Mann Frank D, Mueller Alexandra K, Zeig-Owens Rachel, Choi Jaeun, Prezant David J, Carr Melissa M, Fels Alicia M, Hennington Christina M, Armstrong Megan P, Barber Alissa, Fontana Ashley E, Kroll Cassandra H, Chow Kevin, Melendez Onix A, Smith Abigail J, Christodoulou Christopher, Luft Benjamin J, Hall Charles B, Clouston Sean A P
Department of Family, Population, and Preventive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA.
Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA.
Am J Ind Med. 2025 Feb;68(2):160-174. doi: 10.1002/ajim.23685. Epub 2024 Dec 15.
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.
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.
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.
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.
应对世贸中心（WTC）袭击事件的应急人员遭受了严重的职业暴露，但世贸中心暴露的纽约市消防局（FDNY）应急人员中认知障碍的患病率仍不清楚。本研究使用客观测试对世贸中心暴露的FDNY应急人员进行轻度和重度认知障碍筛查，将患病率与一组未暴露于世贸中心的FDNY应急人员进行比较，并与来自全球、社区和临床人群的轻度认知障碍（MCI）的荟萃分析估计值进行描述性比较。
招募了一组世贸中心暴露的FDNY应急人员样本（n = 343），以完成一系列广泛的认知、心理和身体测试。根据常模参照测试结果估计特定领域损伤的患病率，并使用蒙特利尔认知评估量表（MoCA）、Jak/Bondi标准、Petersen标准以及美国国立衰老研究所和阿尔茨海默病协会（NIA-AA）标准来诊断MCI。NIA-AA标准也用于诊断重度认知障碍。使用广义线性模型和倾向得分匹配，将认知障碍患病率估计值与来自一般应急人员队列（GRC；n = 7102）的一大组未暴露于世贸中心的FDNY应急人员进行比较，这些人员在类似时间段内完成了MoCA测试。
在65岁以下的FDNY应急人员中，根据MCI的操作定义，MCI的未调整患病率在52.57%至60.32%之间变化，但使用应用于MoCA总分的保守临界值（18 < MoCA < 23）时，与其他标准相比，粗患病率明显较低（24.31%）。使用倾向得分匹配，世贸中心暴露的FDNY应急人员中MCI的患病率显著高于世贸中心暴露的GRC应急人员（调整后的相对风险 = 1.13（95%置信区间 = 1.07 - 1.20，p < 0.001），并且在描述上高于来自不同全球、社区和临床人群的荟萃分析估计值。按照NIA-AA诊断指南，4.96%的世贸中心暴露的FDNY应急人员符合重度损伤标准（95%置信区间 = 2.91 - 7.82），在排除65岁以上的应急人员后，该患病率基本保持不变。
世贸中心应急人员中轻度和重度认知障碍的患病率很高，突出了职业、环境和灾难相关暴露在加速认知衰退病因中的假定作用。
