World Trade Center exposure, post‐traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

Abstract

Objective To determine whether World Trade Center (WTC)‐exposure intensity and post‐traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. Method The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self‐perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top‐quartile (≥2) CFI score, and of early post‐9/11 PTSD with top‐quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. Results Mean age at CFI completion was 56.7 ± 7.7 (range: 36–81). Participants with high‐intensity WTC exposure had an increased likelihood of top‐quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07–1.64), controlling for covariates. Current and early PTSD were both associated with top‐quartile CFI (OR: 3.25, 95%CI: 2.53–4.19 and OR: 1.56, 95%CI: 1.26–1.93) respectively. Conclusions High‐intensity WTC exposure was associated with self‐reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC‐exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.

PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

“…Recent data from the Centers for Disease Control and Prevention (CDC) show that the prevalence of self-reported worsening confusion or memory loss in the past 12 months in US adults aged 45 years and older is between 11–12% [ 5 ]. Previously, we reported that exposure to the World Trade Center (WTC) disaster site, post-traumatic stress disorder (PTSD) symptoms, and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers [ 6 ]. Our findings were consistent with those from a study of non-FDNY WTC responders, which reported that WTC exposure and PTSD symptoms were associated with worse performance on an objective cognitive measure [ 7 ].…”

Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees

“…However, our sample was chosen to encompass a middle-aged group of enrollees, so those in our sample were unlikely to suffer from dementia, which could lead to misclassification in reporting of CML. Further, a recent study of the association between 9/11 exposure and 9/11-related PTSD and changes in self-reported cognitive function using the Cognitive Function Instrument (CFI) [ 48 ] demonstrated results that were comparable with those from a recent study that used objective measures of cognitive function [ 35 ]. Furthermore, social desirability bias could lead to under-reporting of CML; similar under-reporting could occur for mental health conditions and symptoms.…”

World Trade Center Health Program: First Decade of Research

“…There is growing evidence of early onset cognitive impairment in the WTC-exposed population [ 148 , 149 , 150 , 151 ]. Two causal pathways have been suggested for exposure-related disease.…”

“…There is mounting evidence from human and animal studies indicating that inhalation of air pollutants can increase the risk of neurodegenerative diseases, including cognitively impairing diseases [ 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 ]. Exposure–response associations between proxies of WTC dust exposure and measures of cognitive impairment have been observed [ 148 ]. For example, WTC first responders with high-intensity exposures were more likely to report subjective cognitive deficits compared to responders with lower-level WTC exposure [ 148 ].…”

“…Exposure–response associations between proxies of WTC dust exposure and measures of cognitive impairment have been observed [ 148 ]. For example, WTC first responders with high-intensity exposures were more likely to report subjective cognitive deficits compared to responders with lower-level WTC exposure [ 148 ]. In another study of responders, the authors found an association between increased time working on-site and lower cognitive functioning [ 149 ].…”