Cognitive Aging with Dementia, Mild Cognitive Impairment, or No Impairment: A Comparison of Same- and Mixed-Sex Couples

Article type: Research Article

Authors: Correro II, Anthony N.^{a; b; *} | Gauthreaux, Kathryn^c | Perales-Puchalt, Jaime^d | Chen, Yen-Chi^{c; e} | Chan, Kwun C.G.^{c; f} | Kukull, Walter A.^c | Flatt, Jason D.^g

Affiliations: [a] Mental Health Service, VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Health, Ann Arbor, MI, USA | [b] Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA | [c] National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA, USA | [d] University of Kansas, Alzheimer’s Disease Research Center, Fairway, KS, USA | [e] Department of Statistics, University of Washington, Seattle, WA, USA | [f] Department of Biostatistics, University of Washington, Seattle, WA, USA | [g] Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, USA

Correspondence: [*] Correspondence to: Anthony N. Correro II, PhD, Assistant Professor, Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA. E-mail: [email protected].

Abstract: Background:Lesbian and gay older adults have health disparities that are risk factors for Alzheimer’s disease, yet little is known about the neurocognitive aging of sexual minority groups. Objective:To explore cross-sectional and longitudinal dementia outcomes for adults in same-sex relationships (SSR) and those in mixed-sex relationships (MSR). Methods:This prospective observational study utilized data from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) collected from contributing Alzheimer’s Disease Research Centers. Participants were adults aged 55+ years at baseline with at least two visits in NACC UDS (from September 2005 to March 2021) who had a spouse, partner, or companion as a co-participant. Outcome measures included CDR® Dementia Staging Instrument, NACC UDS neuropsychological testing, and the Functional Activities Questionnaire. Multivariable linear mixed-effects models accounted for center clustering and repeated measures by individual. Results:Both MSR and SSR groups experienced cognitive decline regardless of baseline diagnosis. In general, MSR and SSR groups did not differ statistically on cross-sectional or longitudinal estimates of functioning, dementia severity, or neuropsychological testing, with two primary exceptions. People in SSR with mild cognitive impairment showed less functional impairment at baseline (FAQ M = 2.61, SD = 3.18 vs. M = 3.97, SD = 4.53, respectively; p < 0.01). The SSR group with dementia had less steep decline in attention/working memory (β estimates = –0.10 versus –0.18; p < 0.01). Conclusion:Participants in SSR did not show cognitive health disparities consistent with a minority stress model. Additional research into protective factors is warranted.

Keywords: Cognitive aging, cognitive dysfunction, dementia, sexual minorities

DOI: 10.3233/JAD-220309

Journal: Journal of Alzheimer's Disease, vol. 92, no. 1, pp. 109-128, 2023