% female) completed measures of RNT, personality traits, purpose in life, worry, rumination, and meditation practice. SCD was assessed continuously via self-perceived cognitive function (Neuro-QoL) and categorically via endorsement (yes/no) of memory complaints. Regression models, using a stepwise backwards elimination, were built to assess associations between SCD, demographics, and all risk/protective factors. Results A total of 24.2% of participants reported memory complaints. In the final prediction models, RNT was the only psychological variable associated with lower self-perceived cognitive function and with a higher likelihood of memory complaints. Conclusions This study empirically corroborates the theoretical relationship between SCD and RNT. Longitudinal studies are needed to establish whether RNT is a prodromal symptom or an independent risk factor, and whether RNT can be a promising construct for future research on SCD and dementia risk.

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Section: Methodsmentioning

confidence: 99%

Repetitive negative thinking is associated with subjective cognitive decline in older adults: a cross-sectional study

et al. 2020

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“…The same study also found that under 1% of participants 80 and older reported a diagnosis of dementia, which was argued to potentially be related to selection and information bias. Another study found that about 25% of LGBT older adults reported subjective cognitive decline, which was particularly common among racial/ethnic minorities and those with depression and functional impairments . No study has compared MCI or dementia risk between sexual minorities and their heterosexual counterparts using the same protocol for diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Risk of dementia and mild cognitive impairment among older adults in same‐sex relationships

Perales‐Puchalt

Gauthreaux

Flatt

et al. 2019

Int J Geriat Psychiatry

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Introduction: Sexual minority discrimination might lead to a higher risk of mild cognitive impairment (MCI) and dementia. The aim of this study was to assess the risk of MCI and dementia between older adults in same-sex relationships (SSR) and opposite-sex relationships (OSR). Methods:We analyzed longitudinal data from the National Alzheimer's Coordinating Center up to September 2017. Analyses included cognitively normal individuals 55+ at baseline who had a spouse, partner, or companion as study partner at any assessment. Associations were calculated using survival analysis adjusting for demographics and APOE-e4 carrier status.Results: Hazard ratios of MCI and dementia did not differ statistically between SSR and OSR individuals in the total sample nor stratified by sex. Conclusion:The lack of association between SSR and MCI and dementia warrants future research into their potential resilience mechanisms and the inclusion of sexual minority status questions in research and surveillance studies. The potential recruitment bias caused by nonprobabilistic sampling of the cohort and the reporting and ascertainment bias caused by using SSR to infer sexual minority status may have influenced our findings. KEYWORDS dementia, disparities, mild cognitive impairment, sexual minorities 1 | BACKGROUND There are reasons to believe that sexual minorities might experience a disproportionate burden of dementia. 1 According to the minority stress theory, sexual minorities experience greater lifetime exposure to stigma, discrimination, and victimization. These stressors may increase sexual minorities' risk for health problems and depression. [2][3][4][5][6] There have been no published studies on cognitive impairment and dementia risk comparing sexual minorities with their heterosexual counterparts; however, in African American older adults, studies have shown a relationship between perceived discrimination and episodic memory 7 and a link between depression and declines in global cognition, episodic memory, and visuospatial ability. 8,9 Similarly, high levels of perceived stress were associated with a 30% greater risk of incident mild cognitive impairment (MCI) in a diverse community-based sample of older adults (30% racial/ethnic minorities) after adjusting for demographics, depression, and APOE. 10 Given sexual minorities' potential greater exposure to lifelong stress, it is important to understand whether this group experiences differences in risk for cognitive impairment and dementia.

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“…Regarding sexual orientation and risk of HAND, De Ronchi et al (2002) reported a higher odds ratio for the development on HIV-associated neurocognitive disorders in homosexual or bisexual subjects vs heterosexual subjects. Flatt et al (2018) found subjective cognitive decline in 25% of LGBT older adults; being a person of color, depressed, or reporting functional impairment were correlated with subjective cognitive decline.…”

Section: Introductionmentioning

confidence: 88%

Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients

Bourgeois

John

Greene

et al. 2019

Int. Psychogeriatr.

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Objective:The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults.Design:From 2012–2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment.Setting:Two San Francisco HIV clinics.Participants:359 HIV-infected patients age 50 years or olderMeasurementsUnadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment.ResultsThirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores.Conclusions:Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.

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Correlates of Subjective Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender Older Adults

Abstract: Depression and functional impairment should be considered when screening LGBT older adults for cognitive impairment and dementia. Future research on the cognitive impairment and dementia risk in LGBT older adults is needed.

Cited by 55 publications

References 79 publications

Repetitive negative thinking is associated with subjective cognitive decline in older adults: a cross-sectional study

Repetitive negative thinking is associated with subjective cognitive decline in older adults: a cross-sectional study

Risk of dementia and mild cognitive impairment among older adults in same‐sex relationships

Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients

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