World Trade Center first responders who inhaled toxic dust while working at Ground Zero are at increasing risk of developing dementia and other forms of memory loss, according to a pair of first-of-its kind studies by Stony Brook University researchers.
Roughly 15% of 9/11 first responders are showing signs of cognitive impairment at roughly three times the rate of the general population in their age bracket, said Sean Clouston, an associate professor of family, population and preventive medicine at Stony Brook University, who co-authored both studies.
The research indicates that first responders who spent lengthy amounts of time in lower Manhattan in the aftermath of the Sept. 11, 2001 terror attacks, and who later developed post-traumatic stress disorder, are more likely to show neurological abnormalities and changes in their blood, similar to those seen in Alzheimer’s disease patients and related dementias.
The studies also found that the brain “age” of a first responder showing signs of cognitive impairment appears to be about 7 to 10 years older than the normal population.
Dr. Benjamin Luft, director of the Stony Brook WTC Health and Wellness Program, said nearly 20 years after the World Trade Center attacks, doctors are seeing an increasing number of first responders showing signs of cognitive disorders and possible dementia.
"It is extremely unusual to have these types of abnormalities in people of this age," said Luft, the senior author on both studies, of the patients who at the beginning of the studies averaged 54 years old. "It is unheard of really, or extremely rare, to find these types of abnormalities in the general population."
An estimated 500,000 people, including nearly 100,000 first responders, were potentially exposed to environmental contaminants in the aftermath of the terror attacks, with many later diagnosed with an array of cancers and respiratory diseases such as asthma, COPD and interstitial lung disease.
"The environmental exposures and psychological pressures experienced by responders during 9/11 and its aftermath have had an insidious effect on their health and well-being,” Luft said.
The first Stony Brook study used MRI imaging to assess the brain matter of nearly 100 first responder patients with and without symptoms of cognitive impairment. The goal of the study, which will be published in "Alzheimer’s and Dementia: Diagnosis, Assessment and Disease Monitoring," was to determine if midlife WTC first responders developed the neurodegenerative conditions due to changes in their brain connected to the toxic exposure at Ground Zero.
The second study, which will be published in "Translational Psychiatry," found that some first responders possess protein changes in their blood consistent with Alzheimer’s disease. Among the 181 first responders studied, researchers also observed a nearly threefold increase in the incidence of mild cognitive impairment among those also diagnosed with PTSD.
Both studies will be presented virtually Tuesday at the Alzheimer's Association International Conference.
Researchers first began to study the patients five years ago to determine if there was accelerated aging among WTC responders.
Imaging revealed that areas of the brain cortex — which is responsible for cognition — were thinning and had atrophied in many WTC patients significantly more than in members of the general population, the study found.
The cortical thickness reduction, Clouston said, is “a possible indicator of early stage dementia" for a portion of these first responders.
"We have a large population of people with memory problems in our cohort," he said. "And what we found here is that people with the cognitive impairment had atrophy in their brains similar to Alzheimer's disease."
But Clouston said patients need to be studied longer to determine how these changes, including the brain atrophy, will progress over time.
Michael Barasch, an attorney who represents 20,000 clients with 9/11-related illnesses, including more than 2,500 from Long Island, said the Stony Brook studies are not surprising.
"The numbers are overwhelming in the amount of family members who have been calling to tell me their husbands couldn't do anything anymore cognitively and couldn't remember anything," said Barasch, managing partner at the law firm of Barasch McGarry. "I have absolutely seen this and it's absolutely heartbreaking."
The studies, Barasch said, should prompt Congress to add cognitive-related illnesses and impairments to the list of 9/11-related ailments that are covered by the September 11th Victims Compensation Fund.
Researchers, Clouston said, will be looking for first responders willing to donate their brain after death to help determine which chemicals are responsible for the cognitive impairment.