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Neuropsychological characteristics of people living in squalor

Published online by Cambridge University Press:  04 February 2014

Sook Meng Lee ,
Matthew Lewis ,
Deborah Leighton ,
Ben Harris ,
Brian Long  and
Stephen Macfarlane
Sook Meng Lee
Affiliation:
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia Department of Geriatric Medicine, Western Health, Sunshine, Victoria, Australia
Matthew Lewis
Affiliation:
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia
Deborah Leighton
Affiliation:
Department of Psychology, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
Ben Harris
Affiliation:
Department of Neuropsychology, Kingston Centre, Monash Health, Cheltenham, Victoria, Australia
Brian Long
Affiliation:
Department of Neuropsychology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
Stephen Macfarlane*
Affiliation:
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia
*
Correspondence should be addressed to: Stephen Macfarlane, Associate Professor, Aged Psychiatry Services, Caulfield Hospital, 260 Kooyong Road, Caulfield 3162, Victoria, Australia. Phone: +613-9076-6600; Fax: +613-9076-6180. Email: s.macfarlane@cgmc.org.au.
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Abstract

Background:

Squalor is an epiphenomenon associated with a range of medical and psychiatric conditions. People living in squalor are not well described in the literature, and prior work has indicated that up to 50% do not have a psychiatric diagnosis. Squalor appears to be linked with neuropsychological deficits suggestive of the presence of impaired executive function. We present a case series of people living in squalor that examines their neuropsychological assessment and diagnosis.

Methods:

Clinicians from local health networks were invited to submit neuropsychological reports of patients living in squalor. These selected reports were screened to ensure the presence of squalor and a comprehensive examination of a set of core neuropsychological domains. Assessments were included if basic attention, visuospatial reasoning, information processing speed, memory function, and executive function were assessed.

Results:

Sixty-nine neuropsychological reports were included. Sixty-eight per cent of the group underwent neuropsychological assessments during an inpatient admission. For participants where it was available (52/69), the mean Mini-Mental State Examination score was 25.29 (SD = 3.96). Neuropsychological assessment showed a range of cognitive impairment with nearly all the participants (92.75%) found to have frontal executive dysfunction. One person had an unimpaired neuropsychological assessment. Results indicated that dorsolateral prefrontal rather than orbitofrontal functions were more likely to be impaired. Vascular etiology was the most common cause implicated by neuropsychologists.

Conclusions:

Frontal executive dysfunction was a prominent finding in the neuropsychological profiles of our sample of squalor patients, regardless of their underlying medical or psychiatric diagnoses. Our study highlights the importance of considering executive dysfunction when assessing patients who live in squalor.

Keywords

squalorhoardingneuropsychologyfrontalexecutive function
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 5 , May 2014 , pp. 837 - 844
Copyright
Copyright © International Psychogeriatric Association 2014 

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