Variation in Subjective Cognitive Decline Among Older Adults in the US South based on Sexual Orientation and Gender Identity.

Abstract

Older LGBTQ adults face elevated risk for subjective cognitive decline (SCD), yet variation by sexual orientation and gender identity (SOGI) remains underexplored. Guided by minority stress theory, we analyzed Wave 1 data from the LGBTQ Social Networks, Aging, and Policy Study (QSNAPS), a nonprobability panel of 1,255 LGBTQ adults aged 50-76 years in four Southern states. SCD was assessed using a 15-item index capturing any, mild, and severe cognitive difficulties. Logistic regression estimated adjusted predicted probabilities of SCD by SOGI, controlling for sociodemographic characteristics, HIV status, and state. Overall, 40% reported any SCD, 11% mild SCD, and 4% severe SCD. Bisexual and transgender/gender diverse participants had significantly higher probabilities of any SCD than gay/lesbian and cisgender peers. Findings reveal substantial heterogeneity in cognitive health within older LGBTQ populations, highlighting the need for targeted, SOGI informed dementia prevention and mental health interventions in the US South.