TY  - JOUR
PY  - 2020//
TI  - Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study
JO  - BJPsych open
A1  - Gicas, Kristina M.
A1  - Jones, Andrea A.
A1  - Thornton, Allen E.
A1  - Petersson, Anna
A1  - Livingston, Emily
A1  - Waclawik, Kristina
A1  - Panenka, William J.
A1  - Barr, Alasdair M.
A1  - Lang, Donna J.
A1  - Vila-Rodriguez, Fidel
A1  - Leonova, Olga
A1  - Procyshyn, Ric M.
A1  - Buchanan, Tari
A1  - MacEwan, G. William
A1  - Honer, William G.
SP  - e21
EP  - e21
VL  - 6
IS  - 2
N2  - 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. <br><br>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. <br><br>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. <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 2056-4724
UR  - http://dx.doi.org/10.1192/bjo.2020.3
ID  - ref1
ER  -