Sean Alexander Penning Clouston

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Stony Brook University | Stony Brook · Department of Family Population and Preventive Medicine

Introduction: Recent research has found that World Trade Center (WTC) responders in their mid-50s have an elevated prevalence of mild cognitive impairment (MCI) that is associated with neural degeneration and subcortical thinning. This article extends our understanding of the molecular complexity of MCI through gene expression profiling of blood....

Fundamental cause theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources: knowledge, money, power, prestige, and beneficial social connections....

INTRODUCTION Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the pre...

Importance Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. Objective To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe expo...

Posttraumatic stress disorder (PTSD) is associated with shortened lifespan and healthspan, which suggests accelerated aging. Emerging evidence suggests that methylation age may be accelerated in PTSD. It is important to examine whether transcriptional age is also accelerated because transcriptome is highly dynamic, associated with age-related outco...

Background World Trade Center (WTC) responders endured exposures to neurotoxic dust particulate matter. This neuroimaging study examined the presence of amyloidosis in Alzheimer’s disease (AD) regions of interest (ROIs) and associations with exposure duration. Method Simultaneous positron‐emission tomography with [18F]‐florbetaben and magnetic res...

Background World Trade Center (WTC) responders endured exposures to neurotoxic dust particulate matter. This neuroimaging study examined the presence of amyloidosis in Alzheimer’s disease (AD) regions of interest (ROIs) and associations with exposure duration. Method Simultaneous positron‐emission tomography with [¹⁸F]‐florbetaben and magnetic res...

Background Racial differences in the prevalence of mild cognitive impairment (MCI) and Alzheimer’s Disease and related dementia (ADRD) are well documented in aging populations. Using data from a large longitudinal study of adults, Black‐White disparities in mild cognitive impairment (MCI) were estimated and putative mediators of Black‐White dispari...

Background The goal of this study was to determine the incidence of dementia before age 65 years in a prospective study of WTC responders, and compare incidence among responders with severe exposures to debris versus responders not exposed to building debris or those who wore personalized protective equipment (PPE). Methods Data were collected in...

Background Sexual‐minority (e.g., lesbian, gay, bisexual [SM]) people may be at an increased risk of Alzheimer’s disease or a related dementia (ADRD) from stress related to experiences of minoritization. Strong levels of social contact and social support decreases dementia risk; these effects may differ by sex/gender and sexuality. The purpose of t...

Background The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC‐exposed‐FDNY‐responders. The present study screened for mild and severe cognitive impairment in WTC‐exposed FDNY responders using objective tests, compar...

Background Amyloid-β proteins, a hallmark of Alzheimer's disease, are believed to play an adaptive role in the cerebral immune response. Objective Amyloid is believed to play a role in cerebral immune response and could play a similar role in response to air pollution exposures. In the present study, we examined whether WTC exposure duration was a...

Previous work using U.S. data has identified generational shifts, reflected in inter-cohort changes, in the incidence and prevalence of diseases in older ages. This study extends previous findings to England by examining similar results in memory complaints, heart conditions, stroke, diabetes, lung disease, and cancer using data from the English Lo...

Background and Objectives Alzheimer’s disease and related dementias (ADRD) remain a pressing concern in the US, which also has one of the highest incarceration rates worldwide. Existing research has analyzed dementia risk and care among currently incarcerated and homeless populations; this paper fills a gap by examining later-life cognitive dispari...

The men and women involved in rescue and recovery operations at the 9/11 World Trade Center (WTC) site have a greater prevalence (23%) of persistent, clinically significant post-traumatic stress disorder (PTSD). Recent structural and functional magnetic resonance imaging (MRI) studies demonstrate significant neural differences between WTC responder...

Background The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compar...

To contribute to our understanding of cohort differences and the Flynn effect in the cognitive decline among older Americans, this study aims to compare rates of cognitive decline between two birth cohorts within a study of older Americans and to examine the importance of medical and demographic confounders. Analyses used data from the National Hea...

Background Research into COVID-19-related cognitive decline has focused on individuals who are cognitively impaired following hospitalization for COVID-19. Our objective was to determine whether cognitive decline emerged after the onset of COVID-19 and was more pronounced in patients with postacute sequelae of SARS-CoV-2 infection (PASC). Methods...

Introduction Air pollution exposures, especially exposures to particulate matter <2.5 μm in size (PM2.5), are considered a modifiable risk factor for Alzheimer’s disease, with some research suggesting that PM2.5 exposures might cause increased serological amyloidogenesis indicative of a possible amyloid-focused immune response. Materials and Metho...

Background Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance. Methods In this cross‐sectional stud...

Polygenic risk scores (PRS) have potential utility as biomarkers of psychiatric disorders. However, while the schizophrenia (SZ) PRS has been consistently associated with case-control status and a more severe course of illness, the associations between the bipolar (BP) PRS and markers of bipolar disorder vary considerably between studies, with stud...

Posttraumatic stress disorder (PTSD) is often chronic and impairing. Maintenance mechanisms underpinning the long-term stability of symptoms remain poorly understood due to heterogenous presentation. We parsed this heterogeneity by examining how individual differences in key stress-symptom mechanisms relate to the long-term maintenance of PTSD. Our...

In the most comprehensive population surveys, mental health is only broadly captured through questionnaires asking about “mentally unhealthy days” or feelings of “sadness.” Further, population mental health estimates are predominantly consolidated to yearly estimates at the state level, which is considerably coarser than the best estimates of physi...

Background and purpose: Fluorine 18-fluoro-L-dopa ([18F]-FDOPA) was approved by the FDA in 2019 and reimbursed by the Centers for Medicare & Medicaid Services in 2022 for use with PET to visualize dopaminergic nerve terminals in the striatum for evaluation of parkinsonism. We sought to determine the optimal image acquisition time for [18F]-FDOPA P...

Multimodal imaging using network connectivity techniques shows promise for investigating neuropathology influencing Post-Traumatic Stress Disorder (PTSD) symptom maintenance and course. We recruited World Trade Center (WTC) responders who continued to suffer from chronic PTSD into a diffusion tensor neuroimaging protocol (n = 100), along with nine...

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European anc...

Objective The present study examined the 20-year course of posttraumatic stress disorder (PTSD) in World Trade Center (WTC) responders to address four questions: (1) How stable are symptoms of PTSD? (2) What is the average symptom trajectory? (3) How much do responders differ from the average trend? (4) How quickly do PTSD symptoms improve or worse...

Background and Objectives We used longitudinal data to determine whether the type of marital loss is associated with the rate of cognitive change before and after divorce or widowhood. Previous research found that relationship status was associated with older adults’ cognitive performance: married persons performed better on memory assessments and...

Background Foreign born (FB) adults from Latin America are projected to account for the largest proportion of the aging immigrant population in the United States (U.S.) Migration related stressors may increase vulnerability for impairments of stress regulatory systems that are vital in maintaining brain health. We assessed how subjective social sta...

Background The role of social networks in maintaining cognitive health is unclear, in part because few longitudinal studies have explored bidirectional associations between changes in social network structures and cognition. Method Secondary analyses of data collected during nine waves of the National Health and Aging Trends Study (NHATS; 2011‐201...

Progressing cognitive decline causes limitations on daily life and emotional changes, including increased aggression, agitation, and restlessness that might occasion greater scrutiny, limitations, discrimination, and disrespect due to a combination of care-provision and ageism. While there are a number of studies of discrimination as a cause of cog...

Objective Functional connectivity of the default mode network (DMN) during rest has been shown to be different among adults with Mild Cognitive Impairment (MCI) relative to aged-matched individuals without MCI and is predictive of transition to dementia. Post-traumatic stress disorder (PTSD) is also associated with aberrant connectivity of the DMN....

Objectives To better understand bidirectional longitudinal relationships between social networks and cognitive decline. Method: We examined nine waves of data from the National Health and Aging Trends Study (2011-2019). Our primary outcome was global cognition, consisting of a summation of scores on episodic memory, orientation, and executive funct...

Objective Responders of the World Trade Center (WTC) disaster suffer from co‐morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post‐traumatic stress disorder (PTSD). Methods WTC Health Program members ( N = 62), 45–65 years, males 87%, body mas...

Symptoms of coronavirus disease 2019 (COVID-19) can persist for months or years after infection, a condition called Post-Acute Sequelae of COVID-19 (PASC). Whole-brain white matter and cortical gray matter health were assessed using multi-shell diffusion tensor imaging. Correlational tractography was utilized to dissect the nature and extent of whi...

Background The application of wastewater-based epidemiology to track the outbreak and prevalence of coronavirus disease (COVID-19) in communities has been tested and validated by several researchers across the globe. However, the RNA-based surveillance has its inherent limitations and uncertainties. Objective This study aims to complement the ongo...

Background: Cognitive impairment is the most common and disabling manifestation of post-acute sequelae of SARS-CoV-2. There is an urgent need for the application of more stringent methods for evaluating cognitive outcomes in research studies. Objective: To determine whether cognitive decline emerges with the onset of COVID-19 and whether it is more...

The predictive utility of language-based assessments (LBAs) of personality was tested across one year. Spoken language in everyday functioning interviews with 343 World Trade Center (WTC) responders was recorded and transcribed. LBAs that were previously developed using social media text were adapted to the interview transcriptions, resulting in ei...

Objective World Trade Center (WTC) responders demonstrate elevated risk for cognitive impairment (CI) consistent with Alzheimer’s Disease and Related Dementias (ADRD). Neuropsychological test performance is valuable in early detection efforts and non-invasive longitudinal tracking of populations at risk of ADRD. We hypothesized that WTC-CI would be...

Posttraumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ance...

Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of differen...

Objective: World Trade Center (WTC) responders are susceptible to both cognitive and neuropsychiatric impairments, particularly chronic posttraumatic stress disorder. The present study examined self-reported behavioral impairments in a sample of 732 WTC responders, 199 of whom were determined to have high risk of WTC-related cortical atrophy by an...

Objective This study aimed to assess changes in social contact with family, friends and healthcare providers, as well as social participation in working, volunteering, religious services and other organized activities, among older adults during the COVID-19 pandemic while examining the role of pre-COVID sociodemographic characteristics or cognitive...

Background: In December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and...

World Trade Center (WTC) responders exposed to traumatic and environmental stressors during rescue and recovery efforts have a high prevalence of chronic WTC-related post-traumatic stress disorder (WTC-PTSD). We investigated neural mechanisms underlying WTC-PTSD by applying eigenvector centrality (EC) metrics and data-driven methods on resting stat...

Objective: We estimated the conversion from cognitively normal to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight, and obese older adults, where the timing of examinations is associated with the severity of dementia. Methods: We analyzed six waves of the National Health and Aging Trends Study (N...

Background: Researchers are increasingly interested in better methods for assessing the pace of aging in older adults, including vocal analysis. The present study sought to determine whether paralinguistic vocal attributes improve estimates of the age and risk of mortality in older adults. Methods: To measure vocal age, we curated interviews pro...

Objective: Using a large longitudinal sample of adults from the Midlife in the United States (MIDUS) study, the present study extended a recently developed hierarchical model to determine how best to longitudinally model cumulative stress, and to determine whether the rate of change in stress or the level of cumulative stress over time are stronger...

Objective This paper models cognitive aging, across mid and late life, and estimates birth cohort and sex differences in both initial-levels and aging trajectories over time in a sample with multiple cohorts and a wide span of ages. Methods The data used in this study came from the first nine waves of the English Longitudinal Study of Ageing (ELSA...

Introduction: The clock drawing task (CDT) is frequently used to aid in detecting cognitive impairment, but current scoring techniques are time-consuming and miss relevant features, justifying the creation of an automated quantitative scoring approach. Methods: We used computer vision methods to analyze the stored scanned images (N = 7,109), and...

Background: Chronically re-experiencing the memory of a traumatic event might cause a glial response. This study examined whether glial activation would be associated with PTSD in a study of responders present after the 9/11 World Trade Center attacks without comorbid cerebrovascular disease. Methods: Plasma was retrieved from 1,520 WTC responde...

Introduction Prostate Cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various US counties in function of different so...

Background Genetic factors contribute to individual differences in the severity of coronavirus disease 2019 (COVID-19). A portion of genetic predisposition can be captured using polygenic risk scores (PRS). Relatively little is known about the associations between PRS and COVID-19 severity or post-acute COVID-19 in community-dwelling individuals....

Introduction: World Trade Center (WTC) responders are experiencing a high risk of mild cognitive impairment (MCI) and dementia, though the etiology remains inadequately characterized. This study investigated whether WTC exposures and chronic post-traumatic stress disorder (PTSD) were correlated with plasma biomarkers characteristic of Alzheimer's...

The Flynn effect refers to increases over time in measured (particularly fluid) intelligence of approximately 3 IQ points per decade. We define the Flynn effect at the family level, using longitudinal data and two new family-level cohort definitions. Multilevel growth curve analyses of the National Longitudinal Survey of Youth 1979 data showed that...

Compared to physical health, population mental health measurement in the U.S. is very coarse-grained. Currently, in the largest population surveys, such as those carried out by the Centers for Disease Control or Gallup, mental health is only broadly captured through "mentally unhealthy days" or "sadness", and limited to relatively infrequent state...

Background: There is a high incidence of cognitive impairment among World Trade Center (WTC) responders, comorbid with post-traumatic stress disorder (PTSD). Yet, it remains unknown whether genetic liability for Alzheimer's disease, PTSD, educational attainment, or for a combination of these phenotypes, is associated with cognitive impairment in t...

Differences by relationship status have been found in both cognitive‐assessment scores and prevalence and incidence rates for Alzheimer’s disease and related dementias (ADRD), but little is known about delayed and missed ADRD diagnoses after cognitive impairment emerges. Existing research has reported underdiagnosis for people of color, men, and pe...

We examined the mediating or moderating effect of stroke on the effect of cardiovascular disease (CVD) and the onset of Alzheimer’s disease (AD) in a nationally-representative sample of older Americans with and without clinical depression. Diagnosis of CVD was adjudicated with the established Health and Retirement Study (1992–2016) methodology and...

Researchers have reported that later-born cohorts often have higher scores on cognitive tests, potentially indicating that some of the differences normally attributed to cognitive aging may reflect developmental differences. The present study examined the hypotheses that social factors at birth and in early adolescence might partially explain birth...

Personality is linked to important health outcomes, but most prior studies have relied on self-reports, making it possible that shared-method variance explains the associations. In the present study, we examined self-reports versus informant-reports of personality and multimethod outcomes. World Trade Center (WTC) responders and informants, 283 pai...

Introduction: The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. U...

Emotional deficits in psychosis are prevalent and difficult to treat. In particular, much remains unknown about facial expression abnormalities, and a key reason is that expressions are very labor-intensive to code. Artificial intelligence measures of non-verbal expressions (nveAI) can remove this barrier. The current study sought to increase under...

Background The factors associated with estimated glomerular filtrate rate (eGFR) decline in low risk adults remain relatively unknown. We hypothesized that a polygenic risk score (PRS) will be associated with eGFR decline. Methods We analyzed genetic data from 1,601 adult participants with European ancestry in the World Trade Center Health Program...

Objective Amyloid positron emission tomography (PET) plays a vital role in the in vivo detection of β-amyloid accumulation in Alzheimer's disease. Increasingly, trainees and infrequent readers are relying on semiquantitative analyses to support clinical diagnostic efforts. Our objective was to determine if the visual assessment of amyloid PET may b...

Responders to the World Trade Center (WTC) attacks on 9/11/2001 inhaled toxic dust and experienced severe trauma for a prolonged period. Studies report that WTC site exposure duration is associated with peripheral inflammation and risk for developing early-onset dementia (EOD). Free Water Fraction (FWF) can serve as a biomarker for neuroinflammatio...

Background and Objectives Posttraumatic stress disorder (PTSD) has been linked to increased risk of cognitive dysfunction and physical functional impairment (PFI). The objective of this prospective cohort study was to examine whether PFI was associated with increased risk of incident mild cognitive impairment (MCI) among World Trade Center (WTC) re...

Purpose Incidence of early onset neurocognitive dysfunction has been reported in World Trade Center (WTC) responders. Ongoing studies are investigating the underlying etiology, as we are concerned that an underlying risk of neurodegenerative dementia may be occurring because of their stressful and neurotoxic exposures to particulate matter when the...

Background Genetic factors contribute to individual differences in the severity of coronavirus disease 2019 (COVID-19). A portion of genetic predisposition can be captured using polygenic risk scores (PRS). Relatively little is known about the associations between PRS and COVID-19 severity or post-acute COVID-19 in community-dwelling individuals....