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Current Alzheimer Research

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ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

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General Research Article

A Comparison of Neurocognitive Decline in Older Adults in Same-Sex and Opposite-Sex Relationships

Author(s): Riccardo Manca and Annalena Venneri*

Volume 17, Issue 12, 2020

Page: [1102 - 1114] Pages: 13

DOI: 10.2174/1567205018666210114111556

Price: $65

Abstract

Background: Individuals from sexual minorities experience health inequalities that have detrimental impacts on their health, especially in the elderly, by exacerbating care needs and symptoms of chronic conditions such as Alzheimer’s disease (AD). Neurocognitive decline due to AD in the sexual minority population remains under-investigated. However, being in a relationship may mitigate the risk of experiencing cognitive impairment.

Objective: The aim of this study was to investigate whether cognitive decline and brain atrophy may differ in people from sexual minorities.

Methods: Clinical data for this study were selected from the National Alzheimer’s Coordinating Center’s Uniform Data Set and structural MRI data collected across 14 Alzheimer’s Disease Centers. Eighty participants including 20 patients with AD and 20 healthy controls (HC) in same-sex relationships were identified and matched to groups of participants (20 AD and 20 HC) in opposite-sex relationships. The effects of diagnosis and relationship were investigated on all measures.

Results: No diagnosis-by-relationship interactions were found on any variable. However, post hoc analyses revealed that the opposite-sex group had grey matter atrophy mainly in medio-temporal areas. In the same-sex group, atrophy also extended to pre-frontal and cingulate areas. The severity of neuropsychiatric symptoms correlated with volume of pre-frontal and insular/temporal areas only in the same-sex group.

Conclusion: Neurocognitive decline due to AD may express similarly across individuals, independently of relationship type, thus suggesting a protective role of relational status. However, the same-sex group appeared to be more likely to experience at least one neuropsychiatric symptom and to have atrophy extending to fronto-limbic areas.

Keywords: Alzheimer's disease, neurodegeneration, marital relationship, sexual minorities, neuropsychiatric symptoms, cognition.

« Previous Next »
[1]
Bristowe K, Hodson M, Wee B, et al. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study. Palliat Med 2018; 32(1): 23-35.
[http://dx.doi.org/10.1177/0269216317705102] [PMID: 28502218]
[2]
Caceres BA, Brody A, Luscombe RE, et al. A systematic review of cardiovascular disease in sexual minorities. Am J Public Health 2017; 107(4): e13-21.
[http://dx.doi.org/10.2105/AJPH.2016.303630] [PMID: 28207331]
[3]
Hatzenbuehler ML, Slopen N, McLaughlin KA. Stressful life events, sexual orientation, and cardiometabolic risk among young adults in the United States. Health Psychol 2014; 33(10): 1185-94.
[http://dx.doi.org/10.1037/hea0000126] [PMID: 25133830]
[4]
Westwood S, Willis P, Fish J, et al. Older LGBT+ health inequalities in the UK: Setting a research agenda. J Epidemiol Community Health 2020; 74(5): 408-11.
[http://dx.doi.org/10.1136/jech-2019-213068] [PMID: 32086374]
[5]
McGovern J. The forgotten: Dementia and the aging LGBT community. J Gerontol Soc Work 2014; 57(8): 845-57.
[http://dx.doi.org/10.1080/01634372.2014.900161] [PMID: 24893150]
[6]
Rosendale N, Josephson SA. The importance of lesbian, gay, bisexual, and transgender health in neurology: What’s in a name? JAMA Neurol 2015; 72(8): 855-6.
[http://dx.doi.org/10.1001/jamaneurol.2015.0226] [PMID: 26121182]
[7]
Alzheimer’s Association. 2019 Alzheimer’s disease facts and figures. Alzheimers Dement 2019; 15(3): 321-87.
[http://dx.doi.org/10.1016/j.jalz.2019.01.010]
[8]
Nelson CL, Andel R. Does sexual orientation relate to health and well-being? Analysis of adults 50+ years of age. Gerontologist 2020; 60(7): 1282-90.
[http://dx.doi.org/10.1093/geront/gnz187] [PMID: 31909416]
[9]
Barrett C, Crameri P, Lambourne S, Latham JR, Whyte C. Understanding the experiences and needs of lesbian, gay, bisexual and trans Australians living with dementia, and their partners. Australas J Ageing 2015; 34(2): 34-8.
[http://dx.doi.org/10.1111/ajag.12271] [PMID: 26525445]
[10]
Fredriksen-Goldsen KI, Jen S, Bryan AEB, Goldsen J. Cognitive impairment, Alzheimer’s disease, and other dementias in the lives of lesbian, gay, bisexual and transgender (LGBT) older adults and their caregivers: Needs and competencies. J Appl Gerontol 2018; 37(5): 545-69.
[http://dx.doi.org/10.1177/0733464816672047] [PMID: 27729400]
[11]
Peel E, Taylor H, Harding R. Sociolegal and practice implications of caring for LGBT people with dementia. Nurs Older People 2016; 28(10): 26-30.
[http://dx.doi.org/10.7748/nop.2016.e852] [PMID: 27900896]
[12]
Brown MJ, Patterson R. Subjective cognitive decline among sexual and gender minorities: Results from a U.S. population-based sample. J Alzheimers Dis 2020; 73(2): 477-87.
[http://dx.doi.org/10.3233/JAD-190869] [PMID: 31796675]
[13]
Flatt JD, Johnson JK, Karpiak SE, Seidel L, Larson B, Brennan-Ing M. Correlates of subjective cognitive decline in lesbian, gay, bisexual, and transgender older adults. J Alzheimers Dis 2018; 64(1): 91-102.
[http://dx.doi.org/10.3233/JAD-171061] [PMID: 29865050]
[14]
Perales-Puchalt J, Gauthreaux K, Flatt J, et al. Risk of dementia and mild cognitive impairment among older adults in same-sex relationships. Int J Geriatr Psychiatry 2019; 34(6): 828-35.
[http://dx.doi.org/10.1002/gps.5092] [PMID: 30864178]
[15]
Beekly DL, Ramos EM, Lee WW, et al. NIA Alzheimer’s Disease Centers. The National Alzheimer’s Coordinating Center (NACC) database: The Uniform Data Set. Alzheimer Dis Assoc Disord 2007; 21(3): 249-58.
[http://dx.doi.org/10.1097/WAD.0b013e318142774e] [PMID: 17804958]
[16]
Besser L, Kukull W, Knopman DS, et al. Neuropsychology Work Group. Directors, and Clinical Core leaders of the National Institute on Aging-funded US Alzheimer’s Disease Centers. Version 3 of the National Alzheimer’s coordinating center’s uniform data set. Alzheimer Dis Assoc Disord 2018; 32(4): 351-8.
[http://dx.doi.org/10.1097/WAD.0000000000000279] [PMID: 30376508]
[17]
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: Clinical characterization and outcome. Arch Neurol 1999; 56(3): 303-8.
[http://dx.doi.org/10.1001/archneur.56.3.303] [PMID: 10190820]
[18]
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34(7): 939-44.
[http://dx.doi.org/10.1212/WNL.34.7.939] [PMID: 6610841]
[19]
Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7(3): 270-9.
[http://dx.doi.org/10.1016/j.jalz.2011.03.008] [PMID: 21514249]
[20]
McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7(3): 263-9.
[http://dx.doi.org/10.1016/j.jalz.2011.03.005] [PMID: 21514250]
[21]
Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7(3): 280-92.
[http://dx.doi.org/10.1016/j.jalz.2011.03.003] [PMID: 21514248]
[22]
Morris JC. The clinical dementia rating (CDR): Current version and scoring rules. Neurology 1993; 43(11): 2412-4.
[http://dx.doi.org/10.1212/WNL.43.11.2412-a] [PMID: 8232972]
[23]
Morris JC, Weintraub S, Chui HC, et al. The Uniform Data Set (UDS): Clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Dis Assoc Disord 2006; 20(4): 210-6.
[http://dx.doi.org/10.1097/01.wad.0000213865.09806.92] [PMID: 17132964]
[24]
Weintraub S, Besser L, Dodge HH, et al. Version 3 of the Alzheimer disease centers’ neuropsychological test battery in the uniform data set (UDS). Alzheimer Dis Assoc Disord 2018; 32(1): 10-7.
[http://dx.doi.org/10.1097/WAD.0000000000000223] [PMID: 29240561]
[25]
Roalf DR, Moberg PJ, Xie SX, Wolk DA, Moelter ST, Arnold SE. Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimers Dement 2013; 9(5): 529-37.
[http://dx.doi.org/10.1016/j.jalz.2012.10.001] [PMID: 23260866]
[26]
Kaufer DI, Cummings JL, Ketchel P, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000; 12(2): 233-9.
[http://dx.doi.org/10.1176/jnp.12.2.233] [PMID: 11001602]
[27]
Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol J Aging Ment Heal 1986; 5(1-2): 165-73.
[28]
Stonnington CM, Tan G, Klöppel S, et al. Interpreting scan data acquired from multiple scanners: A study with Alzheimer’s disease. Neuroimage 2008; 39(3): 1180-5.
[http://dx.doi.org/10.1016/j.neuroimage.2007.09.066] [PMID: 18032068]
[29]
Marchewka A, Kherif F, Krueger G, Grabowska A, Frackowiak R, Draganski B. Alzheimer’s Disease Neuroimaging Initiative. Influence of magnetic field strength and image registration strategy on voxel-based morphometry in a study of Alzheimer’s disease. Hum Brain Mapp 2014; 35(5): 1865-74.
[http://dx.doi.org/10.1002/hbm.22297] [PMID: 23723177]
[30]
Schmitter D, Roche A, Maréchal B, et al. Alzheimer’s Disease Neuroimaging Initiative. An evaluation of volume-based morphometry for prediction of mild cognitive impairment and Alzheimer’s disease. Neuroimage Clin 2014; 7: 7-17.
[http://dx.doi.org/10.1016/j.nicl.2014.11.001] [PMID: 25429357]
[31]
Ashburner J, Friston KJ. Voxel-based morphometry-the methods. Neuroimage 2000; 11(6 Pt 1): 805-21.
[http://dx.doi.org/10.1006/nimg.2000.0582] [PMID: 10860804]
[32]
Ashburner J, Friston KJ. Unified segmentation. Neuroimage 2005; 26(3): 839-51.
[http://dx.doi.org/10.1016/j.neuroimage.2005.02.018] [PMID: 15955494]
[33]
Boublay N, Schott AM, Krolak-Salmon P. Neuroimaging correlates of neuropsychiatric symptoms in Alzheimer’s disease: A review of 20 years of research. Eur J Neurol 2016; 23(10): 1500-9.
[http://dx.doi.org/10.1111/ene.13076] [PMID: 27435186]
[34]
Boublay N, Bouet R, Dorey JM, et al. Alzheimer’s Disease Neuroimaging Initiative. Brain volume predicts behavioral and psychological symptoms in Alzheimer’s disease. J Alzheimers Dis 2020; 73(4): 1343-53.
[http://dx.doi.org/10.3233/JAD-190612] [PMID: 31903989]
[35]
Poulin SP, Bergeron D, Dickerson BC. Alzheimer’s Disease Neuroimaging Initiative. Risk factors, neuroanatomical correlates, and outcome of neuropsychiatric symptoms in Alzheimer’s disease. J Alzheimers Dis 2017; 60(2): 483-93.
[http://dx.doi.org/10.3233/JAD-160767] [PMID: 28869463]
[36]
Munro CE, Donovan NJ, Guercio BJ, et al. Neuropsychiatric symptoms and functional connectivity in mild cognitive impairment. J Alzheimers Dis 2015; 46(3): 727-35.
[http://dx.doi.org/10.3233/JAD-150017] [PMID: 25854929]
[37]
Wang X, Ren P, Mapstone M, et al. and the Alzheimer’s Disease Neuroimaging Initiative. Identify a shared neural circuit linking multiple neuropsychiatric symptoms with Alzheimer’s pathology. Brain Imaging Behav 2019; 13(1): 53-64.
[http://dx.doi.org/10.1007/s11682-017-9767-y] [PMID: 28913718]
[38]
Ballarini T, Iaccarino L, Magnani G, et al. Neuropsychiatric subsyndromes and brain metabolic network dysfunctions in early onset Alzheimer’s disease. Hum Brain Mapp 2016; 37(12): 4234-47.
[http://dx.doi.org/10.1002/hbm.23305] [PMID: 27412866]
[39]
Ng KP, Pascoal TA, Mathotaarachchi S, et al. Alzheimer’s Disease Neuroimaging Initiative. Neuropsychiatric symptoms predict hypometabolism in preclinical Alzheimer disease. Neurology 2017; 88(19): 1814-21.
[http://dx.doi.org/10.1212/WNL.0000000000003916] [PMID: 28404803]
[40]
Showraki A, Murari G, Ismail Z, et al. Cerebrospinal fluid correlates of neuropsychiatric symptoms in patients with Alzheimer’s disease/mild cognitive impairment: A systematic review. J Alzheimers Dis 2019; 71(2): 477-501.
[http://dx.doi.org/10.3233/JAD-190365] [PMID: 31424398]
[41]
Christie D, Shofer J, Millard SP, et al. Genetic association between APOE*4 and neuropsychiatric symptoms in patients with probable Alzheimer’s disease is dependent on the psychosis phenotype. Behav Brain Funct 2012; 8: 62.
[http://dx.doi.org/10.1186/1744-9081-8-62] [PMID: 23270420]
[42]
D’Onofrio G, Panza F, Seripa D, et al. The APOE polymorphism in Alzheimer’s disease patients with neuropsychiatric symptoms and syndromes. Int J Geriatr Psychiatry 2011; 26(10): 1062-70.
[http://dx.doi.org/10.1002/gps.2644] [PMID: 21905100]
[43]
Fabbre VD, Jen S, Fredriksen-Goldsen K. The state of theory in LGBTQ aging: Implications for gerontological scholarship. Res Aging 2019; 41(5): 495-518.
[http://dx.doi.org/10.1177/0164027518822814] [PMID: 30626272]
[44]
Correro AN II, Nielson KA. A review of minority stress as a risk factor for cognitive decline in lesbian, gay, bisexual, and transgender (LGBT) elders. J Gay Lesbian Ment Health 2020; 24(1): 2-19.
[http://dx.doi.org/10.1080/19359705.2019.1644570] [PMID: 33014237]
[45]
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull 2003; 129(5): 674-97.
[http://dx.doi.org/10.1037/0033-2909.129.5.674] [PMID: 12956539]
[46]
Bostwick WB, Boyd CJ, Hughes TL, West BT, McCabe SE. Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. Am J Orthopsychiatry 2014; 84(1): 35-45.
[http://dx.doi.org/10.1037/h0098851] [PMID: 24826824]
[47]
Lick DJ, Durso LE, Johnson KL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci 2013; 8(5): 521-48.
[http://dx.doi.org/10.1177/1745691613497965] [PMID: 26173210]
[48]
Flentje A, Kober KM, Carrico AW, et al. Minority stress and leukocyte gene expression in sexual minority men living with treated HIV infection. Brain Behav Immun 2018; 70: 335-45.
[http://dx.doi.org/10.1016/j.bbi.2018.03.016] [PMID: 29548994]
[49]
Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A framework of minority stress: From physiological manifestations to cognitive outcomes. Gerontologist 2019; 59(6): 1017-23.
[http://dx.doi.org/10.1093/geront/gny104] [PMID: 30169640]
[50]
Gianaros PJ, Jennings JR, Sheu LK, Greer PJ, Kuller LH, Matthews KA. Prospective reports of chronic life stress predict decreased grey matter volume in the hippocampus. Neuroimage 2007; 35(2): 795-803.
[http://dx.doi.org/10.1016/j.neuroimage.2006.10.045] [PMID: 17275340]
[51]
Guo P, Wang S, Chen C, et al. Aberrant brain grey matter volume patterns differ among Chinese Han drug-naïve depression patients with acute and chronic stress. Oncotarget 2017; 8(54): 91958-64.
[http://dx.doi.org/10.18632/oncotarget.20954] [PMID: 29190889]
[52]
Holmes SE, Scheinost D, DellaGioia N, et al. Cerebellar and prefrontal cortical alterations in PTSD: Structural and functional evidence. Chronic Stress (Thousand Oaks) 2018; 22470547018786390
[http://dx.doi.org/10.1177/2470547018786390] [PMID: 30035247]
[53]
Helmer C, Damon D, Letenneur L, et al. Marital status and risk of Alzheimer’s disease: A French population-based cohort study. Neurology 1999; 53(9): 1953-8.
[http://dx.doi.org/10.1212/WNL.53.9.1953] [PMID: 10599764]
[54]
Sundström A, Westerlund O, Mousavi-Nasab H, Adolfsson R, Nilsson LG. The relationship between marital and parental status and the risk of dementia. Int Psychogeriatr 2014; 26(5): 749-57.
[http://dx.doi.org/10.1017/S1041610213002652] [PMID: 24451183]
[55]
Gallucci M, Spagnolo P, Aricò M, Grossi E. Predictors of response to cholinesterase inhibitors treatment of Alzheimer’s disease: Date mining from the TREDEM registry. J Alzheimers Dis 2016; 50(4): 969-79.
[http://dx.doi.org/10.3233/JAD-150747] [PMID: 26836164]
[56]
Kuyper L, Fokkema T. Loneliness among older lesbian, gay, and bisexual adults: The role of minority stress. Arch Sex Behav 2010; 39(5): 1171-80.
[http://dx.doi.org/10.1007/s10508-009-9513-7] [PMID: 19629672]
[57]
Lara E, Caballero FF, Rico-Uribe LA, et al. Are loneliness and social isolation associated with cognitive decline? Int J Geriatr Psychiatry 2019; 34(11): 1613-22.
[http://dx.doi.org/10.1002/gps.5174] [PMID: 31304639]
[58]
Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosom Med 2013; 75(2): 161-70.
[http://dx.doi.org/10.1097/PSY.0b013e31827f09cd] [PMID: 23362501]
[59]
Tilvis RS, Kähönen-Väre MH, Jolkkonen J, Valvanne J, Pitkala KH, Strandberg TE. Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol A Biol Sci Med Sci 2004; 59(3): 268-74.
[http://dx.doi.org/10.1093/gerona/59.3.M268] [PMID: 15031312]
[60]
Rafnsson SB, Orrell M, d’Orsi E, Hogervorst E, Steptoe A. Loneliness, social integration, and incident dementia over 6 years: Prospective findings from the English Longitudinal Study of Ageing. J Gerontol B Psychol Sci Soc Sci 2020; 75(1): 114-24.
[http://dx.doi.org/10.1093/geronb/gbx087] [PMID: 28658937]
[61]
Wilson RS, Krueger KR, Arnold SE, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry 2007; 64(2): 234-40.
[http://dx.doi.org/10.1001/archpsyc.64.2.234] [PMID: 17283291]
[62]
Hsiao YH, Chang CH, Gean PW. Impact of social relationships on Alzheimer’s memory impairment: Mechanistic studies. J Biomed Sci 2018; 25(1): 3.
[http://dx.doi.org/10.1186/s12929-018-0404-x] [PMID: 29325565]
[63]
Düzel S, Drewelies J, Gerstorf D, et al. Structural brain correlates of loneliness among older adults. Sci Rep 2019; 9(1): 13569.
[http://dx.doi.org/10.1038/s41598-019-49888-2] [PMID: 31537846]
[64]
Stern Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol 2012; 11(11): 1006-12.
[http://dx.doi.org/10.1016/S1474-4422(12)70191-6] [PMID: 23079557]
[65]
Bennett DA, Arnold SE, Valenzuela MJ, Brayne C, Schneider JA. Cognitive and social lifestyle: links with neuropathology and cognition in late life. Acta Neuropathol 2014; 127(1): 137-50.
[http://dx.doi.org/10.1007/s00401-013-1226-2] [PMID: 24356982]
[66]
Srinivasan S, Glover J, Tampi RR, Tampi DJ, Sewell DD. Sexuality and the older adult. Curr Psychiatry Rep 2019; 21(10): 97.
[http://dx.doi.org/10.1007/s11920-019-1090-4] [PMID: 31522296]
[67]
Guo H, Siu W, D’Arcy RC, et al. MRI assessment of whole-brain structural changes in aging. Clin Interv Aging 2017; 12: 1251-70.
[http://dx.doi.org/10.2147/CIA.S139515] [PMID: 28848333]
[68]
Dadar M, Maranzano J, Misquitta K, et al. Alzheimer’s Disease Neuroimaging Initiative. Performance comparison of 10 different classification techniques in segmenting white matter hyperintensities in aging. Neuroimage 2017; 157: 233-49.
[http://dx.doi.org/10.1016/j.neuroimage.2017.06.009] [PMID: 28602597]
[69]
Babulal GM, Quiroz YT, Albensi BC, et al. International society to advance Alzheimer’s research and treatment, Alzheimer’s association. Perspectives on ethnic and racial disparities in Alzheimer’s disease and related dementias: Update and areas of immediate need. Alzheimers Dement 2019; 15(2): 292-312.
[http://dx.doi.org/10.1016/j.jalz.2018.09.009] [PMID: 30555031]
[70]
Lehman BJ, David DM, Gruber JA. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Soc Personal Psychol Compass 2017; 11(8)e12328
[http://dx.doi.org/10.1111/spc3.12328]

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