Factors associated with cognitive impairment in a cohort of older homeless adults: results from the HOPE HOME study
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Background We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment.Methods We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition.Results Participants had a median age of 58 years [IQR 54-61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19-4.79) and executive dysfunction (AOR 3.09, CI 1.61-5.92).Conclusions Older homeless adults displayed a prevalence of cognitive impairment 3-4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders.
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TBI is not associated with neurocognition in six studies.
“Not associated with neurocognition in six studies 34,36,37,54,56,62”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [37]
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- Authors
- Hurstak, E., Johnson, J. K., Tieu, L., Guzman, D., Ponath, C., Lee, C. T., Jamora, C. W., & Kushel, M.
- Affiliations
- San Francisco General Hospital (US)
- University of California, San Francisco (US)
- Corresponding author
- Hurstak, Emily
- Kushel, Margot
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 178
- Pages
- 562-570
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC5568464
- OpenAlex
- W2732671089
- Cited by
- 56
- References
- 88
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 9 · 2018: 3
- FWCI
- 8.87
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- University of California, San Francisco
- National Institute on Aging (P30AG015272, R01AG041860, P30AG044281, K24AG046372)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- cognitive impairment, alcohol consumption, substance use, traumatic brain injury, executive dysfunction, processing speed, global cognition, alcoholism
- MeSH terms
- Alcoholism, Cognition, Cognition Disorders, Ill-Housed Persons, Humans, Neuropsychological Tests, Trail Making Test, Cohort Studies, Prevalence, Substance-Related Disorders, Executive Function
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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