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- Title
Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders.
- Authors
Clouston, Sean A. P.; Mann, Frank D.; Meliker, Jaymie; Kuan, Pei-Fen; Kotov, Roman; Richmond, Lauren L.; Babalola, Tesleem; Kritikos, Minos; Yang, Yuan; Carr, Melissa A.; Luft, Benjamin J.
- Abstract
Key Points: Question: Is there an association between occupational exposures while responding to the World Trade Center disaster and the incidence of dementia before 65 years of age? Findings: In this cohort study including 5010 World Trade Center general responders aged a median of 53 years at initial assessment, the incidence of dementia before age 65 years was higher in responders who were more severely exposed. Compared with minimally exposed responders who reported no dust exposure or used personal protective equipment, responders working on the pile of debris who reported severe exposures to dust had a higher incidence of dementia before age 65 years even after adjusting for demographic, medical, and social factors. Meaning: Disasters often require an emergent response in dangerous conditions, but reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Importance: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. Objective: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE). Design, Setting, and Participants: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years. Exposures: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe. Main Outcomes and Measures: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition. Results: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P <.001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P <.001). Conclusions and Relevance: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia. This cohort study compares the incidence rate of dementia before 65 years of age among responders with severe exposure to debris with responders not exposed to building debris or who wore personalized protective equipment during rescue operations following the terrorist attacks on the World Trade Center.
- Subjects
NEW York (State); UNITED States; DIAGNOSIS of dementia; DEMENTIA prevention; PERSONAL protective equipment; QUESTIONNAIRES; DESCRIPTIVE statistics; LONGITUDINAL method; OCCUPATIONAL exposure; MEDICAL emergencies; DISASTERS; ENVIRONMENTAL exposure; DEMENTIA; RESCUE work; PARTICULATE matter; CONFIDENCE intervals; EMERGENCY medical personnel; MIDDLE age
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2416504
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.16504