Physical and mental health pathways to cognitive decline in World Trade Center responders: The roles of pulmonary function and post-traumatic stress disorder

摘要 作为对RFA-OH-21-004的响应，我们探索了WTC暴露和认知之间的联系 通过身体和精神健康状况的非认知途径下降，特别是异常 肺活量测定和慢性创伤后应激障碍。这个项目将回答与长期影响有关的关键问题 了解身心健康状况，进一步扩大我们对非认知性的认识 导致认知能力下降的途径。 世贸中心的反应人员已经被证明经历了快速的身体衰老，精神健康状况不佳 结果，以及最近，认知障碍的早期发作。早发性认知障碍可能是 通过表现为非认知症状的机制运作。肺活量异常和慢性后遗症 创伤应激障碍(PTSD)是两种非常普遍和普遍的身心健康疾病 在WTC应答者中，这可能预示着潜伏的认知能力下降。事实上，自那以来已经有20年了 9·11恐怖袭击，随着这群人步入老年，理清了特定的道路 认知能力下降不仅会影响预防工作，也会影响高危人群的专门干预。 个人。 该项目将使用石溪大学世界贸易中心健康项目的次要数据 (SBU WTC-HP，R01 AG049953)。目标1将检验以下假设：肺活量异常的联合作用 慢性创伤后应激障碍对认知功能下降的影响大于个体效应。然后，AIM 2将调查 肺活量异常和慢性创伤后应激障碍单独和联合调节的程度 WTC暴露和认知能力下降之间的关系。 我们团队以前令人信服的工作支持这个项目：我们之前已经证明了认知 功能和身体功能共同下降；我们已经表明，呼吸道症状和慢性创伤后应激障碍 在WTC中，应答者经常共存；我们已经表明，慢性PTSD正处于早期- WTC应答者的首发认知障碍。这些发现指向了一个共同的潜在机制 影响这些条件和结果；然而，需要进一步调查以确定慢性和 从WTC暴露到认知衰退的路径。 在这个项目中，我们将系统地考察来自WTC的直接和间接的非认知路径 暴露在认知衰退中，以提高对特定非认知型个体的认同感 认知障碍的途径。这最终将导致预防工作，以减轻 通过治疗非认知症状可预防的认知损害。

ABSTRACT In response to RFA-OH-21-004, we explore the association between WTC exposure and cognitive decline via non-cognitive pathways of physical and mental health conditions, specifically abnormal spirometry and chronic PTSD. This project will answer critical questions relating to long-term effects of physical and mental health conditions, and further expand our knowledge on non-cognitive pathways that lead to cognitive decline. World Trade Center responders have been shown to experience rapid physical aging, poor mental health outcomes, and more recently, early onset of cognitive impairment. Early onset cognitive impairment may be operating via mechanisms that manifest as non-cognitive symptoms. Abnormal spirometry and chronic post- traumatic stress disorder (PTSD) are two highly prevalent and pervasive physical and mental health conditions in WTC responders that may be indicative of insidious cognitive decline. Indeed, it has been two decades since the September 11th terrorist attacks, and as this cohort moves into older age, disentangling specific pathways to cognitive decline will inform not only on preventative efforts but also on specialized interventions in high risk individuals. This project will use secondary data from the Stony Brook University World Trade Center Health Program (SBU WTC-HP, R01 AG049953). Aim 1 will test the hypothesis that the joint effects of abnormal spirometry and chronic PTSD on cognitive decline are larger than their individual effects. Aim 2 will then investigate the extent to which abnormal spirometry and chronic PTSD individually and conjointly mediate the association between WTC exposure and cognitive decline. Compelling previous work from our team supports this project: We have previously shown that cognitive function and physical function decline co-jointly; we have shown that respiratory symptoms and chronic PTSD in WTC responders co-occur frequently; and we have shown that chronic PTSD is in the pathway to early- onset cognitive impairment in WTC responders. These findings point towards a shared underlying mechanism affecting these conditions and outcomes; however, further investigation is needed to determine chronicity and paths from WTC exposure to cognitive decline. In this project, we will systemically examine the direct and indirect non-cognitive paths from WTC exposure to cognitive decline to improve identification of individuals who are on specific non-cognitive pathways to cognitive impairment. This will eventually lead to prevention efforts to mitigate preventable cognitive impairment by treating non-cognitive symptoms.