Arch Clin Neuropsychol. 2023 Oct 8:acad067.235. doi: 10.1093/arclin/acad067.235. Online ahead of print.
OBJECTIVE: The occurrence of delayed preventative health screening as a result of health inequities and medical mistrust resulting from intersecting marginalized identities, including race and sexual orientation, is well documented; however, this complex interplay applied to a neuropsychological profile is less established. The present case uses neuropsychological assessment to further the understanding of the brain-behavior relationship in a case with significant medical comorbidities, a history of childhood trauma, underlying psychiatric conditions, and social and cultural identities that have been historically marginalized.
METHOD: The patient is a 53-year-old right-handed Black, gay man with multiple cerebrovascular risk factors, a seizure disorder, two remote concussions, past kidney failure with the subsequent transplant, and HIV with prescribed antiretroviral medications who was referred for neuropsychological evaluation by neurology pursuant to a decline in mental status over the past decade.
RESULTS: Neuropsychological testing reflects global cognitive deficits evidenced by difficulties with intellectual functioning, motor abilities, complex sequencing, problem-solving, executive functioning, verbal fluency, attention, and memory. A self-report of psychological functioning revealed emotional difficulties associated with depression, anxiety, ongoing traumatic stress, and emotional dysregulation. Findings are most consistent with major neurodegenerative disorder and suggest a diagnosis of dementia complicated by depression.
CONCLUSIONS: This neuropsychological case study provides an example of the complex effects of biological, economic, and other sociocultural factors on cognition and emotional functioning. This case further emphasizes the negative impact of medical mistrust and delayed preventative care in the Black, gay community on neuropsychological functioning and quality of life.