Subjective Cognitive Decline Found More Often Among Transgender Individuals
There is currently very limited research for the cognitive function of transgender individuals (people who identify with a gender that is different from what was assigned at birth). The research is becoming more crucial with the knowledge that transgender individuals experience more health disparities and psychosocial stressors, such as high rates of depression, discrimination, and chronic health conditions.
When compared with cisgender individuals (who identify with the same gender as assigned at birth), transgender individuals are 1.73 times more likely to report subjective cognitive decline (SCD) (17.06% vs 10.64%, 95% CI: 1.44-2.08, P<.001) and 2.30 times more likely to report SCD-related functional limitations (64.71% vs 44.37%, 95% CI:1.62-3.27, P=<.0001).
Transgender people who reported SCD were more likely to be subject to the intersectional discrimination of being both transgender and members of the Black, Asian, Hispanic/Latinx, or American Indian communities (37.31% vs 19.53%, P<.0001). Level of education, insurance status, and the presence of depressive disorders also correlated significantly with SCD among transgender people. These data support that further studies are essential to understand the risks among the transgender community to provide support and proper care.
“We are not certain what may be causing the elevated SCD rates among transgender adults. 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,” said Ethan Cicero, PhD, RN, assistant professor at Emory University’s Nell Hodgson Woodruff School of Nursing. “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.”
In another study of gender identity (n=231,414), 955 individuals identified as transgender/nonbinary had significantly higher rates of depression and cognitive disability (a surrogate marker for SCD) compared with cisgender individuals. Among transgender respondents, 37% had depression and 24.7% and cognitive disability. In comparison 19.2% and 10.5% of cisgender respondents had depression and cognitive disability, respectively. Adjusted odds for cognitive disability and depression together were highest in transgender men, followed by cisgender men, cisgender women, and transgender women. Nonbinary individuals had the lowest rate of having both depression and SCD. Transgender and nonbinary individuals were younger as a group than other respondents, however, which may have confounded these results.
Suggested future directions include investigating psychosocial facets of cognitive health that intersect with gender identity as well as evaluating when cognitive screening is appropriate for transgender and nonbinary individuals.