World Trade Center responders with PTSD show signs of accelerated brain aging

A new study published in Translational Psychiatry has found that post-traumatic stress disorder is associated with accelerated biological aging in the brain. Researchers found that World Trade Center responders with PTSD had brains that appeared approximately three years older than their chronological age compared to responders without the disorder. This research suggests that the condition involves tangible structural changes to the brain that persist long after the initial trauma.

The health impacts of the September 11, 2001 attacks extend well beyond the immediate physical injuries sustained at Ground Zero. Many responders who assisted in the rescue and recovery efforts developed chronic psychological conditions. PTSD remains particularly prevalent in this population. Previous studies have linked the disorder to various markers of accelerated aging in the body, such as changes in immune function and inflammation.

The specific impact of the disorder on the biological aging of the brain itself has remained less clear. Determining how PTSD affects brain structure is necessary for understanding long-term health risks. Individuals with the condition face a higher statistical likelihood of developing age-related conditions like memory decline or dementia earlier in life. By identifying biological markers of brain aging, scientists hope to create better tools for early diagnosis and treatment.

“Nearly a quarter of World Trade Center responders continue to experience chronic PTSD more than two decades after 9/11, yet we still lack clear biological markers that capture its long-term impact on the brain,” said study author Azzurra Invernizzi of the Icahn School of Medicine at Mount Sinai.

“Previous MRI studies showed structural and functional brain differences in responders with PTSD, but these findings were often region-specific and difficult to translate into an overall picture of brain health. We wanted to address this gap by asking whether PTSD is associated with accelerated brain aging — a single, intuitive metric that reflects cumulative brain
changes and may help explain long-term cognitive and health risks in this population.”

The research team recruited 99 World Trade Center responders to participate in the study. This group included 47 individuals diagnosed with PTSD and 52 individuals with no history of the disorder. The participants were matched based on key demographics such as age, sex, and occupation to ensure a fair comparison. The average age of the participants was approximately 55 years.

Each participant underwent a high-resolution structural magnetic resonance imaging scan. The researchers then employed a specialized artificial intelligence tool called BrainAgeNeXt to analyze these scans. This tool uses a form of deep learning called a convolutional neural network. The model estimates a person’s “brain age” based on anatomical features captured in the MRI data.

The model was previously trained on over 11,000 MRI scans from healthy individuals to learn what a brain typically looks like at different stages of life. This training allows the software to bypass manual measurements and identify complex patterns across the entire brain volume. The team calculated a metric known as the Brain Age Difference for each responder.

This number represents the gap between the age predicted by the MRI scan and the person’s actual chronological age. A positive number indicates the brain appears older than expected. A negative number suggests it appears younger or consistent with healthy aging. The researchers used this metric to compare the two groups of responders.

“Brain age is a summary measure, not a diagnosis, but even modest shifts are meaningful because they reflect widespread changes across the brain rather than isolated regions,” Invernizzi explained. “Accelerated brain aging has been linked in other studies to cognitive decline and increased risk for age-related neurological conditions.”

The analysis revealed a significant distinction between the groups. Responders diagnosed with PTSD showed an average Brain Age Difference of approximately 3.07 years. In contrast, responders without the disorder showed an average difference of negative 0.43 years. This indicates that the brains of those with the condition showed structural signs associated with advanced age compared to their trauma-exposed peers.

“One striking aspect was how clearly PTSD status alone distinguished brain aging trajectories, even among individuals with shared exposures and similar demographic characteristics,” Invernizzi told PsyPost. “This suggests that PTSD itself may play a central role in shaping long-term brain outcomes, beyond general stress or aging effects.”

Further examination linked these higher brain age estimates to specific anatomical changes. The researchers observed associations between increased brain age and larger volumes of cerebrospinal fluid and ventricular spaces. These patterns typically signify a loss of brain tissue or atrophy. In the PTSD group specifically, a smaller thalamus was associated with an older-appearing brain. The thalamus is a region involved in sensory processing and fear regulation.

The study also assessed the duration of time responders spent working at the World Trade Center site. The data indicated that the length of exposure moderated the relationship between the disorder and brain age. Responders with PTSD who spent more time working at the disaster site tended to show greater increases in estimated brain age.

This interaction suggests that the combination of the psychological condition and prolonged exposure to the environmental stressors of the site may compound the effects on brain structure. Responders faced both psychological trauma and exposure to particulate matter and toxins during the recovery efforts. The study implies these factors might work synergistically to accelerate aging processes.

“The key takeaway is that PTSD is not only a psychological condition—it is associated with measurable, long-lasting changes in the brain,” Invernizzi said. “In responders exposed to the extreme trauma of 9/11, PTSD was linked to a brain that appears ‘older’ than expected for a person’s chronological age. This underscores the importance of recognizing PTSD as a condition with real biological consequences and reinforces the need for long-term monitoring and support for affected individuals.”

While the findings provide insight into the biological footprint of PTSD, there are limitations to consider. The study utilized a cross-sectional design. This means the data was collected at a single point in time. This structure prevents researchers from proving that the disorder caused the accelerated aging. It remains possible that pre-existing brain differences made some individuals more susceptible to developing the condition.

“It’s important to note that an ‘older-appearing’ brain does not mean inevitable cognitive decline or neurodegenerative disease,” Invernizzi noted. “Brain age is a statistical biomarker, not a clinical diagnosis. Additionally, while our findings show a strong association between PTSD and accelerated brain aging, they do not prove causality.”

Future research efforts will likely focus on longitudinal studies that track participants over many years. Monitoring how these brain age markers change over time could help clarify the direction of the relationship between trauma and aging. Scientists also aim to investigate whether specific treatments or lifestyle interventions might slow or reverse these patterns.

“Our next steps include examining how brain aging relates to cognitive performance, physical health, and functional outcomes over time, as well as identifying factors—such as treatment, resilience, or lifestyle—that may slow or reverse accelerated brain aging in PTSD,” Invernizzi told PsyPost. “Ultimately, we hope this work will inform targeted interventions and improve long-term care for trauma exposed populations.”

“This study also highlights the potential of advanced AI-based neuroimaging tools to capture complex brain changes in real-world clinical populations. By using a data-driven approach trained on thousands of brain scans, we can move closer to objective, scalable biomarkers that complement traditional clinical assessments and help bridge neuroscience and public health.”

The study, “MRI signature of brain age underlying post-traumatic stress disorder in World Trade Center responders,” was authored by Azzurra Invernizzi, Francesco La Rosa, Anna Sather, Elza Rechtman, Ismail Nabeel, R. Sean Morrison, Alison C. Pellecchia, Stephanie Santiago-Michels, Evelyn J. Bromet, Roberto G. Lucchini, Benjamin J. Luft, Sean A. Clouston, Erin S. Beck, Cheuk Y. Tang, and Megan K. Horton.