Cognitive impairment among World Trade Center responders: Long‐term implications of re‐experiencing the 9/11 terrorist attacks

Abstract

IntroductionDuring the World Trade Center (WTC) attacks, responders who helped in search, rescue, and recovery endured multiple traumatic and toxic exposures. One-fifth subsequently developed post-traumatic stress disorder (PTSD). PTSD has been linked to dementia in veterans. This study examined the association between WTC-related PTSD and cognitive impairment (CI) in WTC responders.MethodsA one-third sample of responders (N = 818) reporting for annual monitoring visits were screened for cognitive impairment and dementia using the Montreal Cognitive Assessment from January 2014–April 2015. Concurrent diagnoses of PTSD and major depressive disorder (MDD), as well as serial PTSD and depressive symptom inventories, collected since 2002, were examined in relation to current CI.ResultsApproximately 12.8% and 1.2% of responders in this sample respectively had scores indicative of CI and possible dementia. Current PTSD and MDD were associated with CI. Longitudinal results revealed that re-experiencing symptoms were consistently associated with CI (aRR = 2.88, 95% confidence interval = 1.35–6.22), whereas longitudinal increases in other PTSD and depressive symptoms in the years before screening were evident only among those with CI.ConclusionsAnalyses replicated results from Veterans studies and further highlighted the importance of re-experiencing symptoms, a major component of PTSD that was consistently predictive of CI 14 years later. Clinicians should monitor CI when treating individuals with chronic PTSD.

Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder

“…A second possibility is that PTSD may result in increased neurodegeneration. Prior work has detailed similar increases in PTSD symptoms among people with cognitive impairments (Clouston et al, 2016). Of particular concern, a shared pattern of physical and cognitive impairment co-occurring with increases in emotionality may signal the potential for an increased risk of neurodegenerative diseases in general and may, specifically, highlight an elevated potential for behavioral frontotemporal dementia (FTD), a neurodegenerative disease that can include behavioral and emotional changes alongside physical impairments (Mackenzie, 2007).…”

“…Since then, researchers have linked WTC exposures to various health problems, including increased risk of asthma (Wisnivesky et al., ) and gastrointestinal issues (Li et al., ), to name a few. Yet despite the high burden of cognitive impairment, lowered pulmonary functioning, and systemic inflammation in this population (Aldrich et al., ; Clouston et al., ; Kazeros et al., ), little is known about the burden of functional limitations among WTC responders.…”

“…There is a known correlation between PTSD and increased risk of aging-related pathologies including, for example, cognitive impairment (Clouston et al, 2016), dementia (Qureshi et al, 2010), cardiovascular disease (Beristianos, Yaffe, Cohen, & Byers, 2016), obesity (Smith, Tyzik, Neylan, & Cohen, 2015), cellular senescence (Shalev et al, 2013), and mortality (Lohr et al, 2015). Prior work has found that chronic PTSD is also associated with poorer quality of life (Zatzick et al, 1997), and increased levels of disability (Byers, Covinsky, Neylan, & Yaffe, 2014).…”

Incidence of mild cognitive impairment in World Trade Center responders: Long‐term consequences of re‐experiencing the events on 9/11/2001

“…Prior analyses have found that the SBU clinic monitors responders who are similar in terms of exposures, PTSD burden, and age on 9/11/2001 to the responder population [1]. In 2014, SBU began the first and only prospective study to date to assess indicators of aging in WTC responders by incorporating cognitive assessments into the monitoring visit [18].…”

“…Research studies of WTC responders have found impairments in cognitive and physical functioning in this population [16][17][18], which is concentrated among responders reporting high levels of chronic intrusive re-experiencing stress. In addition, early reports have identified a small association between lengthy exposures to the pile/pit and cognitive dysfunction [17].…”