Abstract
Objective: This study examined the association of housing stability with neurocognitive outcomes of a well-characterized sample of homeless adults with mental illness over 18 months and sought to identify demographic and clinical variables associated with changes in neurocognitive functioning.Method: A total of 902 participants in the At Home/Chez Soi study completed neuropsychological measures 6 and 24 months after study enrollment to assess neurocognitive functioning, specifically verbal learning and memory, cognitive flexibility, and complex processing speed. Multivariable linear regression was performed to assess the association of housing stability with changes in neurocognitive functioning between 6 and 24 months and to examine the effect of demographic and clinical variables on changes in neurocognitive functioning.Results: Overall neurocognitive impairment remained high over the study period (70% at 6 months and 67% at 24 months) with a small but significant improvement in the proportion of those experiencing more severe impairment (54% vs. 49% p < 0.002). Housing stability was not associated with any of the neuropsychological measures or domains examined; improvement in neurocognitive functioning was associated with younger age, and bipolar affective disorder at baseline.Conclusions: The high prevalence and persistence of overall neurocognitive impairment in our sample suggests targeted approaches to improve neurocognitive functioning merit consideration as part of health interventions to improve everyday functioning and outcomes for this population. Further efforts are needed to identify potential modifiable factors that contribute to improvement in cognitive functioning in homeless adults with mental illness.
Highlights
Homelessness continues to be a significant social and health concern in North America
A follow-up to this study found that gains in neurocognitive functioning after housing could be maintained after 48 months, and the presence of substance abuse might diminish the beneficial effect of housing on neurocognitive outcomes [17]
An enhanced understanding of factors associated with changes in neurocognitive functioning may help identify subgroups of homeless adults that may benefit from additional interventions to improve their neurocognitive performance and optimize functional outcomes
Summary
Homelessness continues to be a significant social and health concern in North America. Individuals experiencing homelessness have higher rates of serious mental illness (SMI) and substance use than do those who are stably housed [1] and are at increased risk of chronic medical conditions [2] and premature mortality [3, 4]. Cognitive impairment among people experiencing homelessness may be attributable to conditions such as mental illness, substance misuse, traumatic brain injury, and neurological and developmental disorders, among others [5, 7, 10, 11]. Regardless of the cause, the presence of low or impaired neurocognitive functioning among individuals experiencing homelessness and SMI has important clinical and service planning implications, as these individuals may have greater difficulties following treatment regimens, navigating the healthcare and social service systems, and participating in activities that may improve overall quality of life [12]. Previous research indicates that neurocognitive functioning plays a major role in functional outcomes in this population [13, 14], as deficits in learning, memory and cognitive flexibility may impact ability to manage medications, financial matters, and negotiate complex routines and activities of daily living, including housing issues
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