Neurodegeneration and Homelessness: A Bidirectional Relationship Shaping Health and Vulnerability

Neurodegeneration and homelessness are deeply interconnected. Many structural, environmental, and interpersonal conditions experienced during homelessness-for example, inconsistent healthcare, forced displacement, chronic stress, and trauma-can contribute to accelerated cognitive decline through multiple pathways. Related neurocognitive impairment can also increase vulnerability to homelessness. Deficits in memory, executive functioning, attention, and impulse control can make it difficult to maintain employment, manage finances, navigate social services, and sustain supportive relationships. Together, these pathways create a reinforcing pattern: neurodegeneration can increase risk of losing housing, and homelessness can intensify the biologic and psychosocial stressors that drive neurodegeneration. Despite growing evidence suggesting a substantial burden of neurodegenerative conditions among people experiencing homelessness, these conditions are frequently underrecognized and underdiagnosed. Fragmented healthcare and symptom overlap with psychiatric conditions or substance use can hinder timely detection. Missed or delayed diagnosis has significant individual and systemic impacts. As neurodegeneration progresses without recognition or treatment, individuals may experience preventable functional decline, difficulty maintaining relationships, and repeated, often avoidable encounters with hospitals, shelters, and carceral settings. Without diagnosis, individuals may also miss opportunities to access disability benefits, supportive housing options, and personalized care planning that could significantly improve health and quality of life. Emerging models grounded in trauma-informed, harm reduction-oriented approaches-such as mobile outreach, shelter-based clinics, and Housing First programs-offer promising strategies to improve recognition of neurocognitive changes and support long-term neurologic health. Understanding and addressing the bidirectional relationship between neurodegeneration and homelessness is essential for reducing suffering, promoting stability, and delivering care that is both effective and dignity-affirming.