1
|
Mangalik S, Eichstaedt JC, Giorgi S, Mun J, Ahmed F, Gill G, V Ganesan A, Subrahmanya S, Soni N, Clouston SAP, Schwartz HA. Robust language-based mental health assessments in time and space through social media. NPJ Digit Med 2024; 7:109. [PMID: 38698174 PMCID: PMC11065872 DOI: 10.1038/s41746-024-01100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
In the most comprehensive population surveys, mental health is only broadly captured through questionnaires asking about "mentally unhealthy days" or feelings of "sadness." Further, population mental health estimates are predominantly consolidated to yearly estimates at the state level, which is considerably coarser than the best estimates of physical health. Through the large-scale analysis of social media, robust estimation of population mental health is feasible at finer resolutions. In this study, we created a pipeline that used ~1 billion Tweets from 2 million geo-located users to estimate mental health levels and changes for depression and anxiety, the two leading mental health conditions. Language-based mental health assessments (LBMHAs) had substantially higher levels of reliability across space and time than available survey measures. This work presents reliable assessments of depression and anxiety down to the county-weeks level. Where surveys were available, we found moderate to strong associations between the LBMHAs and survey scores for multiple levels of granularity, from the national level down to weekly county measurements (fixed effects β = 0.34 to 1.82; p < 0.001). LBMHAs demonstrated temporal validity, showing clear absolute increases after a list of major societal events (+23% absolute change for depression assessments). LBMHAs showed improved external validity, evidenced by stronger correlations with measures of health and socioeconomic status than population surveys. This study shows that the careful aggregation of social media data yields spatiotemporal estimates of population mental health that exceed the granularity achievable by existing population surveys, and does so with generally greater reliability and validity.
Collapse
Affiliation(s)
- Siddharth Mangalik
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA.
| | - Johannes C Eichstaedt
- Department of Psychology, Stanford University, Stanford, CA, USA.
- Institute for Human-Centered A.I., Stanford University, Stanford, CA, USA.
| | - Salvatore Giorgi
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, USA
| | - Jihu Mun
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Farhan Ahmed
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Gilvir Gill
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Adithya V Ganesan
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | | | - Nikita Soni
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - H Andrew Schwartz
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA.
| |
Collapse
|
2
|
Iban-Arias R, Wang SH, Soares Dias Portela A, Yang EJ, Griggs E, Masieri S, Hu W, Chen LC, Pasinetti GM. Exposure to the World Trade Center Particulate Matter Alters the Gut-Brain Axis in Early Onset Alzheimer's Disease Mice. J Alzheimers Dis 2024; 100:S305-S325. [PMID: 39093074 DOI: 10.3233/jad-240635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Background The September 11, 2001, catastrophe unleashed widespread destruction beyond the World Center (WTC), with fires and toxic gases leaving lasting impacts. First responders at Ground Zero faced prolonged exposure to hazardous particulate matter (PM), resulting in chronic health challenges. Among the multitude of health concerns, the potential association between the WTCPM and Alzheimer's disease (AD) has emerged as an area of intense inquiry, probing the intricate interplay between environmental factors and neurodegenerative diseases. Objective We posit that a genetic predisposition to AD in mice results in dysregulation of the gut-brain axis following chronic exposure to WTCPM. This, in turn, may heighten the risk of AD-like symptoms in these individuals. Methods 3xTg-AD and WT mice were intranasally administered with WTCPM collected at Ground Zero within 72 hours after the attacks. Working memory and learning and recognition memory were monitored for 4 months. Moreover, brain transcriptomic analysis and gut barrier permeability along with microbiome composition were examined. Results Our findings underscore the deleterious effects of WTCPM on cognitive function, as well as notable alterations in brain genes associated with synaptic plasticity, pro-survival, and inflammatory signaling pathways. Complementary, chronic exposure to the WTCPM led to increased gut permeability in AD mice and altered bacteria composition and expression of functional pathways in the gut. Conclusions Our results hint at a complex interplay between gut and brain axis, suggesting potential mechanisms through which WTCPM exposure may exacerbate cognitive decline. Identifying these pathways offers opportunities for tailored interventions to alleviate neurological effects among first responders.
Collapse
Affiliation(s)
- Ruth Iban-Arias
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shu-Han Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eun-Jeong Yang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Griggs
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sibilla Masieri
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wen Hu
- Department of Neurochemistry, Inge Grundke-Iqbal Research Floor, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, NY, USA
| | - Lung-Chi Chen
- Department of Environmental Medicine, NYU Langone School of Medicine, New York, NY, USA
| | - Giulio Maria Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Geriatrics Research, Education and Clinical Center, JJ Peters VA Medical Center, Bronx, NY, USA
| |
Collapse
|
3
|
Lee H, Oh S, Ha E, Joo Y, Suh C, Kim Y, Jeong H, Lyoo IK, Yoon S, Hong H. Cerebral cortical thinning in brain regions involved in emotional regulation relates to persistent symptoms in subjects with posttraumatic stress disorder. Psychiatry Res 2023; 327:115345. [PMID: 37516039 DOI: 10.1016/j.psychres.2023.115345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
A considerable proportion of individuals exposed to trauma experience chronic and persistent posttraumatic stress disorder (PTSD). However, the specific brain and clinical features that render trauma-exposed individuals more susceptible to enduring symptoms remain elusive. This study investigated 112 trauma-exposed participants who had been diagnosed with PTSD and 112 demographically-matched healthy controls. Trauma-exposed participants were classified into those with current PTSD (persistent PTSD, n = 78) and those without (remitted PTSD, n = 34). Cortical thickness analysis was performed to discern group-specific brain structural characteristics. Coping strategies and resilience levels, assessed as clinical attributes, were compared across the groups. The persistent PTSD group displayed cortical thinning in the superior frontal cortex (SFC), insula, superior temporal cortex, dorsolateral prefrontal cortex, superior parietal cortex, and precuneus, relative to the remitted PTSD and control groups. Cortical thinning in the SFC was associated with increased utilization of maladaptive coping strategies, while diminished thickness in the insula correlated with lower resilience levels among trauma-exposed individuals. These findings imply that cortical thinning in brain regions related to coping strategy and resilience plays a vital role in the persistence of PTSD symptoms.
Collapse
Affiliation(s)
- Hyangwon Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sohyun Oh
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Yoonji Joo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Chaewon Suh
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yejin Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyeonseok Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea.
| | - Haejin Hong
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.
| |
Collapse
|
4
|
Invernizzi A, Rechtman E, Curtin P, Papazaharias DM, Jalees M, Pellecchia AC, Santiago-Michels S, Bromet EJ, Lucchini RG, Luft BJ, Clouston SA, Tang CY, Horton MK. Functional changes in neural mechanisms underlying post-traumatic stress disorder in World Trade Center responders. Transl Psychiatry 2023; 13:239. [PMID: 37429850 PMCID: PMC10333341 DOI: 10.1038/s41398-023-02526-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/12/2023] Open
Abstract
World Trade Center (WTC) responders exposed to traumatic and environmental stressors during rescue and recovery efforts have a high prevalence of chronic WTC-related post-traumatic stress disorder (WTC-PTSD). We investigated neural mechanisms underlying WTC-PTSD by applying eigenvector centrality (EC) metrics and data-driven methods on resting state functional magnetic resonance (fMRI). We identified how EC differences relate to WTC-exposure and behavioral symptoms. We found that connectivity differentiated significantly between WTC-PTSD and non-PTSD responders in nine brain regions, as these differences allowed an effective discrimination of PTSD and non-PTSD responders based solely on analysis of resting state data. Further, we found that WTC exposure duration (months on site) moderates the association between PTSD and EC values in two of the nine brain regions; the right anterior parahippocampal gyrus and the left amygdala (p = 0.010; p = 0.005, respectively, adjusted for multiple comparisons). Within WTC-PTSD, a dimensional measure of symptom severity was positively associated with EC values in the right anterior parahippocampal gyrus and brainstem. Functional neuroimaging can provide effective tools to identify neural correlates of diagnostic and dimensional indicators of PTSD.
Collapse
Affiliation(s)
- Azzurra Invernizzi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elza Rechtman
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Demetrios M Papazaharias
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maryam Jalees
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison C Pellecchia
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Santiago-Michels
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
- Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Cheuk Y Tang
- Department of Radiology and Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
5
|
Kritikos M, Diminich ED, Meliker J, Mielke M, Bennett DA, Finch CE, Gandy SE, Carr MA, Yang X, Kotov R, Kuan P, Bromet EJ, Clouston SAP, Luft BJ. Plasma amyloid beta 40/42, phosphorylated tau 181, and neurofilament light are associated with cognitive impairment and neuropathological changes among World Trade Center responders: A prospective cohort study of exposures and cognitive aging at midlife. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12409. [PMID: 36911360 PMCID: PMC9994167 DOI: 10.1002/dad2.12409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 03/14/2023]
Abstract
Introduction World Trade Center (WTC) responders are experiencing a high risk of mild cognitive impairment (MCI) and dementia, though the etiology remains inadequately characterized. This study investigated whether WTC exposures and chronic post-traumatic stress disorder (PTSD) were correlated with plasma biomarkers characteristic of Alzheimer's disease (AD) neuropathology. Methods Eligible participants included WTC-exposed individuals with a baseline cognitive assessment and available plasma sample. We examined levels of the amyloid beta (Aβ)40/42 ratio, phosphorylated tau 181 (p-tau181), and neurofilament light chain (NfL) and associations with a WTC exposures (duration on site ≥15 weeks, dust cloud), the PTSD Symptom Checklist for Diagnostic and Statistical Manual of Mental Disorders, 4th edition PTSD, and classification of amyloid/tau/neurodegeneration (AT[N]) profiles. Multinomial logistic regressions assessed whether biomarkers predicted increased risk of MCI or dementia. Results Of 1179 eligible responders, 93.0% were male, mean (standard deviation) age 56.6 years (7.8). Aβ40/42, p-tau181, and NfL intercorrelated and increased with age. In subgroup analyses of responders with available neuroimaging data (n = 75), Aβ40/42 and p-tau181 were further associated with decreased hippocampal volume (Spearman's ρ = -0.3). Overall, 58.08% of responders with dementia had ≥1 elevated biomarker, and 3.45% had elevations across all biomarkers. In total, 248 (21.05%) had MCI and 70 (5.94%) had dementia. Increased risk of dementia was associated with plasma AT(N) profile T+ or A+N+. Exposure on site ≥15 weeks was independently associated with T+ (adjusted risk ratio [aRR] = 1.03 [1.01-1.05], P = 0.009), and T+N+ profile (aRR = 2.34 [1.12-4.87]). The presence of PTSD was independently associated with risk of A+ (aRR = 1.77 [1.11-2.82]). Discussion WTC exposures and chronic PTSD are associated with plasma biomarkers consistent with neurodegenerative disease.
Collapse
Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of FamilyPopulation, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Erica D. Diminich
- Program in Public Health and Department of FamilyPopulation, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Jaymie Meliker
- Program in Public Health and Department of FamilyPopulation, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Michelle Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush UniversityChicagoIllinoisUSA
| | - Caleb E. Finch
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sam E. Gandy
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine, Mount SinaiNew YorkNew YorkUSA
| | - Melissa A. Carr
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Xiaohua Yang
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Roman Kotov
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Pei‐Fen Kuan
- Department of Applied MathematicsRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Evelyn J. Bromet
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Sean A. P. Clouston
- Program in Public Health and Department of FamilyPopulation, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Benjamin J. Luft
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| |
Collapse
|
6
|
Huang C, Kritikos M, Sosa MS, Hagan T, Domkan A, Meliker J, Pellecchia AC, Santiago-Michels S, Carr MA, Kotov R, Horton M, Gandy S, Sano M, Bromet EJ, Lucchini RG, Clouston SAP, Luft BJ. World Trade Center Site Exposure Duration Is Associated with Hippocampal and Cerebral White Matter Neuroinflammation. Mol Neurobiol 2023; 60:160-170. [PMID: 36242735 PMCID: PMC9758101 DOI: 10.1007/s12035-022-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
Responders to the World Trade Center (WTC) attacks on 9/11/2001 inhaled toxic dust and experienced severe trauma for a prolonged period. Studies report that WTC site exposure duration is associated with peripheral inflammation and risk for developing early-onset dementia (EOD). Free Water Fraction (FWF) can serve as a biomarker for neuroinflammation by measuring in vivo movement of free water across neurons. The present case-controlled study aimed to examine associations between WTC site exposure duration as well as EOD status with increased hippocampal and cerebral neuroinflammation. Ninety-nine WTC responders (mean age of 56) were recruited between 2017 and 2019 (N = 48 with EOD and 51 cognitively unimpaired). Participants were matched on age, sex, occupation, race, education, and post-traumatic stress disorder (PTSD) status. Participants underwent neuroimaging using diffusion tensor imaging protocols for FWF extraction. Region of interest (ROI) analysis and correlational tractography explored topographical distributions of FWF associations. Apolipoprotein-e4 allele (APOEε4) status was available for most responders (N = 91). Hippocampal FWF was significantly associated with WTC site exposure duration (r = 0.30, p = 0.003), as was cerebral white matter FWF (r = 0.20, p = 0.044). ROI analysis and correlational tractography identified regions within the limbic, frontal, and temporal lobes. Hippocampal FWF and its association with WTC exposure duration were highest when the APOEε4 allele was present (r = 0.48, p = 0.039). Our findings demonstrate that prolonged WTC site exposure is associated with increased hippocampal and cerebral white matter neuroinflammation in WTC responders, possibly exacerbated by possession of the APOEε4 allele.
Collapse
Affiliation(s)
- Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA
| | - Mario Serrano Sosa
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Thomas Hagan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Alan Domkan
- Department of Physiology and Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Jaymie Meliker
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA
| | - Alison C Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Melissa A Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Sam Gandy
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA.
| | - Benjamin J Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
7
|
Pellecchia A, Kritikos M, Guralnik J, Ahuvia I, Santiago-Michels S, Carr M, Kotov R, Bromet EJ, Clouston SAP, Luft BJ. Physical Functional Impairment and the Risk of Incident Mild Cognitive Impairment in an Observational Study of World Trade Center Responders. Neurol Clin Pract 2022; 12:e162-e171. [PMID: 36540142 PMCID: PMC9757114 DOI: 10.1212/cpj.0000000000200089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives Posttraumatic stress disorder (PTSD) has been linked to increased risk of cognitive dysfunction and physical functional impairment (PFI). The objective of this prospective cohort study was to examine whether PFI was associated with increased risk of incident mild cognitive impairment (MCI) among World Trade Center (WTC) responders with PTSD. We hypothesized that responders with PTSD would have an elevated risk of incident MCI and that PFI would mediate this increase. Methods We examined responder participants in the WTC Aging Study whose baseline physical assessments were completed by May 2016-April 2017 and were followed up at least once before December 2019. Those without complete demographic, medical, or behavioral data were excluded. PFI was assessed using measures of upper body strength (maximal handgrip strength [HGS]) and lower extremity physical functioning (Short Physical Performance Battery). PTSD was rated using a diagnostic interview and symptom checklist; MCI and dementia were assessed using the Montreal Cognitive Assessment and diagnosed using the National Institute on Aging-Alzheimer's Association criteria. Group differences and longitudinal comparisons were examined. Cox proportional hazards models were evaluated from time to incident MCI and conversion to dementia. A mediation analysis examined whether PFI mediated associations between PTSD and MCI. Results Within the sample of 2,687 WTC responders, 324 (12.06%, 95% CI = [10.83-13.29]) had lower extremity PFI. Responders with lower extremity PFI were older, had lower education and higher body mass, and were at a higher risk of pulmonary embolisms and PTSD. Responders with lower extremity PFI demonstrated lower baseline cognition and had increased hazards of MCI (multivariable-adjusted hazards ratio [aHR] = 1.55 [95% CI 1.21-1.98]); those with MCI converted to dementia more rapidly than those without PFI (2.73 [1.38-5.39] p = 0.004). In addition, each standard deviation decrease in HGS was associated with increased hazards of developing MCI (aHR = 1.35 [95% CI 1.10-1.66]). A mediation model suggested PFI played an intermediary role in the relationship between PTSD and MCI. Discussion WTC responders with PFI demonstrated worse cognitive and behavioral outcomes, and PFI played an intermediary role in the relationship between PTSD and incident MCI, suggesting that PFI may be an early indicator of MCI in responders with PTSD. Regular monitoring of PFI should be considered among PTSD populations.
Collapse
Affiliation(s)
- Alison Pellecchia
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Minos Kritikos
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Jack Guralnik
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Isaac Ahuvia
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Melissa Carr
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Roman Kotov
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Evelyn J Bromet
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Sean A P Clouston
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| | - Benjamin J Luft
- Stony Brook World Trade Center Wellness Program (AP, SS-M, MC, SAPC, BJL), Renaissance School of Medicine at Stony Brook University, NY; Program in Public Health and Department of Family (MK, SAPC), Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY; Department of Epidemiology and Public Health (JG), University of Maryland School of Medicine, Baltimore; Department of Psychology (IA), Stony Brook University, NY; Department of Psychiatry (RK, EJB), Stony Brook University, NY; and Department of Medicine (BJL), Renaissance School of Medicine at Stony Brook University, NY
| |
Collapse
|
8
|
Azmoun S, Diaz YF, Tang CY, Horton M, Clouston SA, Luft BJ, Bromet EJ, Gandy S, Placidi D, Ambrosi C, Mascaro L, Rodella C, Paghera B, Gasparotti R, Chambers JW, Tieu K, Corbo D, Lucchini RG. Cognitive impact of exposure to airborne particles captured by brain imaging. ADVANCES IN NEUROTOXICOLOGY 2022; 7:29-45. [PMID: 37663650 PMCID: PMC10473881 DOI: 10.1016/bs.ant.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
| | | | - Cheuk Y. Tang
- Icahn School of Medicine at Mount Sinai, New York, United States
| | - Megan Horton
- Icahn School of Medicine at Mount Sinai, New York, United States
| | | | - Ben J. Luft
- Stony Brook University, New York, United States
| | | | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, United States
- James J. Peters VA Medical Center, Bronx, New York, United States
| | - Donatella Placidi
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Claudia Ambrosi
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | | | - Carlo Rodella
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Paghera
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Roberto Gasparotti
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | | | - Kim Tieu
- Florida International University, Miami, United States
| | - Daniele Corbo
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Roberto G. Lucchini
- Florida International University, Miami, United States
- University of Brescia, Brescia, Italy
| |
Collapse
|
9
|
Rosen R, Shao Y, Zhang Q, Bao J, Zhang Y, Masurkar A, Wisniewski T, Urban N, Reibman J. Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3440. [PMID: 35329128 PMCID: PMC8948727 DOI: 10.3390/ijerph19063440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022]
Abstract
The World Trade Center Environmental Health Center (WTC EHC), is a federally designated clinical center of excellence for surveillance and treatment of WTC disaster exposed community members (WTC Survivors). Cognitive impairment (CI) has been extensively described in WTC responders and a concern for progressive impairment in all WTC disaster exposed groups has been raised. Cognitive status, however, has not been systematically characterized in the WTC Survivor population. We describe cognitive status in a subgroup of the Survivor population referred for mental health evaluation (N = 480) in the WTC EHC as measured by scores on the Montreal Cognitive Assessment (MoCA) instrument, and examine their association with WTC exposures and individual-level covariates including PTSD and depression screening inventory scores. In regression analyses, probable cognitive impairment (MoCA score < 26) was found in 59% of the study subjects and was significantly associated with age, race/ethnicity, education, income, depression and PTSD scores. Being caught in the dust cloud on 11 September 2011 was significantly associated with cognitive impairment even after controlling for the above. These data suggest an association with cognitive dysfunction in WTC Survivors with exposure to the toxic dust/fumes and psychological stress from the 9/11 terrorist attack and warrant further systematic study.
Collapse
Affiliation(s)
- Rebecca Rosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Yongzhao Shao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
| | - Qiao Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Jia Bao
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Arjun Masurkar
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Thomas Wisniewski
- NYU Alzheimer’s Disease Research Center, New York, NY 10016, USA; (A.M.); (T.W.)
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nina Urban
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA;
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
| | - Joan Reibman
- World Trade Center Environmental Health Center, NYC Health+Hospitals, New York, NY 10016, USA; (Q.Z.); (J.B.); (Y.Z.); (J.R.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| |
Collapse
|