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Sensitivity of cognitive function tests to acute hypoxia in healthy subjects: a systematic literature review

Post, T.E. and Heijn, L.G. and Jordan, J. and van Gerven, J.M.A. (2023) Sensitivity of cognitive function tests to acute hypoxia in healthy subjects: a systematic literature review. Frontiers in Physiology, 14, p. 1244279. Frontiers Media S.A. doi: 10.3389/fphys.2023.1244279. ISSN 1664-042X.

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Official URL: https://dx.doi.org/10.3389/fphys.2023.1244279


Acute exposure to hypoxia can lead to cognitive impairment. Therefore, hypoxia may become a safety concern for occupational or recreational settings at altitude. Cognitive tests are used as a tool to assess the degree to which hypoxia affects cognitive performance. However, so many different cognitive tests are used that comparing studies is challenging. This structured literature evaluation provides an overview of the different cognitive tests used to assess the effects of acute hypoxia on cognitive performance in healthy volunteers. Less frequently used similar cognitive tests were clustered and classified into domains. Subsequently, the different cognitive test clusters were compared for sensitivity to different levels of oxygen saturation. A total of 38 articles complied with the selection criteria, covering 86 different cognitive tests. The tests and clusters showed that the most consistent effects of acute hypoxia were found with the Stroop test (where 42% of studies demonstrated significant abnormalities). The most sensitive clusters were auditory/verbal memory: delayed recognition (83%); evoked potentials (60%); visual/spatial delayed recognition (50%); and sustained attention (47%). Attention tasks were not particularly sensitive to acute hypoxia (impairments in 0%-47% of studies). A significant hypoxia level-response relationship was found for the Stroop test (p = 0.001), as well as three clusters in the executive domain: inhibition (p = 0.034), reasoning/association (p = 0.019), and working memory (p = 0.024). This relationship shows a higher test sensitivity at more severe levels of hypoxia, predominantly below 80% saturation. No significant influence of barometric pressure could be identified in the limited number of studies where this was varied. This review suggests that complex and executive functions are particularly sensitive to hypoxia. Moreover, this literature evaluation provides the first step towards standardization of cognitive testing, which is crucial for a better understanding of the effects of acute hypoxia on cognition.

Item URL in elib:https://elib.dlr.de/199925/
Document Type:Article
Title:Sensitivity of cognitive function tests to acute hypoxia in healthy subjects: a systematic literature review
AuthorsInstitution or Email of AuthorsAuthor's ORCID iDORCID Put Code
Post, T.E.German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, GermanyUNSPECIFIEDUNSPECIFIED
Heijn, L.G.Centre for Human Drug Research (CHDR), Leiden, NetherlandsUNSPECIFIEDUNSPECIFIED
Jordan, J.UNSPECIFIEDhttps://orcid.org/0000-0003-4518-0706UNSPECIFIED
van Gerven, J.M.A.Centre for Human Drug Research (CHDR), Leiden, NetherlandsUNSPECIFIEDUNSPECIFIED
Date:11 October 2023
Journal or Publication Title:Frontiers in Physiology
Refereed publication:Yes
Open Access:Yes
Gold Open Access:Yes
In ISI Web of Science:Yes
Page Range:p. 1244279
Publisher:Frontiers Media S.A
Keywords:acute hypobaric hypoxia; acute normobaric hypoxia; cognitive function; healthy volunteers; sensitivity
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Research under Space Conditions
DLR - Research theme (Project):R - CardioBrain, R - Bone metabolism and structural adaptation
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Institute of Aerospace Medicine > Leitungsbereich ME
Deposited By: Schrage, Larissa
Deposited On:05 Dec 2023 16:00
Last Modified:30 Jan 2024 10:28

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