A Prospective Evaluation of the Acute Effects of High Altitude on Cognitive and Physiological Functions in Lowlanders

Marika Falla, Costanza Papagno, Tomas Dal Cappello, Anna Vögele, Katharina Hüfner, Jenny Kim, Elisabeth M Weiss, Bernhard Weber, Martin Palma, Simona Mrakic-Sposta, Hermann Brugger, Giacomo Strapazzon, Marika Falla, Costanza Papagno, Tomas Dal Cappello, Anna Vögele, Katharina Hüfner, Jenny Kim, Elisabeth M Weiss, Bernhard Weber, Martin Palma, Simona Mrakic-Sposta, Hermann Brugger, Giacomo Strapazzon

Abstract

Cognitive function impairment due to high altitude exposure has been reported with some contradictory results regarding the possible selective cognitive domain involvement. We prospectively evaluated in 36 lowlanders, exposed for 3 consecutive days to an altitude of 3,269 m, specific cognitive abilities (attention, processing speed, and decision-making) required to safely explore the mountains, as well as to work at altitude. We simultaneously monitored the physiological parameters. Our study provides evidence of a reduced processing speed in lowlanders when exposed to altitude in the first 24 h. There was a fairly quick recovery since this impairment was no more detectable after 36 h of exposure. There were no clinically relevant effects on decision-making, while psychomotor vigilance was unaffected at altitude except for individuals with poor sleep. Significant changes were seen in physiological parameters (increased heart rate and reduced peripheral oxygen saturation). Our results may have practical implications, suggesting that individuals should practice prudence with higher ascent when performing risky activities in the first 24-36 h, even at altitudes below 3,500 m, due to an impairment of the cognitive performance that could worsen and lead to accidents.

Keywords: altitude; attention; cognitive functions; decision-making; speed-processing.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Falla, Papagno, Dal Cappello, Vögele, Hüfner, Kim, Weiss, Weber, Palma, Mrakic-Sposta, Brugger and Strapazzon.

Figures

Figure 1
Figure 1
Timeline of cognitive test, questionnaires administration, and physiological-parameter recording. BART, Balloon Analogue Risk Task; D, day; DSST, Digit Symbol Substitution Test; GQ, general questionnaire; HR, heart rate; ISI, Insomnia Severity Index; LLS, Lake Louise Score; PVT, Psychomotor Vigilance Test; S, session; SpO2, peripheral oxygen saturation; STAI, State and Trait Anxiety Inventory (Y1-state and Y2-trait).
Figure 2
Figure 2
Boxplots of Lake Louise Score (LLS), Insomnia Severity Index (ISI), State and Trait Anxiety Inventory (STAI-Y1-state), Heart rate (HR), and peripheral oxygen saturation (SpO2) at baseline and sessions at altitude (3,269 m). Test performed was Friedman test. Pairwise comparisons were analyzed by means of Wilcoxon signed-rank test and the p-values were adjusted by means of Holm-Bonferroni correction. Statistically significant (p < 0.05) pairwise comparisons were denoted by the following symbols: *for session 1 (day 1, 8:00–12:00 AM) vs. session 2 (day 1, 6:00–10:00 PM), °for session 1 vs. session 3 (day 2, 6:00–8:00 AM), ¶for session 1 vs. session 4 (day 3, 6:00–8:00 AM), ^for session 2 vs. session 3, §for session 2 vs. session 4, and #for session 3 vs. session 4. bpm, beats per minute; •, outlier.
Figure 3
Figure 3
Boxplots of cognitive test parameters at baseline and sessions at altitude (3,269 m). The p-values were calculated by means of generalized estimating equations (GEE) and adjusted by means of Holm-Bonferroni correction. Statistically significant (p < 0.05) pairwise comparisons were denoted by the following symbols: *for session 1 (day 1, 8:00–12:00 AM) vs. session 2 (day 1, 6:00–10:00 PM), ¶for session 1 vs. session 4 (day 3, 6:00–8:00 AM), §for session 2 vs. session 4, and #for session 3 (day 2, 6:00–8:00 AM) vs. session 4. BART, Balloon Analogue Risk Task; DSST, Digit Symbol Substitution Test; PVT, Psychomotor Vigilance Test; RT, reaction time; •, outlier.

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