Prevalence of Mild and Severe Cognitive Impairment in World Trade Center Exposed Fire Department of the City of New York (FDNY) and General Emergency Responders

Details

• Personal Author:
  Armstrong MP ; Barber A ; Carr MM ; Choi J ; Chow K ; Christodoulou C ; Clouston SAP ; Fels AM ; Fontana AE ; Hall CB ; Hennington CM ; Kroll CH ; Luft BJ ; Mann FD ; Melendez OA ; Mueller AK ; Prezant DJ ; Smith AJ ; Zieg-Owens R
• Description:
  Background: The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations. Methods: A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests. The prevalences of domain-specific impairments were estimated based on the results of norm-referenced tests, and the Montreal Cognitive Assessment (MoCA), Jak/Bondi criteria, Petersen criteria, and the National Institute on Aging and Alzheimer's Association (NIA-AA) criteria were used to diagnose MCI. NIA-AA criteria were also used to diagnose severe cognitive impairment. Generalized linear models and propensity score matching were used to compare prevalence estimates of cognitive impairment to a large sample of WTC-exposed-non-FDNY responders from the General Responder Cohort (GRC; n = 7102) who completed the MoCA during a similar time frame. Result: Among FDNY responders under 65 years, the unadjusted prevalence of MCI varied from 52.57% to 60.32% depending on the operational definition of MCI, apart from using a conservative cut-off applied to MoCA total scores (18 < MoCA < 23), which yielded a markedly lower crude prevalence (24.31%) compared to alternative criteria. Using propensity score matching, the prevalence of MCI was significantly higher among WTC-exposed FDNY responders, compared to WTC-exposed GRC responders (adjusted RR = 1.13 (CI 95% = 1.07-1.20, p < 0.001), and descriptively higher than meta-analytic estimates from different global, community, and clinical populations. Following NIA-AA diagnostic guidelines, 4.96% of WTC-exposed-FDNY-responders met the criteria for severe impairments (95% CI = 2.91-7.82), a prevalence that remained largely unchanged after excluding responders over the age of 65 years. Discussion: There is a high prevalence of mild and severe cognitive impairment among WTC-responders, highlighting the putative role of occupational, environmental, and disaster-related exposures in the etiology of accelerated cognitive decline. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Epidemiology Firefighters Nervous System Occupational Exposure Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Author Keywords: Cognitive Impairment Cognitive Function Cohort Studies Emergency Responders Executive Function Exposure Fire Fighters Memory Occupational Exposure Prevalence World Trade Center WTC

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• ISSN:
  0271-3586
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  160-174
• Volume:
  68
• Issue:
  2
• NIOSHTIC Number:
  nn:20070415
• Citation:
  Am J Ind Med 2025 Feb; 68(2):160-174
• Contact Point Address:
  Sean A. P. Clouston, Department of Family, Population, and Preventive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
• Email:
  sean.clouston@stonybrookmedicine.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  State University of New York at Stony Brook
• Peer Reviewed:
  True
• Start Date:
  20210701
• Source Full Name:
  American Journal of Industrial Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f09dba44e3af1d9d417074f648d504ceed9516ec415350953752c825fdb93df3774f788eb0b78f7e7c1e7001d2c638162c7e82390c174d663687de2616ab2fa4
• Download URL:
  https://stacks.cdc.gov/view/cdc/208637/cdc_208637_DS1.pdf
• File Type:
  [PDF - 1.18 MB ]