Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees

Abstract

Background: Burgeoning research suggests that people exposed to the 9/11/2001 terrorist attacks in New York City (NYC) may be at greater risk for cognitive impairment due to a variety of potential exposures. We investigated whether posttraumatic stress disorder (PTSD) history was associated with self-reported confusion or memory loss (CML) among World Trade Center Health Registry enrollees. Methods: The study sample included enrollees who completed all five wave surveys (W1 in 2003–04 through W5 in 2020–21), were between the ages of 35 and 64 during W3-W5, and had no history of stroke or dementia (N = 11,432). We categorized PTSD history during W1-W3 as chronic-high, increased, decreased, or resilient-low with trajectory analysis. Generalized estimating equations modeling was used for the repeated measures analysis of the outcome, CML. Results: Compared to those in the resilient-low PTSD group, those in the decreased and increased PTSD groups were at over 52% greater risk of reporting CML; those in the chronic-high PTSD group had between a 1.62 and 1.92 times greater risk of CML than the resilient-low PTSD group, with non-rescue/recovery workers having greater risk on average. PTSD history was also associated with elevated risk of more severe CML-related outcomes in W5 – specifically, experiencing worsening symptoms and functioning in daily life. Limitations: CML symptoms are self-reported, and generalizability of results may be limited. Conclusions: These findings suggest that survivors with PTSD should be monitored for cognitive issues, including CML. Effective treatment of PTSD may have benefits beyond mitigation of PTSD symptoms.

Keywords

• PTSD
• Cognitive decline
• Cohort study
• Disaster epidemiology