Risk of Incident Mild Cognitive Impairment and Dementia Soon After Leaving Incarceration Among a US Veteran Population
Abstract
Objectives
Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia.
Methods
This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association.
Results
This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00–1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06–1.39) but not MCI only.
Discussion
Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.
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References
1.
Williams B, Abraldes R. Growing older: challenges of prison and reentry for the aging population. In: Public Health behind Bars: From Prisons to Communities [Internet]. Springer-Verlag; 2007.
2.
Wang EA, Wang Y, Krumholz HM. A high risk of hospitalization following release from correctional facilities in medicare beneficiaries: a retrospective matched cohort study, 2002 to 2010. JAMA Intern Med. 2013;173(17):1621-1628.
3.
Williams BA, Stern MF, Mellow J, Safer M, Greifinger RB. Aging in correctional custody: setting a policy agenda for older prisoner health care. Am J Public Health. 2012;102(8):1475-1481.
4.
Greene M, Ahalt C, Stijacic-Cenzer I, Metzger L, Williams B. Older adults in jail: high rates and early onset of geriatric conditions. Health Justice. 2018;6(1):3.
5.
Aday RH. Aging prisoners. In: Handbook of Social Work in Health and Aging [Internet]. Oxford Academic; 2006:231-244.
6.
Hughes T, Wilson DJ. Reentry trends in the U.S. inmates returning to the community after serving time in prison. In: Justice USD. Office of Justice Programs: Bureau of Justice Statistics; 2002.
7.
Kuffel RL, Byers AL, Williams B, et al. Prevalence of dementia and mild cognitive impairment before incarceration. J Am Geriatr Soc. 2022;70(6):1792-1799.
8.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619.
9.
Peterson R, Gundlapalli AV, Metraux S, et al. Identifying homelessness among veterans using VA administrative data: opportunities to expand detection criteria. PLoS One. 2015;10(7):e0132664.
10.
McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Horm Behav. 2003;43(1):2-15.
11.
Barry LC, Steffens DC, Covinsky KE, et al. High risk of substance use disorder-related outcomes in veterans released from correctional facilities in mid to late life. J Gen Intern Med. 2023;38(5):1109-1118.
12.
Stroup TS, Olfson M, Huang C, et al. Age-specific prevalence and incidence of dementia diagnoses among older US adults with schizophrenia. JAMA Psychiatry. 2021;78(6):632-641.
13.
Günak MM, Billings J, Carratu E, Marchant NL, Favarato G, Orgeta V. Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis. Br J Psychiatry. 2020;217(5):600-608.
14.
Mattke S, Jun H, Chen E, Liu Y, Becker A, Wallick C. Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. Alzheimers Res Ther. 2023;15(1):128.
15.
Canaslan K, Ates Bulut E, Kocyigit SE, Aydin AE, Isik AT. Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr. 2022;22(1):440.
Information & Authors
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Copyright
© 2025 American Academy of Neurology.
Publication History
Received: July 30, 2024
Accepted: January 8, 2025
Published online: February 18, 2025
Published in issue: March 25, 2025
Disclosure
The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.
Study Funding
This work was supported by Award Number RF1 MH117604 from the National Institute of Mental Health (PI: Byers/Barry) and by Award Number R01 AG082157 from the National Institute on Aging (PI: Byers/Barry). Dr. Byers is the recipient of a Research Career Scientist award (IK6 CX002386) from the Department of Veterans Affairs. Dr. Barry and Dr. Fortinsky are also supported by the UConn Claude D. Pepper Older Americans Independence Center (NIA P30-AG067988). A portion of Dr. Williams' time is funded by the NIH: National Institute on Aging project entitled “Health Disparities Research in Aging: The Aging Research in Criminal Justice & Health (ARCH) Network” (R24 AG065175). Support for VA/CMS data is provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Support for the Mortality Data Repository (MDR) is provided by the VA Center of Excellence for Suicide Prevention; Department of Veterans Affairs, Office of Mental Health and Suicide Prevention; Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository; Data compiled from the National Death Index. The sponsors had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review, approval of the manuscript, or decision to submit the manuscript for publication. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the US Government, or the US Department of Veterans Affairs, and no official endorsement should be inferred. There are no financial disclosures to report.
Authors
Author Contributions
A.L. Byers: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. B. Williams: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data. R. Fortinsky: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data. W.J. Boscardin: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data. Y. Li: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. R. Clark: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; analysis or interpretation of data. R.T. Morin: drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data. L.C. Barry: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data.
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