PROJECT SUMMARY/ABSTRACT Alzheimer’s disease and related dementias (ADRD) is a public health priority and is well-established as a health disparity for some racial and ethnically minoritized groups. Transgender and gender diverse (TGD) people (i.e., those with a gender identity that differs from their sex assigned at birth) are a marginalized group that share many of the same psychosocial stressors and adverse health conditions linked to ADRD risk among cisgender adults (non-TGD) from minoritized ethnoracial communities. Yet, little is known about the epidemiology of and risk factors for ADRD among TGD adults. Most existing ADRD research was not designed to identify TGD participants or assess how ADRD risk is affected by TGD-specific experiences and psychosocial stressors (e.g., TGD status disclosure, gender-affirming hormone therapy (GAHT) use, anti-TGD discrimination). It is also unclear if ADRD prevalence and risk vary by TGD subgroups (e.g., transfeminine, transmasculine, nonbinary) or those using GAHT. The overarching goal of this K23 Mentored Patient-Oriented Research Career Development Award is to provide the applicant with the skills necessary to become an independent researcher and a leader in ADRD and cognitive aging among TGD adults. Specific training goals include: 1) Develop proficiency in advanced statistical methods for the analysis of longitudinal data; 2) Enhance skills in qualitative and mixed methods research, 3) Cultivate a more nuanced understanding of key influences on ADRD and cognitive function among TGD adults and obtain training in cognitive function assessment; and 4) Build expertise in community-engaged research that equitably and meaningfully involves TGD community members throughout the research process. The research proposed in this K23 will first examine the epidemiology of ADRD among TGD adults using Kaiser Permanente electronic health record (EHR) data from the ongoing Study of Transition, Outcomes and Gender (STRONG, R01AG066956, PI: Goodman). To enhance our knowledge about ADRD risk among TGD adults and move towards understanding the mechanisms contributing to ADRD disparities, we will then collect detailed and focused participant data using qualitative methods. Among a community-based sample of TGD adults, this study component will explore TGD-specific experiences and psychosocial stressors expected to influence ADRD risk and cognitive impairment. Finally, we will develop and pilot test a data collection protocol that objectively assesses cognitive function, TGD psychosocial stressors, and ADRD risk/protective factors among a cohort of middle-aged and older TGD adults. Research findings are expected to inform clinical practice and research by determining the extent of ADRD disparities among TGD adults and across TGD subgroups, discerning TGD-specific psychosocial-related mechanisms associated with ADRD disparities, and establishing a protocol for a full-scale prospective cohort study of brain health and ADRD risk among TGD adults.

PROJECT NARRATIVE Alzheimer’s disease and related dementias (ADRD) is a public health priority and is well-established as a health disparity for some racial and ethnically minoritized groups. Transgender and gender diverse (TGD) people (i.e., those with a gender identity that differs from their sex assigned at birth) are a marginalized group that share many of the same psychosocial stressors and adverse health conditions linked to ADRD risk among cisgender adults (i.e., non-TGD) from minoritized ethnoracial communities; yet little is understood about the epidemiology and risk of ADRD among TGD adults. This proposal will determine the extent of ADRD disparities and ADRD risk among TGD adults, characterize TGD-specific experiences (e.g., TGD status disclosure) and psychosocial stressors (e.g., anti-TGD discrimination, social isolation) expected to influence cognition, and explore associations between cognitive function, TGD psychosocial stressors, and ADRD risk and protective factors among a cohort of middle-aged and older TGD adults.