The Role of Incarceration as a Risk Factor for Cognitive Impairment.

OBJECTIVES: The objective of this study was to understand disparities in cognitive impairment between middle aged formerly incarcerated (FI) and nonincarcerated (NI) individuals.

METHODS: The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal dataset containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia, and dementia. Multivariable regression models were estimated including prior incarceration status and covariates associated with incarceration and cognitive functioning.

RESULTS: FI individuals had lower unadjusted scores on TICS-m (-2.5, p<.001), and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR=2.4, p<.001) and dementia (OR=2.7, p<.001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualifying Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.

DISCUSSION: The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in ADRD.