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Proud Heart, Healthy Brain: Cognitive Health & Dementia Risk in the LGBTQ+ Community

  • Writer: Dr. Weston Donaldson
    Dr. Weston Donaldson
  • Jun 30
  • 6 min read


Dementia sucks.


We know that. 


But what can we do about it?


This month, my writing has focused heavily on the lived experiences of LGBTQ+ individuals navigating dementia and the care partners standing beside them. Lately, I’ve been thinking a lot about the conversations I’ve had with people who are carrying the weight of a family history of Alzheimer's. They ask about genetic testing, worry over minor memory slips, and wonder: Is this just normal aging, or is it something worse?


Throughout my career working as a geropsychologist in primary care clinics, hospital units, and nursing homes, I have always tried to balance these very real fears with what science tells us about dementia risk reduction. While we can't change our DNA, there is an incredible amount we can do to optimize our brain health.


When we focus on the proactive steps we can take, we reclaim our sense of agency. We stop feeling like victims of our genes and circumstances. I believe this shift is particularly vital for LGBTQ+ people. Because we face unique health inequities and systemic risk factors, choosing to actively protect our brains is also an important act of resilience.


Thoughtful middle aged gay man in a white shirt sits on a bed, hands clasped, wondering about how to protect his brain health and reduce risk of dementia.


What Happens When We Notice a Shift?


In the medical and psychological world, we have a formal name for that sinking feeling of “I think I’m having memory problems.” We call it Subjective Cognitive Decline (SCD).


Simply put, SCD is the self-reported experience of worsening confusion or memory loss over the past year. It’s that phase where you notice your brain isn't firing quite as fast or as accurately as it used to, even if a doctor’s standard cognitive tests don't show any clinical impairment yet.


When people first notice these shifts, the immediate response is almost always anxiety. The mind jumps straight to the worst-case scenario: Am I getting dementia? But here is an important piece of context that often brings immense relief: while SCD can be an early indicator of Alzheimer’s disease, it is far from the only explanation. 


There are many treatable, manageable reasons why you might be observing changes in your thinking abilities. It could be a side effect of a new medication, a reflection of a depressed or anxious mood, chronic poor sleep, or even unaddressed changes to your hearing or vision. This is why it is so crucial to raise these concerns with a trusted healthcare provider who can help you untangle the symptoms and determine the actual root cause.


If those underlying factors are ruled out, that worry doesn't have to paralyze you. Instead, we can reframe that anxiety as a powerful early warning system—a biological nudge to take your long-term brain health seriously.


This conversation is incredibly urgent for our community, because the data shows we are carrying a disproportionate burden:*


  • The Broad Reality: LGBTQ+ adults are 29% more likely to report subjective cognitive decline than our cisgender, heterosexual peers.


  • Transgender Adults: The disparity becomes even more stark for individuals whose gender identity differs from the sex they were assigned at birth. Transgender adults are nearly twice as likely to report SCD.


  • The Impact on Daily Life: Furthermore, transgender adults are more than twice as likely to report SCD to the point that it impacts their ability to do day-to-day tasks, work, or socialize.


Instead of letting these statistics scare us, we can use them to mobilize. When we feel that internal shift and think, “Hey, my memory isn't what it used to be,” it is our cue to partner with a doctor and look closely at the lifestyle factors and health disparities we actually have the power to change.


What Can We Do Now? Reclaiming Our Agency


While we cannot change our genetics or the historical stress we have endured, the field of brain health gives us some incredibly good news: up to 40% of dementia cases worldwide could be prevented or delayed by targeting modifiable lifestyle factors.**


For LGBTQ+ people, taking control of these factors isn't just about wellness—it is a powerful act of self-care and community resilience. Here is where we can start focusing our energy right now to protect our cognitive reserve:


1. What’s Good for Your Heart is Good for Your Brain


There is a direct, unbreakable link between your cardiovascular health and your mind. Conditions like high blood pressure, high cholesterol, and diabetes damage the blood vessels supplying oxygen to your brain, heavily increasing the risk of vascular dementia. Because minority stress can elevate blood pressure, staying on top of your cardiovascular health with a trusted, affirming doctor is a top priority.


2. Kick the Tobacco Habit


Historically, targeted marketing by tobacco companies and the need to cope with systemic stress have led to higher smoking rates among LGBTQ+ people. However, smoking heavily accelerates brain aging by causing inflammation and cellular wear and tear that damages healthy brain cells. Quitting smoking—at any age—instantly begins to lower your neurodegenerative risk.


3. Move Your Body and Eat with Intention


Regular physical exercise is essentially a fountain of youth for the brain. It stimulates growth factors that keep brain cells healthy and adaptable. Pair regular movement with a brain-healthy diet rich in antioxidants, healthy fats, and leafy greens to shield your brain from daily cellular damage.


4. Fortify Your Chosen Family


Social isolation is a massive, independent risk factor for cognitive decline. As I've written about before, LGBTQ+ people are statistically more likely to live alone, meaning that actively investing in your social circles, queer community spaces, and "chosen family" acts as a vital cognitive shield. Staying socially engaged keeps your brain active, adaptable, and challenged.


Frequently Asked Questions About LGBTQ+ Brain Health


Can you reduce your risk of dementia if you are LGBTQ+?

Yes, you can significantly reduce your risk of dementia by managing modifiable lifestyle factors, even if you have experienced chronic minority stress. Focusing on cardiovascular fitness, quitting smoking, maintaining strong chosen-family networks, and getting support to manage daily stress and the unique identity-related stresses affecting LGBTQ+ people all directly protect your brain health.

Smoking increases dementia risk by causing systemic inflammation, restricting oxygen-rich blood flow to the brain, and damaging vital blood vessels. This damage accelerates brain aging and significantly increases the likelihood of developing vascular cognitive impairment or Alzheimer's disease.

Early signs of subjective cognitive decline include a noticeable, self-reported increase in confusion, memory lapses, or trouble maintaining focus over the past year. If you find yourself thinking, "I think I'm having memory problems," but your day-to-day independence is still intact, it is an ideal time to discuss these changes with a doctor.

It is completely normal for all of us, as we age, to need more time to process information, multitask, and recall certain details. It becomes a problem when these changes begin to affect a person's ability to do daily tasks—like paying bills, cooking meals, or safely navigating the community. If you are concerned about changes, you can seek out a discussion with a medical or behavioral health professional who can perform a cognitive screening, which can also help monitor changes over time.


Let's Talk About Stress


Navigating the intersection of aging, memory worries, and queer history can feel incredibly heavy, but you do not have go it alone. As a geropsychologist, I built Proud Heart Therapy Services to be a safe, identity-affirming space where you can actively invest in both your emotional and cognitive well-being.


Here is how we can partner together to reclaim your agency:



Follow the Proud Heart Therapy Blog for more insights on how LGBTQ+ people can navigate the complexities of midlife and beyond. Subscribe and share this post with someone who might need to read it today.


*-Alzheimer’s Association 2021 news release: https://aaic.alz.org/releases_2021/transgender-adults-cognition.asp


**Livingston, G., Huntley, J., Liu, K. et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.The Lancet, 404, 572-628


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