Objectives The 9/11 World Trade Centre Disaster (WTCD) has resulted in many chronic health problems among survivors. Rescue/recovery workers (RRW), having the highest exposures, would likely be at the highest risk for these problems. We sought to evaluate cognitive impairment among RRW with and without prevalent posttraumatic stress disorder (PTSD) which may act as a mediator.
Method The World Trade Centre Health Registry is a voluntary longitudinal cohort study. Surveys collected demographics as well as 9/11 related exposures and health outcomes. We limited analysis to RRW workers only. WTCD exposure among RRW was classified from low to very high based on a sum of twelve 9/11 exposures. Cognitive impairment was defined by the frequency of trouble remembering things over the prior 7 days, and presence and/or worsening of memory loss or confusion over the prior 12 month period. A PTSD checklist score of 44 or greater was used to assess the presence of probable PTSD.
Results Of 18 932 RRW, 2436 (12.9%) had PTSD while 16 506 (87.1%) did not have PTSD. Among those without PTSD, 7.9% in the low exposure group were cognitively impaired, 8.9% with medium exposure, 10.3% with high exposure, and 14.4% with very high exposure. Among those with PTSD, 33.6% in the low exposure group were cognitively impaired, 33.5% with medium exposure, 32.5% with high exposure, and 38.1% with very high exposure.
Conclusions In WTCD RRW without PTSD, there is a dose-response for cognitive impairment with increased exposure. However, approximately one-third with PTSD have cognitive impairment regardless of exposure level.
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