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A Cognitive Reserve and Social Support-Focused Latent Class Analysis to Predict Self-Reported Confusion or Memory Loss among Middle-Aged World Trade Center Health Registry Enrollees

Author

Listed:
  • Kacie Seil

    (New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA)

  • Shengchao Yu

    (New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA)

  • Howard Alper

    (New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA)

Abstract

The World Trade Center Health Registry includes 9/11 survivors who have been surveyed about their health conditions over time. The prevalence of posttraumatic stress disorder (PTSD) remains high among the cohort and is a risk factor for cognitive impairment or dementia. We thus sought to examine the degree to which confusion or memory loss (CML)—potential symptoms of cognitive decline—are occurring among enrollees aged 35–64 years. Cognitive reserve theory suggests that higher levels of education and engaging in cognitively challenging activities can create stronger neural connections, offering protection against cognitive decline. We hypothesized that enrollees with less cognitive reserve would be more likely to report CML. In this study, we: (1) estimated the incidence of CML in our study sample; (2) identified indicators of cognitive reserve (e.g., indicators of educational attainment, social support); and (3) determined whether CML is associated with cognitive reserve level, stratified by PSTD status. First, we described demographics of the study sample ( n = 14,574) and probable PTSD status, also stratifying by CML. Next, we conducted a latent class analysis on two groups: those with probable PTSD and those without probable PTSD, creating classes with varying cognitive reserve levels. Finally, using adjusted log binomial models, we predicted risk of CML based on cognitive reserve level. The probable PTSD group ( n = 1213) and not probable PTSD group ( n = 13,252) each had four latent classes: low, medium-low, medium-high, and high cognitive reserve. In the probable PTSD model, compared to the high cognitive reserve class, those with medium-low cognitive reserve were 35% more likely to report CML (relative risk (RR) = 1.4, 95% confidence interval (CI): 1.1, 1.7). Among the not probable PTSD group, those with low and medium levels of cognitive reserve were significantly more likely to report CML (RR = 1.8 and 1.4, respectively). Overall, those with less cognitive reserve were more likely to report CML regardless of PTSD status.

Suggested Citation

  • Kacie Seil & Shengchao Yu & Howard Alper, 2019. "A Cognitive Reserve and Social Support-Focused Latent Class Analysis to Predict Self-Reported Confusion or Memory Loss among Middle-Aged World Trade Center Health Registry Enrollees," IJERPH, MDPI, vol. 16(8), pages 1-12, April.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:8:p:1401-:d:223991
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    References listed on IDEAS

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    1. Isobel E M Evans & David J Llewellyn & Fiona E Matthews & Robert T Woods & Carol Brayne & Linda Clare & on behalf of the CFAS-Wales research team, 2018. "Social isolation, cognitive reserve, and cognition in healthy older people," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-14, August.
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    Cited by:

    1. Rebecca Rosen & Yongzhao Shao & Qiao Zhang & Jia Bao & Yian Zhang & Arjun Masurkar & Thomas Wisniewski & Nina Urban & Joan Reibman, 2022. "Cognitive Function among World Trade Center-Exposed Community Members with Mental Health Symptoms," IJERPH, MDPI, vol. 19(6), pages 1-13, March.
    2. Howard E. Alper & Rifat A. Tuly & Kacie Seil & Jennifer Brite, 2020. "Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees," IJERPH, MDPI, vol. 17(19), pages 1-11, October.
    3. Robert D. Daniels & Sean A. P. Clouston & Charles B. Hall & Kristi R. Anderson & David A. Bennett & Evelyn J. Bromet & Geoffrey M. Calvert & Tania Carreón & Steven T. DeKosky & Erica D. Diminich & Cal, 2021. "A Workshop on Cognitive Aging and Impairment in the 9/11-Exposed Population," IJERPH, MDPI, vol. 18(2), pages 1-24, January.
    4. Robert M. Brackbill & Judith M. Graber & William A. (Allen) Robison, 2019. "Editorial for “Long-Term Health Effects of the 9/11 Disaster” in International Journal of Environmental Research and Public Health , 2019," IJERPH, MDPI, vol. 16(18), pages 1-6, September.

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