Sexual Orientation Disparities in Subjective Cognitive Decline in a Large Cohort of Female Nurses

Purpose: Sexual minority (SM) women have more dementia risk factors than heterosexual women, but it remains unknown whether they experience increased symptoms of subjective cognitive decline (SCD)-a key predictor of dementia. Methods: We investigated sexual orientation-related disparities in SCD in Nurses' Health Study II (N = 70,772). Sexual orientation subgroups included completely heterosexual (n = 62,884); participants identifying as heterosexual with same-sex experience ("heterosexual-SM", n = 5017); and participants identifying as mostly heterosexual (n = 1825), bisexual (n = 287), or lesbian/gay (n = 759). SCD was measured using seven symptoms from the Structured Telephone Interview for Dementia Assessment, controlling for demographics with Poisson regression models. Results: Relative to completely heterosexual participants, SM participants had 29% more SCD symptoms (95% confidence interval [CI] = 1.26-1.32). Symptoms were elevated in every SM subgroup; the largest disparities were among bisexual and mostly heterosexual subgroups (adjusted risk ratios for 1-unit increment in symptoms [aRR]: 1.60, 95% CI = 1.45-1.77; 1.48, 95% CI = 1.42-1.54, respectively) followed by lesbian/gay (aRR: 1.22, 95% CI = 1.14-1.31) and heterosexual-SM participants (aRR: 1.21, 95% CI = 1.18-1.25). Conclusion: SM women-particularly bisexual and mostly heterosexual women-had more symptoms of SCD than completely heterosexual women. These findings align with known sexual orientation-related disparities in dementia risk factors (e.g., mental health, substance use), and indicate that better understanding and closer monitoring of cognitive health in SM groups remains important for prevention efforts as an increasing proportion of aging Americans identifies as SM.