World Trade Center Responders with Cognitive Impairment Found to Have Decreased Cerebellar Cortical Thickness

Jessica George ’24

Figure 1: WTC responders were exposed to a multitude of stressors – both physical and psychological 

There is no doubt that the September 11th attack on the World Trade Center (WTC) left devastating effects on the community. WTC-affected individuals, including survivors, first responders, and those involved in the clean up/recovery operation were exposed to a multitude of physical and psychological stressors. Prior neuroimaging studies demonstrate that WTC responders with cognitive impairment experienced connectivity changes in the white matter of their cerebellum. To expand on this research, Dr. Sean A. P Clouston from Renaissance School of Medicine at Stony Brook and colleagues sought to examine changes in cerebellar cortical thickness in WTC responders with cognitive impairment. 

A cohort of 99 WTC responders, 48 of them with cognitive impairment, participated in structural magnetic resonance imaging (MRI). The MRIs were processed to calculate bilateral cortical thickness in 12 cerebral lobes. Analysis revealed that there were symmetric reductions in cerebellar cortical thickness in the Cerebellar Crus I (−0.28 mm) and II (−0.24 mm), and in Lobules IV (−0.09 mm), VI (−0.11 mm), VIIb (−0.18 mm), VIIIa (−0.12 mm), VIIIb (−0.11 mm), and IX (−0.19 mm). Overall, WTC responders with cognitive impairment have a lower cerebellar cortical thickness of -0.17mm. Researchers also explored any possible associations between cerebellar cortical thickness and physical and cognitive functioning. Cognitive functioning was measured via Cogstate battery, a computer-administered program that presented tasks that resembled games. These tasks measured throughput, visual memory, episodic memory, visuospatial learning, visuospatial recall, intraindividual item-response variability, reaction speed, and processing speed. Physical functioning was measured by the Short Physical Performance Battery, which measured chair-rise speed, walking speed, and balance. Results indicate that the group with cognitive impairment displayed worse episodic memory, response and processing speed, visual spatial learning and memory, overall attention, visual memory, and throughput. In regards to physical functioning, the group with cognitive impairments scored worse for walking speed.

Reduced cerebellar cortical thickness in the group with cognitive impairment is associated with an increase in physical and cognitive shortcomings. Furthermore, the lobules of the cerebellum that decreased in thickness overlapped with those lobules that are atrophied in neurodegenerative diseases such as Alzheimer’s disease. However, further research is needed to fully characterize and understand this novel condition in WTC responders with cognitive impairment as no signal was found to align with a previously known neurodegenerative disease. Once a comprehensive understanding is achieved, new treatments can be developed for individuals that have undergone a traumatic event and are suffering from cognitive impairments as a consequence.


[1] S. Clousto, et al., Reduced cerebellar cortical thickness in World Trade Center responders with cognitive impairment. Transl Psychiatry 12, 107 (2022). doi:10.1038/s41398-022-01873-6

[2] Image retrieved from:


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