Skip to main content

Clinical Management of the Homeless Patient with Traumatic Brain Injury and Cognitive Impairment

  • Chapter
  • First Online:
Clinical Management of the Homeless Patient

Abstract

The global incidence of traumatic brain injuries (TBIs) in the homeless population has been estimated to be up to 53%. TBI is almost always associated with cognitive impairment, even if only transiently. Cognitive impairments are a risk factor for becoming homeless and may impede an individual’s ability to escape homelessness by interfering with their ability to sustain employment. Management of both conditions in the homeless population is complex given the numerous barriers encountered in their healthcare. A holistic and multimodal approach may be the optimal strategy for care, but first understanding what a traumatic brain injury is, what conditions are associated with it, and what other factors may be impairing cognition is perhaps the most important step in developing tailored treatments for a homeless patient with TBI and cognitive impairments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Topolovec-Vranic J, Ennis N, Colantonio A, Cusimano MD, Hwang SW, Kontos P, Ouchterlony D, Stergiopoulos V. Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health. 2012;12:1059. https://doi.org/10.1186/1471-2458-12-1059.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj. 2001;15(11):935–45. https://doi.org/10.1080/02699050110065295.

    Article  CAS  PubMed  Google Scholar 

  3. Metraux S, Clegg LX, Daigh JD, Culhane DP, Kane V. Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts. Am J Public Health. 2013;2(Suppl 2):S255–61. https://doi.org/10.2105/AJPH.2013.301432. Epub 2013 Oct 22.

    Article  Google Scholar 

  4. Hwang SW, Colantonio A, Chiu S, Tolomiczenko G, Kiss A, Cowan L, et al. The effect of traumatic brain injury on the health of homeless people. CMAJ. 2008;179(8):779–84. https://doi.org/10.1503/cmaj.080341.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Herman DB, Susser ES, Struening EL, Link BL. Adverse childhood experiences: are they risk factors for adult homelessness? Am J Public Health. 1997;87(2):249–55. https://doi.org/10.2105/ajph.87.2.249.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. van Velzen JM, van Bennekom CA, Edelaar MJ, Sluiter JK, FringsDresen MH. How many people return to work after acquired brain injury? A systematic review. Brain Inj. 2009;23(6):473–88. https://doi.org/10.1080/02699050902970737.

    Article  PubMed  Google Scholar 

  7. Dixon KJ. Pathophysiology of traumatic brain injury. Phys Med Rehabil Clin N Am. 2017;28(2):215–25. https://doi.org/10.1016/j.pmr.2016.12.001.

    Article  PubMed  Google Scholar 

  8. Pervez M, Kitagawa RS, Chang TR. Definition of traumatic brain injury, neurosurgery, trauma orthopedics, neuroimaging, psychology, and psychiatry in mild traumatic brain injury. Neuroimaging Clin N Am. 2018;28(1):1–13. https://doi.org/10.1016/j.nic.2017.09.010.

    Article  PubMed  Google Scholar 

  9. Bledsoe BE, Casey MJ, Feldman J, Johnson L, Diel S, Forred W, Gorman C. Glasgow coma scale scoring is often inaccurate. Prehosp Disaster Med. 2015;30(1):46–53. https://doi.org/10.1017/S1049023X14001289. Epub 2014 Dec 9.

    Article  PubMed  Google Scholar 

  10. Kulbe JR, Geddes JW. Current status of fluid biomarkers in mild traumatic brain injury. Exp Neurol. 2016;275 Pt 3(0 3):334–52. https://doi.org/10.1016/j.expneurol.2015.05.004.

    Article  CAS  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention. https://www.cdc.gov/traumaticbraininjury/ March 29, 2019.

  12. Svoboda T, Ramsay JT. High rates of head injury among homeless and low income housed men: a retrospective cohort study. Emerg Med J. 2014;31:571–5.

    Article  Google Scholar 

  13. TM MM, Laurie M, Oddy M, Menzies M, Stewart E, Wainman-Lefley J. Head injury and mortality in the homeless. J Neurotrauma. 2015;32(2):116–9. https://doi.org/10.1089/neu.2014.3387.

    Article  Google Scholar 

  14. Topolovec-Vranic J, Schuler A, Gozdzik A, Somers J, Bourque PÉ, Frankish CJ, et al. The high burden of traumatic brain injury and comorbidities amongst homeless adults with mental illness. J Psychiatr Res. 2017;87:53–60. https://doi.org/10.1016/j.jpsychires.2016.12.004.

    Article  PubMed  Google Scholar 

  15. Lombardi K, Pines JM, Mazer-Amirshahi M, Pourmand A. Findings of a national dataset analysis on the visits of homeless patients to US emergency departments during 2005–2015. Public Health. 2020;178:82–9. https://doi.org/10.1016/j.puhe.2019.09.003.

    Article  CAS  PubMed  Google Scholar 

  16. Fazel S, Lichtenstein P, Grann M, Långström N. Risk of violent crime in individuals with epilepsy and traumatic brain injury: a 35-year Swedish population study. PLoS Med. 2011;8(12):e1001150. https://doi.org/10.1371/journal.pmed.1001150.

    Article  PubMed  PubMed Central  Google Scholar 

  17. To MJ, OʼBrien K, Palepu A, Hubley AM, Farrell S, Aubry T, et al. Healthcare utilization, legal incidents, and victimization following traumatic brain injury in homeless and vulnerably housed individuals: a prospective cohort study. J Head Trauma Rehab. 2015;30(4):270–6. https://doi.org/10.1097/HTR.0000000000000044.

    Article  Google Scholar 

  18. Saboori P, Walker G. Brain injury and impact characteristics. Ann Biomed Eng. 2019;47(9):1982–92. https://doi.org/10.1007/s10439-019-02199-z.

    Article  PubMed  Google Scholar 

  19. Topal NB, Hakyemez B, Erdogan C, Bulut M, Koksal O, Akkose S, et al. MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury. Neurol Res. 2008;30(9):974–8. https://doi.org/10.1179/016164108X323799.

    Article  PubMed  Google Scholar 

  20. Farkas O, Lifshitz J, Povlishock JT. Mechanoporation induced by diffuse traumatic brain injury: an irreversible or reversible response to injury? J Neurosci. 2006;26(12):3130–40. https://doi.org/10.1523/JNEUROSCI.5119-05.2006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury - an update. Phys Med Rehabil Clin N Am. 2016;27(2):373–93. https://doi.org/10.1016/j.pmr.2016.01.003.

    Article  PubMed  Google Scholar 

  22. Kawamata T, Katayama Y, Hovda DA, Yoshino A, Becker DP. Lactate accumulation following concussive brain injury: the role of ionic fluxes induced by excitatory amino acids. Brain Res. 1995;674(2):196–204. https://doi.org/10.1016/0006-8993(94)01444-m.

    Article  CAS  PubMed  Google Scholar 

  23. McMahon P, Hricik A, Yue JK, Puccio AM, Inoue T, Lingsma HF, et al. TRACK-TBI investigators. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26–33. https://doi.org/10.1089/neu.2013.2984.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tapia RN, Eapen BC. Rehabilitation of persistent symptoms after concussion. Phys Med Rehabil Clin N Am. 2017;28(2):287–99. https://doi.org/10.1016/j.pmr.2016.12.006.

    Article  PubMed  Google Scholar 

  25. Gould KR, Ponsford JL, Johnston L, Schonberger M. Predictive and associated factors of psychiatric disorders after traumatic brain injury: a prospective study. J Neurotrauma. 2011;28(7):1155–63. https://doi.org/10.1089/neu.2010.1528.

    Article  PubMed  Google Scholar 

  26. Reed N, Greenspoon D, Iverson GL, DeMatteo C, Fait P, Gauvin-Lepage J, et al. Management of persistent postconcussion symptoms in youth: a randomised control trial protocol. BMJ Open. 2015;5:e008468. https://doi.org/10.1136/bmjopen-2015-008468.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Marion DW, Puccio A, Wisniewski SR, Kochanek P, Dixon CE, Bullian L, Carlier P. Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Crit Care Med. 2002;30(12):2619–25. https://doi.org/10.1097/00003246-200212000-00001.

    Article  CAS  PubMed  Google Scholar 

  28. Vella MA, Crandall M, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017;97(5):1015–30. https://doi.org/10.1016/j.suc.2017.06.003.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smits M, Dippel DW, de Haan GG, Dekker HM, Vos PE, Kool DR, et al. External validation of the Canadian CT head rule and the New Orleans criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519–25. https://doi.org/10.1001/jama.294.12.1519.

    Article  CAS  PubMed  Google Scholar 

  30. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S1–106. https://doi.org/10.1089/neu.2007.9999.

    Article  Google Scholar 

  31. Chang BS, Lowenstein DH. Practice parameter: antiepileptic drug prophylaxis in severe traumatic brain injury. Neurology. 2003;60(1):10–6. https://doi.org/10.1212/01.wnl.0000031432.05543.14.

    Article  PubMed  Google Scholar 

  32. Lamar CD, Hurley RA, Rowland JA, Taber KH. Post-traumatic epilepsy: review of risks, pathophysiology, and potential biomarkers. Neuropsychiat Clin Neurosci. 2014;26(2):iv–113. https://doi.org/10.1176/appi.neuropsych.260201.

    Article  Google Scholar 

  33. Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91(5):750–60. https://doi.org/10.3171/jns.1999.91.5.0750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Vespa P, Tubi M, Claassen J, Buitrago-Blanco M, McArthur D, Velazquez AG, et al. Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol. 2016;79(4):579–90. https://doi.org/10.1002/ana.24606.

    Article  PubMed  Google Scholar 

  35. Vespa PM, McArthur DL, Xu Y, Eliseo M, Etchepare M, Dinov I, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010;75(9):792–8. https://doi.org/10.1212/WNL.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Zimmermann LL, Diaz-Arrastia R, Vespa PM. Seizures and the role of anticonvulsants after traumatic brain injury. Neurosurg Clin N Am. 2016;27(4):499–508. https://doi.org/10.1016/j.nec.2016.06.001.

    Article  PubMed  Google Scholar 

  37. Jinadasa S, Boone MD. Controversies in the Management of Traumatic Brain Injury. Anesthesiol Clin. 2016;34(3):557–75. https://doi.org/10.1016/j.anclin.2016.04.008.

    Article  PubMed  Google Scholar 

  38. Silverberg ND, Crane PK, Dams-O'Connor K, Holdnack J, Ivins BJ, Lange RT, et al. Developing a cognition endpoint for traumatic brain injury clinical trials. J Neurotrauma. 2017;34(2):363–71. https://doi.org/10.1089/neu.2016.4443.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Depp CA, Vella L, Orff HJ, Twamley EW. A quantitative review of cognitive functioning in homeless adults. J Nerv Ment Dis. 2015;203(2):126–31. https://doi.org/10.1097/NMD.0000000000000248.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Backer TE, Howard EA. Cognitive impairments and the prevention of homelessness: research and practice review. J Prim Prev. 2007;28(3–4):375–88. https://doi.org/10.1007/s10935-007-0100-1.

    Article  PubMed  Google Scholar 

  41. Schmitt T, Thornton AE, Rawtaer I, Barr AM, Gicas KM, Lang DJ, et al. Traumatic brain injury in a community-based cohort of homeless and vulnerably housed individuals. J Neurotrauma. 2017;34(23):3301–10. https://doi.org/10.1089/neu.2017.5076.

    Article  PubMed  Google Scholar 

  42. Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary. 2019;22:270–82. https://doi.org/10.1007/s11102-019-00957-9.

    Article  PubMed  Google Scholar 

  43. Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):1–11. https://doi.org/10.1016/j.psc.2013.11.004.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Green RE, Colella B, Christensen B, Johns K, Frasca D, Bayley M, Monette G. Examining moderators of cognitive recovery trajectories after moderate to severe traumatic brain injury. Arch Phys Med Rehabil. 2008;89(12 Suppl):S16–24. https://doi.org/10.1016/j.apmr.2008.09.551.

    Article  PubMed  Google Scholar 

  45. Lee SH, Kang Y, Cho SJ. Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality. J Headache Pain. 2017;18(1):77. https://doi.org/10.1186/s10194-017-0779-1.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Braun KP. Preventing cognitive impairment in children with epilepsy. Curr Opin Neurol. 2017;30(2):140–7. https://doi.org/10.1097/WCO.0000000000000424.

    Article  PubMed  Google Scholar 

  47. Kolakowsky-Hayner SA, Wright J, Englander J, Duong T, Ladley-O'Brien S. Impact of late post-traumatic seizures on physical health and functioning for individuals with brain injury within the community. Brain Inj. 2013;27(5):578–86. https://doi.org/10.3109/02699052.2013.765595.

    Article  PubMed  Google Scholar 

  48. Zimmermann LL, Martin RM, Girgis F. Treatment options for posttraumatic epilepsy. Curr Opin Neurol. 2017;30(6):580–6. https://doi.org/10.1097/WCO.0000000000000505.

    Article  PubMed  Google Scholar 

  49. Piccenna L, Shears G, O'Brien TJ. Management of post-traumatic epilepsy: an evidence review over the last 5 years and future directions. Epilepsia Open. 2017;2(2):123–44. 10.1002/epi4.12049.eCollection 2017 Jun.

    Article  Google Scholar 

  50. Ijff DM, Aldenkamp AP. Cognitive side-effects of antiepileptic drugs in children.2013. Handb Clin Neurol. 2013;111:707–18. https://doi.org/10.1016/B978-0-444-52891-9.00073-7.

    Article  PubMed  Google Scholar 

  51. Taylor LA, Kreutzer JS, Demm SR, Meade MA. Traumatic brain injury and substance abuse: a review and analysis of the literature. Neuropsychol Rehabil. 2003;13(1–2):165–88. https://doi.org/10.1080/09602010244000336.

    Article  PubMed  Google Scholar 

  52. Pagulayan KF, Temkin NR, Machamer JE, Dikmen SS. Patterns of alcohol use after traumatic brain injury. J Neurotrauma. 2016;33(14):1390–6. https://doi.org/10.1089/neu.2015.4071.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kolakowsky-Hayner SA, Gourley EV 3rd, Kreutzer JS, Marwitz JH, Cifu DX, McKinley WO. Pre-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Inj. 1999;13(8):571–81. https://doi.org/10.1080/026990599121313.

    Article  CAS  PubMed  Google Scholar 

  54. Beaulieu-Bonneau S, St-Onge F, Blackburn MC, Banville A, Paradis-Giroux AA, Ouellet MC. Alcohol and drug use before and during the first year after traumatic brain injury. J Head Trauma Rehabil. 2018;33(3):E51–60. https://doi.org/10.1097/HTR.0000000000000341.

    Article  PubMed  Google Scholar 

  55. de Vet R, van Luijtelaar MJ, Brilleslijper-Kater SN, Vanderplasschen W, Beijersbergen MD, Wolf JR. Effectiveness of case management for homeless persons: a systematic review. Am J Public Health. 2013;103(10):e13–26. https://doi.org/10.2105/AJPH.2013.301491.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Fluharty M, Taylor AE, Grabski M, Munafò MR. The Association of Cigarette Smoking with Depression and Anxiety: A systematic review. Nicotine Tob Res. 2017;19(1):3–13. https://doi.org/10.1093/ntr/ntw140.

    Article  PubMed  Google Scholar 

  57. Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? Breathe (Sheff). 2017;13(1):e1–9. https://doi.org/10.1183/20734735.001417.

    Article  Google Scholar 

  58. Baggett TP, Campbell EG, Chang Y, Rigotti NA. Other tobacco product and electronic cigarette use among homeless cigarette smokers. Addict Behav. 2016;60:124–30. https://doi.org/10.1016/j.addbeh.2016.04.006.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010;303(19):1938–45. https://doi.org/10.1001/jama.2010.599.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: A systematic review. J Neurotrauma. 2016;33(22):1969–94. https://doi.org/10.1089/neu.2015.4252.

    Article  PubMed  Google Scholar 

  61. Carvalho AF, Miskowiak KK, Hyphantis TN, Kohler CA, Alves GS, Bortolato B, et al. Cognitive dysfunction in depression - pathophysiology and novel targets. CNS Neurol Disord Drug Targets. 2014;13(10):1819–35. https://doi.org/10.2174/1871527313666141130203627.

    Article  PubMed  Google Scholar 

  62. Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225. https://doi.org/10.1371/journal.pmed.0050225.

    Article  PubMed  PubMed Central  Google Scholar 

  63. American Psychiatric Association. Depressive disorders. In: Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Publishing; 2013.

    Chapter  Google Scholar 

  64. Wagner S, Doering B, Helmreich I, Lieb K, Tadic A. A meta-analysis of executive dysfunctions in unipolar major depressive disorder without psychotic symptoms and their changes during antidepressant treatment. Acta Psychiatr Scand. 2012;125(4):281–92. https://doi.org/10.1111/j.1600-0447.2011.01762.x.

    Article  CAS  PubMed  Google Scholar 

  65. McIntyre RS, Lophaven S, Olsen CK. A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. Int J Neuropsychopharmacol. 2014;17(10):1557–67. https://doi.org/10.1017/S1461145714000546.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. McIntyre RS, Soczynska JK, Woldeyohannes HO, Miranda A, Vaccarino A, Macqueen G, Lewis GF, Kennedy SH. A randomized, double-blind, controlled trial evaluating the effect of intranasal insulin on neurocognitive function in euthymic patients with bipolar disorder. Bipolar Disord. 2012;14(7):697–706. https://doi.org/10.1111/bdi.12006.

    Article  CAS  PubMed  Google Scholar 

  67. Bora E, Harrison BJ, Yücel M, Pantelis C. Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychol Med. 2013;43(10):2017–26. https://doi.org/10.1017/S0033291712002085.

    Article  CAS  PubMed  Google Scholar 

  68. Kruse RC, Li Z, Prideaux CC, Brown AW. Pharmacologic treatment for depression at injury is associated with fewer clinician visits for persistent symptoms after mild traumatic brain injury: A medical record review study. PM R. 2018;10(9):898–902. https://doi.org/10.1016/j.pmrj.2018.03.003.

    Article  PubMed  Google Scholar 

  69. Slowinski A, Coetzer R, Byrne C. Pharmacotherapy effectiveness in treating depression after traumatic brain injury: A meta-analysis. J Neuropsychiatry Clin Neurosci. 2019;31(3):220–7. https://doi.org/10.1176/appi.neuropsych.18070158.

    Article  PubMed  Google Scholar 

  70. Kant R, Smith-Seemiller L, Zeiler D. Treatment of aggression and irritability after head injury. Brain Inj. 1998;12(8):661–6. https://doi.org/10.1080/026990598122223.

    Article  CAS  PubMed  Google Scholar 

  71. Gertler P, Tate RL, Cameron ID. Non-pharmacological interventions for depression in adults and children with traumatic brain injury. Cochrane Database Syst Rev. 2015;12:CD009871. https://doi.org/10.1002/14651858.CD009871.pub2.

    Article  Google Scholar 

  72. Hudak A, Warner M, de la Plata M, Moore C, Harper C, Diaz-Arrastia R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Res. 2011;191(3):160–5. https://doi.org/10.1016/j.pscychresns.2010.10.003.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Bedard M, Felteau M, Marshall S, Dubois S, Gibbons C, et al. Mindfulness-based cognitive therapy: benefits in reducing depression following a traumatic brain injury. Adv Mind Body Med Spring. 2012;26(1):14–20.

    Google Scholar 

  74. Ashman T, Cantor JB, Tsaousides T, Spielman L, Gordon W. Comparison of cognitive behavioral therapy and supportive psychotherapy for the treatment of depression following traumatic brain injury: a randomized controlled trial. J Head Trauma Rehabil. 2014;29(6):467–78. https://doi.org/10.1097/HTR.0000000000000098.

    Article  PubMed  Google Scholar 

  75. Aoun R, Rawal H, Attarian H, Sahni A. Impact of traumatic brain injury on sleep: an overview. Nat Sci Sleep. 2019;11:131–40. https://doi.org/10.2147/NSS.S182158.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Nakase-Richardson R, Sherer M, Barnett SD, Yablon SA, Evans CC, Kretzmer T, Schwartz DJ, Modarres M. Prospective evaluation of the nature, course, and impact of acute sleep abnormality after traumatic brain injury. Arch Phys Med Rehabil. 2013;94(5):875–82.

    Article  Google Scholar 

  77. Fogelberg DJ, Hoffman JM, Dikmen S, Temkin NR, Bell KR. Association of sleep and co-occurring psychological conditions at 1 year after traumatic brain injury. Arch Phys Med Rehabil. 2012;93(8):1313–8. https://doi.org/10.1016/j.apmr.2012.04.031.

    Article  PubMed  Google Scholar 

  78. Fortier-Brochu W, Morin CM. Cognitive impairment in individuals with insomnia: clinical significance and correlates. Sleep. 2014;37(11):1787–98. https://doi.org/10.5665/sleep.4172.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Reitzel LR, Short NA, Schmidt NB, Garey L, Zvolensky MJ, Moisiuc A, et al. Distress tolerance links sleep problems with stress and health in homeless. Am J Health Behav. 2017;41(6):760–74. https://doi.org/10.5993/ajhb.41.6.10.

    Article  PubMed  Google Scholar 

  80. Chang HL, Fisher FD, Reitzel LR, Kendzor DE, Nguyen MA, Businelle MS. Subjective sleep inadequacy and self-rated health among homeless adults. Am J Health Behav. 2015;39(1):14–21. https://doi.org/10.5993/AJHB.39.1.2.

    Article  PubMed  Google Scholar 

  81. Taylor A, Murillo R, Businelle MS, Chen TA, Kendzor DE, McNeill LH, Reitzel LR. Physical activity and sleep problems in homeless adults. PLoS One. 2019;14(7):e0218870. https://doi.org/10.1371/journal.pone.0218870.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Kerner NA, Roose SP. Obstructive sleep apnea is linked to depression and cognitive impairment: evidence and potential mechanisms. Am J Geriatr Psychiatry. 2016;24(6):496–508. https://doi.org/10.1016/j.jagp.2016.01.134.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Leng Y, McEvoy CT, Allen IE, Yaffe K. Association of sleep-disordered breathing with cognitive function and risk of cognitive impairment: a systematic review and meta-analysis. 2017. JAMA Neurol. 2017;74(10):1237–45. https://doi.org/10.1001/jamaneurol.2017.2180.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Daurat A, Sarhane M, Tiberge M. Obstructive sleep apnea syndrome and cognition: A review. Neurophysiol Clin. 2016;46(3):201–15. https://doi.org/10.1016/j.neucli.2016.04.002.

    Article  PubMed  Google Scholar 

  85. Kuhn E, Schwarz EI, Bratton DJ, Rossi VA, Kohler M. Effects of CPAP and mandibular advancement devices on health-related quality of life in OSA: A systematic review and meta-analysis. Chest. 2017;151(4):786–94. https://doi.org/10.1016/j.chest.2017.01.020.

    Article  PubMed  Google Scholar 

  86. Viola-Saltzman M, Musleh C. Traumatic brain injury-induced sleep disorders. 2016. Neuropsychiatr Dis Treat. 2016;12:339–48. https://doi.org/10.2147/NDT.S69105.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Sampathkumar H, DiTommaso C, Holcomb E, Tallavajhula S. Assessment of sleep after traumatic brain injury (TBI). NeuroRehabilitation. 2018;43(3):267–76. https://doi.org/10.3233/NRE-182485.

    Article  PubMed  Google Scholar 

  88. Barshikar S, Bell KR. Sleep disturbance after TBI. Curr Neurol Neurosci Rep. 2017;17(87) https://doi.org/10.1007/s11910-017-0792-4.

  89. Salisbury-Afshar E. Management of Insomnia disorder in adults. Am Fam Physician. 2018;98(5):319–22.

    PubMed  Google Scholar 

  90. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204. https://doi.org/10.7326/M14-2841.

    Article  PubMed  Google Scholar 

  91. Paudyal V, MacLure K, Buchanan C, Wilson L, Macleod J, Stewart D. When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night': behavioural determinants of homeless patients' adherence to prescribed medicines. Public Health. 2017;148:1–8. https://doi.org/10.1016/j.puhe.2017.03.002.

    Article  CAS  PubMed  Google Scholar 

  92. Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–55. https://doi.org/10.1097/01.yco.0000165594.60434.84.

    Article  PubMed  Google Scholar 

  93. Villasana LE, Peters A, McCallum R, Liu C, Schnell E. Diazepam inhibits post-traumatic neurogenesis and blocks aberrant dendritic development. J Neurotrauma. 2019;36(16):2454–67. https://doi.org/10.1089/neu.2018.6162.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Mets MAJ, de Vries JM, de Senerpont Domis LM, Volkerts ER, Olivier B, Verster JC. Next-day effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on highway driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects. Sleep. 2011;34(10):1327–34. https://doi.org/10.5665/SLEEP.1272.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Chiu HY, Lin EY, Wei L, Lin JH, Lee HC, Fan YC, Tsai PS. Hypnotics use but not insomnia increased the risk of dementia in traumatic brain injury patients. Eur Neuropsychopharmacol. 2015;25(12):2271–7. https://doi.org/10.1016/j.euroneuro.2015.09.011.

    Article  CAS  PubMed  Google Scholar 

  96. Grima NA, Rajaratnam SHW, Mansfield D, Sletten TL, Spitz G, Ponsford JL. Efficacy of melatonin for sleep disturbance following traumatic brain injury: A randomized controlled trial. BMC Med. 2018;16(1):8. https://doi.org/10.1186/s12916-017-0995-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Leguerica A, Jasey N, Portelli Tremont N, Chiaravalloti ND. Pilot study on the effect of ramelteon on sleep disturbance after traumatic brain injury: preliminary evidence from a clinical trial. Arch Phys Med Rehabil. 2015;96(10):1802–9. https://doi.org/10.1016/j.apmr.2015.05.011.

    Article  Google Scholar 

  98. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

    Google Scholar 

  99. Finkel AG, Yerry J, Scher A, Choi YS. Headaches in soldiers with mild traumatic brain injury: findings and phenomenologic descriptions. Headache. 2012;52(6):957–65. https://doi.org/10.1111/j.1526-4610.2012.02167.x.

    Article  PubMed  Google Scholar 

  100. DeKosky ST, Ikonomovic MD, Gandy S. Traumatic brain injury—football, warfare, and long-term effects. N Engl J Med. 2010;363:1293–6. https://doi.org/10.1056/NEJMp1007051.

    Article  CAS  PubMed  Google Scholar 

  101. Minen MT, Boubour A, Walia H, Barr W. Post-concussive syndrome: a focus on post-traumatic headache and related cognitive, psychiatric, and sleep issues. Curr Neurol Neurosci Rep. 2016;16(11):100. https://doi.org/10.1007/s11910-016-0697-7.

    Article  PubMed  Google Scholar 

  102. Vuralli D, Ayata C, Bolay H. Cognitive dysfunction and migraine. J Headache Pain. 2018;19(109). https://doi.org/10.1186/s10194-018-0933-4.

  103. Huang L, Juan Dong H, Wang X, Wang Y, Xiao Z. Duration and frequency of migraines affect cognitive function: evidence from neuropsychological tests and event-related potentials. J Headache Pain. 2017;18(1):54. https://doi.org/10.1186/s10194-017-0758-6.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Riechers RG 2nd, Walker MF, Ruff RL. Post-traumatic headaches. 2015. Handb Clin Neurol. 2015;128:567–78. https://doi.org/10.1016/B978-0-444-63521-1.00036-4.

    Article  PubMed  Google Scholar 

  105. Schwedt TJ, Chong CD, Peplinski J, Ross K, Berisha V. Persistent post-traumatic headache vs. migraine: an MRI study demonstrating differences in brain structure. J Headache Pain. 2017;18(1):87. https://doi.org/10.1186/s10194-017-0796-0.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Obermann M, Naegel S, Bosche B, Holle D. An update on the management of post-traumatic headache. Ther Adv Neurol Disord. 2015;8(6):311–5. https://doi.org/10.1177/1756285615605699.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Larsen EL, Ashina H, Iljazi A, Al-Khazali HM, Seem K, Ashina M, et al. Acute and preventive pharmacological treatment of post-traumatic headache: a systematic review. J Headache Pain. 2019;20(1):98. https://doi.org/10.1186/s10194-019-1051-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Fraser F, Matsuzawa Y, Lee YSC, Minen M. Behavioral treatments for post-traumatic headache. Curr Pain Headache Rep. 2017;21(5):22. https://doi.org/10.1007/s11916-017-0624-x.

    Article  PubMed  Google Scholar 

  109. Soble JR, Critchfield EA, O'Rourke JJ. Neuropsychological evaluation in traumatic brain injury. Phys Med Rehab Clin N Am. 2017;28(2):339–50. https://doi.org/10.1016/j.pmr.2016.12.009.

    Article  Google Scholar 

  110. Koehler R, Wilhelm EE, Shoulson I. Cognitive rehabilitation therapy for traumatic brain injury: evaluating the evidence. Washington, DC: National Academies Press; 2012.

    Google Scholar 

  111. Stephens JA, Williamson KN, Berryhill ME. Cognitive rehabilitation after traumatic brain injury: a reference for occupational therapists. OTJR (Thorofare N J). 2015;35(1):5–22. https://doi.org/10.1177/1539449214561765.

    Article  Google Scholar 

  112. Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, et al. Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014. Arch Phys Med Rehabil. 2019;100(8):1515–33. https://doi.org/10.1016/j.apmr.2019.02.011.

    Article  PubMed  Google Scholar 

  113. Meusel LA, Hall GB, Fougere P, McKinnon MC, MacQueen GM. Neural correlates of cognitive remediation in patients with mood disorders. Psychiatry Res. 2013;214(2):142–52. https://doi.org/10.1016/j.pscychresns.2013.06.007.

    Article  PubMed  Google Scholar 

  114. Deckersbach T, Nierenberg AA, Kessler R, Lund HG, Ametrano RM, Sachs G, et al. RESEARCH: Cognitive rehabilitation for bipolar disorder: An open trial for employed patients with residual depressive symptoms. CNS Neurosci Ther. 2010;16(5):298–307. Published online 2010 Sep 3. https://doi.org/10.1111/j.1755-5949.2009.00110.x.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Clemow DB, Walker DJ. The potential for misuse and abuse of medications in ADHD: a review. Postgrad Med. 2014;126(5):64–81. https://doi.org/10.3810/pgm.2014.09.2801.

    Article  PubMed  Google Scholar 

  116. Dougall D, Poole N, Agrawal N. Pharmacotherapy for chronic cognitive impairment in traumatic brain injury. Cochrane Database Syst Rev. 2015;12:CD009221. https://doi.org/10.1002/14651858.CD009221.pub2.

    Article  Google Scholar 

  117. Bhatnagar S, Iaccarino MA, Zafonte R. Pharmacotherapy in rehabilitation of post-acute traumatic brain injury. Brain Res. 2016;1640(Pt A):164–79. https://doi.org/10.1016/j.brainres.2016.01.021.

    Article  CAS  PubMed  Google Scholar 

  118. Caplan B, Schutt RK, Turner WM, Goldfinger SM, Seidman LJ. Change in neurocognition by housing type and substance abuse among formerly homeless seriously mentally ill persons. Schizophr Res. 2006;83(1):77–86.

    Article  Google Scholar 

  119. Hwang SW, Burns T. Health interventions for people who are homeless. Lancet. 201;384(9953):1541–7. https://doi.org/10.1016/S0140-6736(14)61133-8.

  120. Kalechstein AD, Newton TF, van Gorp WG. Neurocognitive functioning is associated with employment status: A quantitative review. J Clin Exp Neuropsychol. 2003;25(8):1186–91. https://doi.org/10.1076/jcen.25.8.1186.16723.

    Article  CAS  PubMed  Google Scholar 

  121. Drake AI, Gray N, Yoder S, Pramuka M, Llewellyn M. Factors predicting return to work following mild traumatic brain injury: A discriminant analysis. J Head Trauma Rehabil. 2000;15(5):1103–12. https://doi.org/10.1097/00001199-200010000-00004.

    Article  CAS  PubMed  Google Scholar 

  122. Nyamathi A, Shuler P. Factors affecting prescribed medication compliance of the urban homeless adult. Nurse Pract. 1989;14(8):47. -8, 51-2, 54

    Article  CAS  Google Scholar 

  123. Hunter CE, Palepu A, Farrell S, Gogosis E, O'Brien K, Hwang SW. Barriers to prescription medication adherence among homeless and vulnerably housed adults in Three Canadian Cities. J Prim Care Community Health. 2015;6(3):154–61. https://doi.org/10.1177/2150131914560610.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 This is a U.S. government work and not under copyright protection in the U.S. foreign copyright protection may apply

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Subbarao, B.S., Eapen, B.C. (2021). Clinical Management of the Homeless Patient with Traumatic Brain Injury and Cognitive Impairment. In: Ritchie, E.C., Llorente, M.D. (eds) Clinical Management of the Homeless Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-70135-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-70135-2_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-70134-5

  • Online ISBN: 978-3-030-70135-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics