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Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

  • Kristina M. Gicas (a1) (a2), Andrea A. Jones (a2), Allen E. Thornton (a3), Anna Petersson (a3), Emily Livingston (a3), Kristina Waclawik (a3), William J. Panenka (a2), Alasdair M. Barr (a4), Donna J. Lang (a5), Fidel Vila-Rodriguez (a2), Olga Leonova (a2), Ric M. Procyshyn (a2), Tari Buchanan (a2), G. William MacEwan (a2) and William G. Honer (a6)...

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Kristina M. Gicas. Email: kgicas@yorku.ca

Footnotes

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Declaration of interest: A.E.T. reports grants from Canadian Institute for Health Research, William and Ada Isabelle Steel Fund, Simon Fraser University Psychology Department. W.J.P. reports personal fees from Abbatis Bioceuticals, Medipure Pharmaceuticals and is owner of Translational Life Sciences. F.V.-R. reports personal fees from Janssen; and grants from Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, and Brain Canada. R.M.P. reports personal fees from Janssen, Lundbeck and Otsuka. W.G.H. reports personal fees from Canadian Agency for Drugs and Technology in Health, AlphaSights, Guidepoint, Translational Life Sciences, Otsuka, Lundbeck, and Newron; grants from Canadian Institutes of Health Research, BC Mental Health and Addictions Services; and has been a consultant (non-paid) for In Silico. K.M.G, A.M.B., D.J.L., O.L., A.A.J, A.P., E.L., K.W., T.B., G.W.M. report no competing interests.

Footnotes

References

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Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

  • Kristina M. Gicas (a1) (a2), Andrea A. Jones (a2), Allen E. Thornton (a3), Anna Petersson (a3), Emily Livingston (a3), Kristina Waclawik (a3), William J. Panenka (a2), Alasdair M. Barr (a4), Donna J. Lang (a5), Fidel Vila-Rodriguez (a2), Olga Leonova (a2), Ric M. Procyshyn (a2), Tari Buchanan (a2), G. William MacEwan (a2) and William G. Honer (a6)...

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Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

  • Kristina M. Gicas (a1) (a2), Andrea A. Jones (a2), Allen E. Thornton (a3), Anna Petersson (a3), Emily Livingston (a3), Kristina Waclawik (a3), William J. Panenka (a2), Alasdair M. Barr (a4), Donna J. Lang (a5), Fidel Vila-Rodriguez (a2), Olga Leonova (a2), Ric M. Procyshyn (a2), Tari Buchanan (a2), G. William MacEwan (a2) and William G. Honer (a6)...
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