Posttraumatic stress disorder (PTSD) has been linked to increased prevalence and incidence of cognitive and physical impairment. When comorbid, these conditions may be associated with poor long-term outcomes. We examined associations between chronic PTSD and symptom domains with cognitive and physical functioning in World Trade Center (WTC) responders nearly 20 years after the September 11, 2001, terrorist attacks. Participants included a cross-sectional sample of 4,815 responders who attended a monitoring program in 2015–2018. Montreal Cognitive Assessment scores less than 23 indicated cognitive impairment (CogI); Short Physical Performance Battery scores 9 or lower on a hand-grip test indicated physical impairment (PhysI). Comorbid cognitive/physical impairment (Cog/PhysI) was defined as having cognitive impairment with at least one objective PhysI indicator. Clinical chart review provided PTSD diagnoses; symptom domains were assessed using the PTSD Checklist. Participants were on average 53.05 years (SD = 8.01); 13.44% had PTSD, 7.8% had CogI, 24.8% had PhysI, and 5.92% had comorbid Cog/PhysI. Multivariable-adjusted multinomial logistic regression demonstrated that Responders with PTSD have more than three times the risk of Cog/PhysI (adjusted RR = 3.29, 95% CI 2.44- 4.44). Domain-specific analyses revealed that emotional numbing symptoms predicted an increased risk of PhysI (adjusted RR = 1.57, 95% CI 1.08-2.28), whereas reexperiencing symptoms were associated with comorbid Cog/PhysI (adjusted RR = 3.96, 95% CI, 2.33-6.74). These results suggest that responders with chronic PTSD may have increased risk of deficits beyond age-expected impairment characterized by the emergence of comorbid Cog/PhysI at midlife.

中文翻译：

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世贸中心响应者的慢性创伤后应激障碍和合并认知和身体障碍

创伤后应激障碍 (PTSD) 与认知和身体损伤的患病率和发病率增加有关。当合并症时，这些情况可能与长期预后不良有关。我们在 2001 年 9 月 11 日恐怖袭击事件发生近 20 年后，研究了世界贸易中心 (WTC) 响应者中慢性 PTSD 和症状域与认知和身体功能之间的关联。参与者包括 4,815 名响应者的横截面样本，他们在 2015-2018 年参加了一项监测计划。蒙特利尔认知评估评分低于 23 分表明认知障碍 (CogI)；短期物理性能电池在手握测试中得分为 9 或更低表明存在身体损伤 (PhysI)。合并认知/身体障碍 (Cog/PhysI) 被定义为具有至少一个客观 PhysI 指标的认知障碍。临床图表审查提供了 PTSD 诊断；使用 PTSD 检查表评估症状域。参与者平均为 53.05 岁（标准差 = 8.01); 13.44% 有 PTSD，7.8% 有 CogI，24.8% 有 PhysI，5.92% 有 Cog/PhysI 共病。多变量调整多项逻辑回归表明，患有 PTSD 的响应者发生 Cog/PhysI 的风险是其三倍以上（调整后的RR = 3.29，95% CI 2.44-4.44）。特定领域的分析显示，情绪麻木症状预示着 PhysI 的风险增加（调整后的RR = 1.57, 95% CI 1.08-2.28），而重新体验症状与 Cog/PhysI 共病相关（调整后的RR = 3.96, 95% CI, 2.33 -6.74)。这些结果表明，患有慢性 PTSD 的反应者可能会增加超出预期年龄损伤的缺陷风险，其特征是在中年出现共病 Cog/PhysI。