Susan (information changed), was an 85-year-old Caucasian, right-handed transgender female with 12 years of education and a medical history significant for cardiovascular risk factors and completing gender affirmation surgery in her 70’s. Susan’s home-based primary care physician referred her for an outpatient neuropsychological evaluation due to clinician observed cognitive and functional decline over a two-year period. Susan’s primary care physician was concerned regarding her ability to live independently, and requested a neuropsychological evaluation to determine the appropriate level of care needed to ensure her safety. Prior to the current evaluation, she completed a cognitive screening measure and her score was suggestive of mild dementia. Susan consented for her data to be used in a case study.
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At the time of the neuropsychological evaluation, Susan demonstrated limited insight into her medical history and functional decline. Susan was aware she had been diagnosed with Alzheimer’s disease, although was “unsure why.” She reported she was “functioning fine;” however, acknowledged a decline in memory over the prior four years. Medical records indicated Susan had difficulty recalling her autobiographical information for five years prior to the current evaluation. For example, she possibly confabulated many stories to fit with her current gender (i.e., stories about her “husband,” her delivery of her children). Susan endorsed having difficulty driving and reported that her driving privileges were revoked by her primary care physician at 82 years of age. At the time of the evaluation, Susan lived alone in a senior housing apartment complex and had limited social support. She participated in limited leisure activities (e.g., watched television, attended lunch with a friend) and recently reduced her participation at a local senior center. She denied socializing with family and friends that lived nearby.
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The patient denied a history of “significant depression.” However, during the clinical evaluation she expressed “a lot of sadness” due to her family’s rejection of her decision to transition from male to female. Per medical history, at the time of her decision to transition, she became estranged from her family. In addition, the patient lost her community social support subsequent to her transition. At the time of the evaluation, she also endorsed feeling “lonely, anxious and sad,” in the context of limited socialization and loss of independence.
