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


METHODS
A 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.


RESULTS
Approximately 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.


CONCLUSIONS
Analyses 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.
Program in Public Health, Stony Brook University, Stony Brook, NY, USA; Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
Sean A P
SA
Clouston
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Roman
R
Kotov
Department of Psychiatry, Yale University, New Haven, CT, USA.
Robert H
RH
Pietrzak
Department of Medicine, School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Benjamin J
BJ
Luft
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Adam
A
Gonzalez
Unit for Lifelong Health and Ageing, University College London, London, UK.
Marcus
M
Richards
Department of Psychology, University of North Texas, Denton, TX, USA.
Camilo J
CJ
Ruggero
Department of Epidemiology and Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
Avron
A
Spiro
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Evelyn J
EJ
Bromet
Cognitive impairment; Disasters; Epidemiology; Posttraumatic stress disorder; Psychiatry; World Trade Center