{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:36:18Z","timestamp":1783704978673,"version":"3.55.0"},"reference-count":50,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T00:00:00Z","timestamp":1555545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["2U50\/OH009739 & 5U50\/OH009739"],"award-info":[{"award-number":["2U50\/OH009739 & 5U50\/OH009739"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005220","name":"Agency for Toxic Substances and Disease Registry","doi-asserted-by":"publisher","award":["5U50\/OH009739"],"award-info":[{"award-number":["5U50\/OH009739"]}],"id":[{"id":"10.13039\/100005220","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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)\u2014potential symptoms of cognitive decline\u2014are occurring among enrollees aged 35\u201364 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.<\/jats:p>","DOI":"10.3390\/ijerph16081401","type":"journal-article","created":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T11:58:21Z","timestamp":1555588701000},"page":"1401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["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"],"prefix":"10.3390","volume":"16","author":[{"given":"Kacie","family":"Seil","sequence":"first","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengchao","family":"Yu","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Alper","sequence":"additional","affiliation":[{"name":"New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 125 Worth Street, New York, NY 10013, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1001\/jama.2009.1121","article-title":"Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack","volume":"302","author":"Brackbill","year":"2009","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1002\/ajim.22644","article-title":"Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the 11 September 2001, terrorist attacks","volume":"59","author":"Li","year":"2016","journal-title":"Am. 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