Neuropsychological characteristics of people living in squalor.
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.
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia.
Sook Meng
SM
Lee
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia.
Matthew
M
Lewis
Department of Psychology, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia.
Deborah
D
Leighton
Department of Neuropsychology, Kingston Centre, Monash Health, Cheltenham, Victoria, Australia.
Ben
B
Harris
Department of Neuropsychology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
Brian
B
Long
Aged Psychiatry Service, Caulfield Hospital, Alfred Health, Victoria, Australia.
Stephen
S
Macfarlane
D000368:Aged; D001288:Attention / Q000502:physiology; D001315:Australia / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000473:pathology; D059907:Functional Neuroimaging / Q000706:statistics & numerical data; D006801:Humans; D007361:Intelligence Tests / Q000706:statistics & numerical data; D008297:Male; D008568:Memory / Q000502:physiology; D016743:Mental Competency; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011204:Poverty Areas; D011597:Psychomotor Performance / Q000502:physiology; D012924:Social Conditions