Cognitive impairment and World Trade Centre-related exposures

Clouston, Sean; Hall, Charles B.; Kritikos, Minos; Bennett, David A.; DeKosky, Steven T.; Edwards, Jerri D.; Finch, Caleb E.; Kreisl, William Charles; Mielke, Michelle M.; Peskind, Elaine R.; Raskind, Murray A.; Richards, Marcus; Sloan, Richard P.; Spiro, Avron; Vasdev, Neil; Brackbill, Robert M.; Farfel, Mark R.; Horton, Megan; Lowe, Sandra; Lucchini, Roberto; Prezant, David J.; Reibman, Joan; Rosen, Rebecca; Seil, Kacie; Zeig‐Owens, Rachel; Deri, Yael; Diminich, Erica D.; Fausto, Bernadette A.; Gandy, Sam; Sano, Mary; Bromet, Evelyn J.; Luft, Benjamin J.

doi:10.1038/s41582-021-00576-8

Cited by 24 publications

(38 citation statements)

References 198 publications

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“…Our findings are consistent with existing studies of WTC Responders and support the hypothesis that the WTC dust toxins and traumatic experience, and potentially the resulting PTSD and other medical and mental health comorbidities, have had an adverse impact on cognitive function [ 1 , 4 , 6 , 7 , 41 ]. However, the WTC Responder population may have different rates and risks for CI given that they are predominantly male, white, trained for disaster response, and had different patterns of exposure to the destruction.…”

Section: Discussionsupporting

confidence: 90%

“…Acute exposure to the WTC dust on 9/11 was a significant predictor of MoCA score in both the univariate and the multivariable analysis, suggesting that the environmental exposure might influence the reduction in cognitive function. Many studies of WTC Responders also found that the long duration of exposure is associated with cognitive impairment [ 1 , 4 , 6 ]. In addition to the adverse impact of acute exposures, the chronic exposures among WTC Survivors due to local residence or work, with potential for exposure to resuspended dust and also fumes from the fires (which burned through the end of December 2001), may also contribute significantly to cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…Given that mental health complaints are very common among WTC Survivors, probable CI should be further studied and the rate of probable CI among WTC Survivors warrants unbiased assessment in better-designed, future studies, including those with comparison groups without WTC exposures. As reviewed by Clouston and colleagues [ 1 ], there are multiple plausible pathways underlying the mechanisms by which WTC exposures can impact mental and physical conditions and cognitive impairments. Our results suggest an association of probable CI with demographic characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive studies of those involved in the rescue and recovery efforts after 11 September 2011 (WTC Responders) indicate that WTC exposures may be associated with neuroinflammation, neurodegeneration and increased cognitive impairment, and in turn, with increased risk of Alzheimer’s disease and related dementia in subsequent years [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. In particular, cognitive impairment among WTC Responders has been extensively studied using validated instruments for measuring objective cognitive dysfunctions including the Montreal Cognitive Assessment (MoCA, [ 9 ]), and in-depth assessments using well-established blood-based biomarkers and neuroimaging markers of cognitive impairment [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. These reports also include a large number of association studies of cognitive impairment with WTC exposures and associated mental health conditions among WTC Responders.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have also found PTSD to be associated with cognitive impairment in both military and non-military populations [ 4 , 5 , 7 , 10 , 37 , 38 , 39 , 40 , 41 , 42 ]. Extensive research has been carried out on cognitive functioning and decline in the WTC Responder population including on self-reported cognitive complaints [ 10 , 41 ], an association with PTSD [ 4 , 5 , 7 ], dust exposure [ 1 ], as well as biomarkers and neuroimaging studies [ 2 , 3 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Rosen

Shao

Zhang

et al. 2022

IJERPH

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Rosen

Shao

Zhang

et al. 2022

IJERPH

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Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders

Clouston,

Mann,

Meliker

et al. 2024

JAMA Netw Open

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ImportanceReports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected.ObjectiveTo assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE).Design, Setting, and ParticipantsThis prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years.ExposuresExposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe.Main Outcomes and MeasuresIncidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition.ResultsOf 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P &lt; .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P &lt; .001).Conclusions and RelevanceIn this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.

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Cross‐sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders

Choi,

Hall,

Clouston

et al. 2024

American J Industrial Med

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BackgroundPosttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance.MethodsIn this cross‐sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma‐specific version of the posttraumatic stress disorder checklist (PCL‐17) adapted for the WTC attacks. The 1‐second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function.ResultsHigher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, p < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, p < 0.001), but not in non‐trained (est. = 0.004, 95% C.I. = −0.01, 0.02, p = 0.39) responders.ConclusionsIn the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high‐risk populations should be studied, especially since intervention in one modality may have an impact on others.

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Cognitive impairment and World Trade Centre-related exposures

Cited by 24 publications

References 198 publications

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

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

Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders

Cross‐sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders

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