Structural and Functional Neuroimaging of Post Traumatic Stress Disorder and Cognitive Impairment in World Trade Center Responders

项目摘要 世界贸易中心（WTC）的反应者暴露于极端的心理创伤有高比例的创伤后应激障碍， 这与认知障碍和大脑的显著改变独立相关。在 在斯托尼布鲁克世贸中心健康计划队列中，近20%的应答者自9/11以来发展了DSM-IV PTSD。 他们目前的平均年龄为54岁，处于认知能力下降的风险期。为了 为预期的认知变化提供基线，世贸中心健康计划的斯托尼布鲁克部门开始 评估认知功能在蒙特利尔认知筛查的前2,400名应答者中， 在莫卡评估中，中度至重度认知功能障碍（得分<20）的发生率为2.6%， 与WTC-PTSD的相关性非常显著。世贸中心的反应者也暴露于神经毒性的混合物， 空气中不同大小的颗粒物，包括可吸入颗粒物、纳米颗粒物和超细颗粒物、金属、多氯联苯、二恶英和 溶剂.最近的文献表明，纳米颗粒，定义为至少在一个维度上<0.1μm的颗粒， 可以通过嗅觉途径到达大脑并导致长期的神经退化。因此，我们认为， 神经毒性可能是由于吸入的氧化应激引起的慢性神经炎症所致。 颗粒和通过免疫系统的参与。 本申请的目的是更好地了解认知功能障碍的反应者之间的脑功能障碍。 损伤和创伤后应激障碍也就是说，类似于对退伍军人的研究越来越多， 对于创伤后应激障碍，确定大脑中是否存在独特的结构模式至关重要 与WTC应答者的认知障碍相关。因此，我们建议使用体内磁共振 成像（MRI）技术，包括功能性MRI（fMRI）和正电子发射断层扫描（PET/MRI） 成像来检查这些图案。 本申请是对120名SBU-WTC应答者的初步研究，其中30名患有认知障碍（莫卡<20）， PTSD，30例无PTSD的认知障碍，30例认知功能正常（莫卡>26）， 创伤后应激障碍，30岁认知功能正常无创伤后应激障碍。所有应答者将在年龄上匹配， 职业以及30名非WTC暴露者，与莫卡评分>26的对照组相匹配。 我们希望能提高对潜在神经认知效应机制的理解， WTC曝光。该项目的最终目标是提供一个基础，以防止潜在的世贸中心反应者的 心理健康恶化。研究结果也将为我国的 了解和预防一般人群中的神经退行性疾病。

Project Summary World Trade Centers (WTC) responders exposed to extreme psychological trauma have high rates of PTSD, which is independently associated both with cognitive impairment and with significant alteration in the brain. In the Stony Brook WTC Health Program cohort, nearly 20% of responders developed DSM-IV PTSD since 9/11. Their current average age is 54, placing them at the cusp of the risk period for cognitive decline. In order to provide a baseline for anticipated cognitive changes, the Stony Brook arm of the WTC Health Program began assessing cognitive functioning in 2014. In the first 2,400 responders screened with the Montreal Cognitive Assessment (MoCA), the rate of moderate-to-severe cognitive impairment (scores <20) was 2.6%, and the association with WTC-PTSD was highly significant. WTC responders were also exposed to a mix of neurotoxic airborne particles of different size including respirable, nano-sized and ultrafine, metals, PCB, dioxins and solvents. Recent literature shows that nanoparticles, defined as a particle <0.1μm in at least one dimension, can reach the brain through the olfactory pathway and cause long-term neuro-degeneration. Therefore, neurotoxicity may be due to chronic neuro-inflammation caused by oxidative stress induced by the inhaled particles and via involvement of immune system. The purpose of this application is to better understand brain dysfunction among responders with cognitive impairment and Post Traumatic Stress Disorders. That is, similar to the growing body of research on veterans with PTSD, it is of fundamental importance to determine if there are unique structural patterns in the brain associated with cognitive impairment in WTC responders. We thus propose to use in vivo magnetic resonance imaging (MRI) techniques, including functional MRI (fMRI) and positron emission tomography (PET/MRI) imaging to examine these patterns. This application is a pilot study of 120 SBU-WTC responders, 30 with cognitive impairment (MoCA <20) and PTSD, 30 with cognitive impairment without PTSD, 30 with normal cognitive functioning (MoCA>26) and PTSD, 30 with normal cognitive functioning without PTSD. All responders will be matched on age and occupation as well as 30 non-WTC exposed, matched controls with MoCA scores >26. We hope to improve the understanding of mechanisms underlying the potential neuro-cognitive effect from WTC exposure. The ultimate goal of this project is to provide a basis to prevent potential WTC responders' mental health deterioration. The study results will also provide important and novel information for the understanding and prevention of neurodegenerative disorders in the population at large.