Cognitive impairment and World Trade Centre-related exposures

Abstract

On 11 September 2001 the World Trade Center (WTC) in New York was attacked by terrorists, causing the collapse of multiple buildings including the iconic 110-story 'Twin Towers'. Thousands of people died that day from the collapse of the buildings, fires, falling from the buildings, falling debris, or other related accidents. Survivors of the attacks, those who worked in search and rescue during and after the buildings collapsed, and those working in recovery and clean-up operations were exposed to severe psychological stressors. Concurrently, these 'WTC-affected' individuals breathed and ingested a mixture of organic and particulate neurotoxins and pro-inflammogens generated as a result of the attack and building collapse. Twenty years later, researchers have documented neurocognitive and motor dysfunctions that resemble the typical features of neurodegenerative disease in some WTC responders at midlife. Cortical atrophy, which usually manifests later in life, has also been observed in this population. Evidence indicates that neurocognitive symptoms and corresponding brain atrophy are associated with both physical exposures at the WTC and chronic post-traumatic stress disorder, including regularly re-experiencing traumatic memories of the events while awake or during sleep. Despite these findings, little is understood about the long-term effects of these physical and mental exposures on the brain health of WTC-affected individuals, and the potential for neurocognitive disorders. Here, we review the existing evidence concerning neurological outcomes in WTC-affected individuals, with the aim of contextualizing this research for policymakers, researchers and clinicians and educating WTC-affected individuals and their friends and families. We conclude by providing a rationale and recommendations for monitoring the neurological health of WTC-affected individuals.

Figure 1.

Exposures at the World Trade Center separated by potential pathways to neurogenerative disease

Figure 2.

Theoretical mechanisms linking exposure to World Trade Center activities and inclusion of Alzheimer’s disease pathological cascade indicative of potential pathways between proteinopathy, and cognitive symptoms identified in responders

Figure 3.

Differences in cortical atrophy comparing (Panel A) cognitively impaired WTC responders compared to cognitively normal responders and (Panel B) cognitively unimpaired WTC responders to normative data. Regions where cortical atrophy was evident are highlighted with colors showing areas of increasingly severe cortical loss including regions in the frontal, temporal, and parietal lobes among others. Source: