Citation

Gicas KM, Jones AA, Thornton AE, Petersson A, Livingston E, Waclawik K, Panenka WJ, Barr AM, Lang DJ, Vila-Rodriguez F, Leonova O, Procyshyn RM, Buchanan T, MacEwan GW, Honer WG. BJPsych Open 2020; 6(2): e21.

Affiliation

Department of Psychiatry, University of British Columbia; and British Columbia Mental Health and Substance Use Services Research Institute, Canada.

Copyright

(Copyright © 2020, Royal College of Psychiatrists)

DOI

10.1192/bjo.2020.3

PMID

32043436

Abstract

BACKGROUND: Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group. AIMS: To longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people.

METHOD: This is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality.

RESULTS: Traumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality.

CONCLUSIONS: Findings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.

Language: en

Keywords

Mortality; ageing; cognition; comorbidity; marginalisation