Cognitive Impairment in Marginally Housed Youth: Prevalence and Risk Factors

Abstract

Objective: Homeless and marginally housed youth are particularly vulnerable members of society, and are known to experience numerous health problems, including psychiatric illness, substance use, and viral infection. Despite the presence of these risk factors for cognitive compromise, there is limited research on the cognitive functioning of homeless and marginally housed youth. The present study examines the degree and pattern of cognitive impairment and associations with key risk factors in a sample of marginally housed young adults.Method: Participants (N = 101) aged 20–29 years old were recruited from single-room occupancy hotels, and underwent cognitive, psychiatric, neurological, and serological assessments.Results: Forty percent of participants were identified as mildly cognitively impaired across multiple domains, and 16% were moderately-severely impaired. Deficits in memory and attention were most prevalent, while impairments in inhibitory control/processing speed and cognitive flexibility were also present but tended to be less severe. Developmental and historical factors (premorbid intellectual functioning, neurological soft signs, earlier exposure to and longer duration of homelessness or marginal housing), as well as current health risks (stimulant dependence and hepatitis C exposure), were associated with cognitive impairment.Conclusions: The strikingly high rate of cognitive impairment in marginally housed young adults represents a major public health concern and is likely to pose a significant barrier to treatment and rehabilitation. These results suggest that the pathway to cognitive impairment involves both developmental vulnerability and modifiable risk factors. This study highlights the need for early interventions that address cognitive impairment and risk factors in marginalized young people.

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

“…below the normative mean to define scores that fall within the clinically impaired range on a given test, in accord with existing guidelines 26 and with other studies in homeless people. 7,12…”

“…below the normative mean to define scores that fall within the clinically impaired range on a given test, in accord with existing guidelines 26 and with other studies in homeless people. 7,12 A history of traumatic brain injury was ascertained using a structured medical history questionnaire and defined as the occurrence of at least one injury to the head associated with any duration of loss of consciousness, confusion and/or memory loss, or neuroradiological evidence of trauma on whole brain images collected on a 3T Phillips Achieva scanner, or evidence of persistent sequelae attributable to injury (for example seizures, need for anticonvulsants, organic personality disorder). We adopted an inclusive definition of traumatic brain injury by grouping individuals as either having a history based on the above criteria, or no history, a previously used approach.…”

“…6,7,9,10 Cognitive dysfunction occurs across the age spectrum, including in homeless youth. 11,12 However, whether impairments are static, reversible or progressive is unclear.…”

Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample

“…1,3 Homeless and precariously housed youth and young adults may have differential risk factors and health outcomes and represent a uniquely vulnerable demographic within this marginalized population. 4,5 Although not formally homeless, individuals who live in precarious housing (e.g., shelters, single-room occupancy hotels, rooming houses) have comparable mortality, chronic health conditions, and unmet health care needs. 6,7 Over half of homeless and precariously housed individuals have a history of traumatic brain injury (TBI), and approximately one-fifth have a history of moderate or severe TBI.…”

Homelessness and Research: Methodological Obstacles and Lessons Learned from a Psychological Study in Parisian Homeless Services

“…Study context. Studies have shown that homelessness is associated with several risk factors for developing cognitive disorders, such as traumatic brain injuries [4,23], neurodevelopmental issues [24,25], or alcohol consumption [26,27], and that the prevalence of cognitive disorders is higher in people experiencing homelessness [11,28]. Although research into mental disorders in homeless people has been carried out in France [29][30][31], there is a lack of data for cognitive disorders specifically from a French population.…”