Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms

Abstract

The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for progressive impairment in all WTC disaster exposed groups has been raised. Cognitive status, however, has not been systematically characterized in the WTC Survivor population. We describe cognitive status in a subgroup of the Survivor population referred for mental health evaluation (N = 480) in the WTC EHC as measured by scores on the Montreal Cognitive Assessment (MoCA) instrument, and examine their association with WTC exposures and individual-level covariates including PTSD and depression screening inventory scores. In regression analyses, probable cognitive impairment (MoCA score < 26) was found in 59% of the study subjects and was significantly associated with age, race/ethnicity, education, income, depression and PTSD scores. Being caught in the dust cloud on 11 September 2011 was significantly associated with cognitive impairment even after controlling for the above. These data suggest an association with cognitive dysfunction in WTC Survivors with exposure to the toxic dust/fumes and psychological stress from the 9/11 terrorist attack and warrant further systematic study.

Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members

“…The WTC Survivors studied were enrolled in the WTC Environmental Health Center (WTC EHC) and many of the individuals had acute traumatic exposures to the initial dust clouds created as the WTC buildings collapsed (WTC dust cloud) on 11 September 2001, as well as having witnessed death and dismemberment, and often experienced their own fear of death as they escaped collapsing buildings or were engulfed in blinding dust clouds. The adverse health effects included chronic symptoms of PTSD, depression, anxiety, upper and lower respiratory symptoms, cancers and cognitive decline [ 15 , 16 , 17 , 18 , 19 , 20 , 22 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 40 , 57 , 58 ].…”

“…The environmental exposures from WTC dust and fumes, as well as from general air pollution have been linked to a wide range of adverse health effects [ 2 , 44 ], including increased risk of mental health disorders [ 45 , 46 , 47 ], respiratory and cardiovascular diseases [ 14 , 23 , 48 , 49 , 50 , 51 , 52 , 53 ], neurotoxicity and neuropathy [ 54 , 55 , 56 ], cancers [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ], and cognitive decline [ 57 , 58 ]. The biological mechanisms contributing to this wide range of adverse health effects have been hypothesized to involve systemic inflammation resulting from oxidative stress [ 51 , 59 , 60 ].…”

“…This relationship might have further implications for aging and other long term health issues at the WTC EHC. In particular, PTSD is a well-known risk factor of cognitive decline [ 57 , 58 , 78 , 79 , 80 ], and also found as a mediator of the association between WTC exposure and subjective concerns of cognitive decline among the WTC-exposed firefighters [ 81 ]. Cognitive decline beyond normal aging has become a significant health concern in the aging 9/11 cohorts.…”

Molecular Clustering Analysis of Blood Biomarkers in World Trade Center Exposed Community Members with Persistent Lower Respiratory Symptoms

“…Additionally, we identified biomarkers that were associated with WTC exposure. Our group and others have previous established association of WTC exposures with LRS, cancer, mental health disorders, neuropathic symptoms, and cognitive declines in WTC survivors [35][36][37][38][39][40][41][42][43][44][45][46].…”

Heart failure and late-onset Alzheimer’s disease: A Mendelian randomization study

“…For example, Escolar et al (2019) reported that major air pollutants, such as SO 2 (precursor of acid rain) (r = 0.2692, p < 0.001) and NOX air (major air pollutant formed by combustion systems and motor vehicles) (r = 0.2196, p < 0.001) have a significant impact on the HF-related hospital admissions rate and, hence, on HF decompensations and patient's quality of life. In addition to many published associations between World Trade Center (WTC) related environmental exposures and cardiovascular symptoms, Clouston et al (2022) and Rosen et al (2022) reviewed a large literature of published studies on significant associations of WTC-related exposures and potentially AD-related cognitive impairment.…”