World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

A. Singh, R. Zeig-Owens, C. B. Hall, Y. Liu, L. Rabin, T. Schwartz, M. P. Webber, D. Appel, D. J. Prezant

Research output: Contribution to journalArticle


Objective: To determine whether World Trade Center (WTC)-exposure intensity and post-traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. Method: The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self-perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top-quartile (≥2) CFI score, and of early post-9/11 PTSD with top-quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. Results: Mean age at CFI completion was 56.7 ± 7.7 (range: 36–81). Participants with high-intensity WTC exposure had an increased likelihood of top-quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07–1.64), controlling for covariates. Current and early PTSD were both associated with top-quartile CFI (OR: 3.25, 95%CI: 2.53–4.19 and OR: 1.56, 95%CI: 1.26–1.93) respectively. Conclusions: High-intensity WTC exposure was associated with self-reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC-exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.

Original languageEnglish (US)
Pages (from-to)275-284
Number of pages10
JournalActa Psychiatrica Scandinavica
Issue number3
StatePublished - Mar 1 2020



  • cognitive dysfunction
  • mental health
  • occupational health
  • post-traumatic
  • stress disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health

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