Longitudinal Study of Cognitive and Biological Aging in Midlife and Older Sexual and Gender Minority Adults

Vanderbilt University, Nashville TN

Investigators

Abstract

Most health research on sexual and gender minority (SGM) populations focuses on younger people. Only 7.6% of NIH-funded SGM-related projects examine aging, despite 27% of SGM individuals being over age 50. The limited data we do have reveal significant disparities in health and aging outcomes among midlife and older SGM adults, including earlier and more severe cognitive decline, increased risk of Alzheimer’s disease and related dementias (ADRD), and earlier mortality, likely driven by chronic exposures to minority stressors over the life course. There is an urgent need for high-quality data on midlife and older SGM adults to identify intervention opportunities and address upstream determinants of health. Our current project, the LGBTQ+ Social Networks, Aging, and Policy Study (QSNAPS; R01AG063771), successfully recruited and retained the largest cohort of older SGM adults in the US South (N=1256; Age 50-76). QSNAPS data have provided valuable insights into health and aging outcomes among midlife and older SGM adults, emphasizing the importance of SGM-affirming healthcare. With NIH pilot and supplement funds, we collected for the first time biomarkers of aging and objective measures of cognitive function among self-identified SGM adults. Public release of all data is in process. This renewal project strategically expands research on midlife and older SGM adults by continuing to provide high-quality, longitudinal data and expanding biomarker and cognitive testing data in this NIH health disparity priority population. We will reinterview QSNAPS participants (N=1256) and recruit a 30% refresher sample (N=375), oversampling underrepresented groups to improve representation (Aim 1). Waves 4 and 5 will be publicly available and linkable to prior waves, capturing up to 8 participant life-years. All Wave 4 participants will be invited to participate in cognitive testing and biomarker collection, both of which we have piloted in this sample to ensure feasibility, acceptability, and the presence of preliminary associations consistent with hypotheses. Using cognitive testing data at Waves 3, 4, and 5, we will examine differences in cognitive function and change by sexual orientation and gender identity and test the effects of SGM-specific stressors on cognitive functioning and change over a 4-year period (Aim 2). We will also collect biomarkers linked to chronic stress and inflammation (CRP, IL-6, TNF), and construct surrogate markers using DNA methylation data that reflect global measures of biological aging, inflammation, and neurodegeneration using the Tasso+ self-collection device. We will use biomarker data to test the effects of SGM-specific stressors on chronic stress and inflammation, biological aging, and neurodegeneration, thereby advancing minority stress research by directly testing the proposed physiological mechanisms (Aim 3). Overall, this study addresses the critical need for high-quality SGM-inclusive aging studies and uses innovative methods to collect--for the first time--objective measures of cognitive function and biomarker data among a large panel of self-identified SGM adults.