RT Journal Article
SR Electronic
T1 Physical Functional Impairment and the Risk of Incident Mild Cognitive Impairment in an Observational Study of World Trade Center Responders
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP 10.1212/CPJ.0000000000200089
DO 10.1212/CPJ.0000000000200089
A1 Alison Pellecchia
A1 Minos Kritikos
A1 Jack Guralnik
A1 Isaac Ahuvia
A1 Stephanie Santiago-Michels
A1 Melissa Carr
A1 Roman Kotov
A1 Evelyn J. Bromet
A1 Sean A. P. Clouston
A1 Benjamin J. Luft
YR 2022
UL http://cp.neurology.org/content/early/2022/10/12/CPJ.0000000000200089.abstract
AB 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 5/2016–4/2017 and were followed up at least once prior to 12/2019. 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 NIA-AA criteria. Group differences and longitudinal comparisons were examined. Cox proportional hazards models evaluated time to incident MCI and conversion to dementia. Mediation analysis examined whether PFI mediated associations between PTSD and MCI.Results: Within the sample of 2,687 WTC responders, 324 (12.06%, 95% C.I. = [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 higher risk of pulmonary embolisms and PTSD. Responders with lower extremity PFI demonstrated lower baseline cognition and had increased hazards of MCI (aHR=1.55 [95% C.I. 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). Additionally, each standard deviation decrease in HGS was associated with increased hazards of developing MCI (aHR=1.35 [95% C.I. 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 PFI may be an early indicator of MCI in responders with PTSD. Regular monitoring of PFI should be considered among PTSD populations.