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

IF 2.7 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

American journal of industrial medicine Pub Date : 2024-12-15 DOI:10.1002/ajim.23685

Frank D. Mann, Alexandra K. Mueller, Rachel Zeig-Owens, Jaeun Choi, David J. Prezant, Melissa M. Carr, Alicia M. Fels, Christina M. Hennington, Megan P. Armstrong, Alissa Barber, Ashley E. Fontana, Cassandra H. Kroll, Kevin Chow, Onix A. Melendez, Abigail J. Smith, Christopher Christodoulou, Benjamin J. Luft, Charles B. Hall, Sean A. P. Clouston

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

世界贸易中心暴露的纽约市消防部门（FDNY）和一般紧急救援人员中轻度和重度认知障碍的患病率

背景：应对世界贸易中心（WTC）袭击事件的应急人员承受了严重的职业暴露，但在受到 WTC 暴露的 FDNY 应急人员中，认知障碍的发生率仍然未知。本研究使用客观测试筛查了受 WTC 影响的 FDNY 响应者中轻度和重度认知障碍的情况，将患病率与未受 FDNY WTC 影响的响应者队列进行了比较，并与全球、社区和临床人群中 MCI 的元分析估计值进行了描述性比较：方法：我们招募了受世界贸易中心影响的美国联邦国防纽约局受访者样本（n = 343），让他们完成一系列认知、心理和身体测试。根据常模参照测试的结果估算了特定领域损伤的患病率，并采用蒙特利尔认知评估（MoCA）、Jak/Bondi 标准、Petersen 标准以及美国国家老龄化研究所和阿尔茨海默氏症协会（NIA-AA）标准来诊断 MCI。NIA-AA 标准也用于诊断严重认知障碍。研究人员使用广义线性模型和倾向得分匹配法，将认知功能障碍的患病率估计值与在类似时间段内完成 MoCA 测试的普通响应者队列（GRC；n = 7102）中大量受 WTC 影响的非 FDNY 响应者样本进行比较：结果：在 65 岁以下的 FDNY 受访者中，MCI 的未调整患病率从 52.57% 到 60.32% 不等，这取决于 MCI 的操作定义，以及对 MoCA 总分采用的保守临界值（18 讨论）：在参与世界贸易中心活动的人员中，轻度和重度认知障碍的发病率很高，这凸显了职业、环境和灾难相关暴露在加速认知功能衰退的病因中可能扮演的角色。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of industrial medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.90

自引率

5.70%

发文量

108

审稿时长

4-8 weeks

期刊介绍： American Journal of Industrial Medicine considers for publication reports of original research, review articles, instructive case reports, and analyses of policy in the fields of occupational and environmental health and safety. The Journal also accepts commentaries, book reviews and letters of comment and criticism. The goals of the journal are to advance and disseminate knowledge, promote research and foster the prevention of disease and injury. Specific topics of interest include: occupational disease; environmental disease; pesticides; cancer; occupational epidemiology; environmental epidemiology; disease surveillance systems; ergonomics; dust diseases; lead poisoning; neurotoxicology; endocrine disruptors.