Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population

Author:

Stubbs Jacob L,Jones Andrea A,Wolfman Daniel,Chan Ryan C Y,Vila-Rodriguez Fidel,Vertinsky Alexandra T,Heran Manraj K,Su Wayne,Lang Donna J,Field Thalia S,Gicas Kristina M,Woodward Melissa L,Thornton Allen E,Barr Alasdair M,Leonova Olga,MacEwan William,Rauscher Alexander,Honer William G,Panenka William J

Abstract

BackgroundHomeless or precariously housed individuals live with poor health and experience premature mortality compared with the general population, yet little is known about age-related brain changes among these individuals. We evaluated whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared with a general population sample.MethodsWe compared T1-weighted and diffusion tensor imaging measures of brain macrostructure and white matter microstructure in a well-characterised sample of 312 precariously housed participants with a publicly available dataset of 382 participants recruited from the general population. We used piecewise and multiple linear regression to examine differential associations between MRI measures and between the samples, and to explore associations with risk factors in the precariously housed sample.ResultsCompared with the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=−0.20, p=0.0029), lower whole-brain fractional anisotropy (β=−0.32, p<0.0001) and higher whole-brain mean diffusivity (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35–40 in the precariously housed sample. History of traumatic brain injury, stimulant dependence and heroin dependence was associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample.ConclusionsOlder age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared with the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.

Funder

BC Mental Health and Substance Use Services Research Institute

Canadian Institutes of Health Research

UK Biotechnology and Biological Sciences Research Council

Cambridge Centre for Ageing and Neuroscience

University of Cambridge, UK

UK Medical Research Council

Publisher

BMJ

Subject

Neurology (clinical),Neurology

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