UNLV researcher Jace Flatt has studied cognitive decline and dementia risk in LGBTQ+ Americans for over a decade. Here’s what his team learned in research which was recently defunded in line with the federal government’s ban on diversity, equity, and inclusion.
Loneliness, heart disease, diabetes, and mental health conditions all put older Americans at a higher risk of developing cognitive decline and Alzheimer’s disease. Looking at specific segments of the population — like people from specific cultural or socioeconomic backgrounds, or specific communities, i.e. veterans — helps researchers better understand how these factors as a whole influence the disease and could one day unlock better treatments for everyone.
In 2016, Jace Flatt became interested in studying Alzheimer’s and dementia risk through the lens of LGBTQ+ health. In the past, researchers had looked at other health conditions, noting that LGBTQ+ people had a higher prevalence of many of the conditions linked to dementia. Did this mean LGBTQ+ people had a higher risk of dementia? If so, why? And what could scientists learn about neurodegenerative disease by probing this question?
That same year Flatt started down this path, the National Institute of Minority Health Disparities classified sexual and gender minorities as a health disparity — a group whose health is significantly worse than the general population. This move helped kickstart new research initiatives to help address the public health gap, designating federal funds to research like Flatt’s.
What we’ve learned about LGBTQ+ health and Alzheimer’s disease
To start his work, Flatt and his colleagues leveraged the CDC behavioral risk factor surveillance system to examine self-reported concerns about memory and thinking skills over time in the aging population. The survey was conducted across multiple states between 2015 and 2018, with some states also collecting information about people’s sexual and gender identity.
“We found that for LGBTQIA+ people, right around one in seven, they were aged 45 and older, reporting this subjective cognitive decline, compared to around one in 10 for non-LGBTQIA+ people,” said Flatt. Among transgender people in the study, as well as LGBTQ+ people who were racial and ethnic minorities, the rates of subjective cognitive decline were even higher — closer to one in four.
The survey included follow-up questions to understand the extent of the subjective cognitive decline. “We’re finding that they’re [LGBTQ+ people] having more issues with their day-to-day activities, maintaining their households, having to stop work or not being able to socialize,” said Flatt.
Although self-reported studies like this one have limitations, it provided a signal that this population might be vulnerable to dementia and is worthy of following up with more rigorous research.
His next step involved looking at 200,000 people over 10 years by analysing electronic health records collected from Kaiser Permanente in Northern California. “We could look at people from 1996 through 2015 and look at the prevalence and incidence of dementia and then other risk factors,” he explained.
Lesbian and bisexual women in the study were being diagnosed with dementia one to two years earlier than heterosexual people and a higher overall risk despite having fewer risk factors.
“They’re more likely to have a college degree, which is actually supposed to be protective of dementia,” said Flatt. “But they’re getting it earlier.” This group also had lower rates of blood pressure and diabetes, which should be protective, but higher rates of depression and post-traumatic stress disorder, which increased the risk.
Since the electronic health records tracked how often people visited their doctor, Flatt and his team could rule out a few explanations. For example, lesbian and bisexual women weren’t getting the diagnosis early because they visited their doctor or were seeking care more often.
But in men, sexual and gender identity didn’t impact dementia risk. “We thought it was quite surprising that we didn’t see any concerns for gay and bisexual men,” said Flatt.
Research shows that a disproportionately high percentage of LGBTQ+ older adults who are at risk of cognitive decline and dementia live with certain risk factors, and studying these risk factors in a subpopulation can help scientists learn more about disease risk at large.
“A large population of older adults live alone. That applies to other people that may be facing economic challenges,” Flatt told STAT News. “Telling us that it doesn’t enhance health or understanding for broader Americans? That’s not true.”
Flatt’s research would provide more insight into the small but growing body of research looking at LGBTQ+ aging.
A 2019 study found that older LGBTQ+ individuals were more likely to do worse on cognitive tests, an early sign of cognitive decline putting them at risk of dementia. Another 2023 study looked at Medicare data and found that among transgender Medicare beneficiaries, the rates of dementia were about one in five — almost double the rate of dementia in cisgender individuals.
These research studies have a broad impact on all Americans, Flatt said. Almost everyone has friends, family members, neighbours, or others in their community who are LGBTQ+, and “we’re adding to the knowledge around risk and protective factors for Alzheimer’s disease,” Flatt noted. “We’re also increasing awareness of Alzheimer’s and connecting people to studies.”
Why was the grant rescinded?
Now, Flatt’s research grants —just over $120,000 in annual federal funding from the National Institute on Aging — have been rescinded due to an executive order banning Diversity, Equity, and Inclusion, effectively defunding his lab and making him unable to complete the final stages of his team’s research project.
In early March, Flatt and at least 17 other scientists received notices from the NIA notifying them their grants would not only be ineligible for renewal, but that they would be cut short. Flatt and other researchers received word their grant funding was terminated, effective immediately, four months before its current cycle’s completion date.
“Research programs based on gender identity are often unscientific, have little identifiable return on investment, and do nothing to enhance the health of many Americans,” wrote Jeni Militano from the NIA’s office of grants and contracts management, the signee of the grant termination letters, in the notice to Flatt. Her letter also alleged that many such studies “ignore, rather than seriously examine, biological realities.” (Militano did not respond to multiple emails from Being Patient requesting comment.)
According to Flatt, nearly 20 independent neuroscience experts were asked, in a standard peer-review process, to review his study and its methodology in 2018, and the groiup unanimously deemed it had scientific merit and impact. From one panelist, Flatt noted, the research even earned a rare perfect score.
Now that the funding is gone, this will slow the final data analysis and delay the publication of the scientific findings. Eight jobs he had created in his laboratory are being eliminated, including those of two full-time scientists, five graduate students, and another student paid hourly. (He is in talks with his staff and the university to help his employees and students and plans to appeal the decision to cancel the grant.)
Another study in which Flatt was involved was also killed due to the abrupt, mid-cycle withdrawal of designated federal funding. That project, led by Emory University researcher Whitney Wharton, was funded in 2021 to develop a resource that could help LGBTQ+ and non-LGBTQ+ individuals find clinical trials for dementia and provide them with resources to support families and patients.
Can this research continue without federal funding? Not easily: According to Flatt, rescinding grants that help LGBTQ+ people participate in trials “compromises the science,” as much of the funding supported efforts to recruit sufficient numbers of eligible enrollees. Recruitment will be all the more challenging, Flatt said, with fears around data privacy and coming forward as LGBTQ+ as states increasingly roll out laws that prevent teaching about LGBTQ+ issues in school curriculums, ban topically relevant books and drag performances, and restrict gender-affirming care, among other restrictions.
Flatt’s four-year $1.4 million grant with the Defense Health Agency that was in the final stages of approval was withdrawn from consideration. The grant would have supported research to study LGBTQ+ veterans and their risk for dementia, as well as the challenges caregivers face in accessing care and resources. The Defense Health Agency wrote that the research “was not in line” with the DEI executive order.
My sister is 71 yrs old and is in later stages of alzheimers.she was an airline stewarist for yrs .she worked with a crew of 6 mainly doing overseas flts 3 of the 6
Are todaysuffering from advanced alzheimers we have wondered ifworking in such conditions of depleted oxygen had some effect to tthe fact of theirhaving this disease Thank you for recieving might note
Hi Ruth, thank you for being here and for sharing. We’re sorry to hear about your sister and what your family is going through. While we don’t have information connecting flight conditions to Alzheimer’s, it’s an interesting question and we appreciate you bringing it to the conversation. Take care.