1
|
De Wachter J, Roose M, Proost M, Habay J, Verstraelen M, De Bock S, De Pauw K, Meeusen R, Van Cutsem J, Roelands B. Prefrontal cortex oxygenation during a mentally fatiguing task in normoxia and hypoxia. Exp Brain Res 2024; 242:1807-1819. [PMID: 38839618 PMCID: PMC11208267 DOI: 10.1007/s00221-024-06867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
Mental fatigue (MF) and hypoxia impair cognitive performance through changes in brain hemodynamics. We want to elucidate the role of prefrontal cortex (PFC)-oxygenation in MF. Twelve participants (22.9 ± 3.5 years) completed four experimental trials, (1) MF in (normobaric) hypoxia (MF_HYP) (3.800 m; 13.5%O2), (2) MF in normoxia (MF_NOR) (98 m; 21.0%O2), (3) Control task in HYP (CON_HYP), (4) Control in NOR (CON_NOR). Participants performed a 2-back task, Digit Symbol Substitution test and Psychomotor Vigilance task before and after a 60-min Stroop task or an emotionally neutral documentary. Brain oxygenation was measured through functional Near Infrared Spectroscopy. Subjective feelings of MF and physiological measures (heart rate, oxygen saturation, blood glucose and hemoglobin) were recorded. The Stroop task resulted in increased subjective feelings of MF compared to watching the documentary. 2-back accuracy was lower post task compared to pre task in MF_NOR and CON_NOR, while no differences were found in the other cognitive tasks. The fraction of inspired oxygen did not impact feelings of MF. Although performing the Stroop resulted in higher subjective feelings of MF, hypoxia had no effect on the severity of self-reported MF. Additionally, this study could not provide evidence for a role of oxygenation of the PFC in the build-up of MF.
Collapse
Affiliation(s)
- Jonas De Wachter
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manon Roose
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Matthias Proost
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jelle Habay
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Matthias Verstraelen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sander De Bock
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jeroen Van Cutsem
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- VIPER Research Unit, Royal Military Academy, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium.
| |
Collapse
|
2
|
Gao J, Guo Z, Zhao M, Cheng X, Jiang X, Liu Y, Zhang W, Yue X, Fei X, Jiang Y, Chen L, Zhang S, Zhao T, Zhu L. Lipidomics and mass spectrometry imaging unveil alterations in mice hippocampus lipid composition exposed to hypoxia. J Lipid Res 2024; 65:100575. [PMID: 38866327 DOI: 10.1016/j.jlr.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
Lipids are components of cytomembranes that are involved in various biochemical processes. High-altitude hypoxic environments not only affect the body's energy metabolism, but these environments can also cause abnormal lipid metabolism involved in the hypoxia-induced cognitive impairment. Thus, comprehensive lipidomic profiling of the brain tissue is an essential step toward understanding the mechanism of cognitive impairment induced by hypoxic exposure. In the present study, mice showed reduced new-object recognition and spatial memory when exposed to hypobaric hypoxia for 1 day. Histomorphological staining revealed significant morphological and structural damage to the hippocampal tissue, along with prolonged exposure to hypobaric hypoxia. Dynamic lipidomics of the mouse hippocampus showed a significant shift in both the type and distribution of phospholipids, as verified by spatial lipid mapping. Collectively, a diverse and dynamic lipid composition in mice hippocampus was uncovered, which deepens our understanding of biochemical changes during sustained hypoxic exposure and could provide new insights into the cognitive decline induced by high-altitude hypoxia exposure.
Collapse
Affiliation(s)
- Jiayue Gao
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Zhiying Guo
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Ming Zhao
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiang Cheng
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiufang Jiang
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yikun Liu
- State Key Laboratory of Precision Measurement Technology and Instruments, Department of Precision Instrument, Tsinghua University, Beijing, China
| | - Wenpeng Zhang
- State Key Laboratory of Precision Measurement Technology and Instruments, Department of Precision Instrument, Tsinghua University, Beijing, China
| | - Xiangpei Yue
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xuechao Fei
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yaqun Jiang
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Lu Chen
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Shaojie Zhang
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Tong Zhao
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Lingling Zhu
- Department of Brain Plasticity, Beijing Institute of Basic Medical Sciences, Beijing, China; Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.
| |
Collapse
|
3
|
Su R, Jia S, Zhang N, Wang Y, Li H, Zhang D, Ma H, Su Y. The effects of long-term high-altitude exposure on cognition: A meta-analysis. Neurosci Biobehav Rev 2024; 161:105682. [PMID: 38642865 DOI: 10.1016/j.neubiorev.2024.105682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Abstract
Long-term high altitudes (HA) exposure's impact on cognition has yielded inconsistent findings in previous research. To address this, we conducted a meta-analysis of 49 studies (6191 individuals) to comprehensively evaluate this effect. Moderating factors such as cognitive task type, altitude (1500-2500 m, 2500-4000 m, and above 4000 m), residential type (chronic and lifelong), adaptation level and demographic factors were analyzed. Cognitive tasks were classified into eight categories: perceptual processes, psychomotor function, long-term memory, working memory, inhibitory control, problem-solving, language, and others. Results revealed a moderate negative effect of HA on cognitive performance (g = -.40, SE =.18, 95% CI = -.76 to -.05). Psychomotor function and long-term memory notably experience the most pronounced decline, while working memory and language skills show moderate decreases due to HA exposure. However, perceptual processes, inhibitory control, and problem-solving abilities remain unaffected. Moreover, residing at altitudes above 4000 m and being a HA immigrant are associated with significant cognitive impairment. In summary, our findings indicate a selective adaptation of cognitive performance to HA conditions.
Collapse
Affiliation(s)
- Rui Su
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, China; Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China
| | - Shurong Jia
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China
| | - Niannian Zhang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China
| | - Yiyi Wang
- Department of Psychology, University of Chicago, Chicago, IL 60637, United States
| | - Hao Li
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China
| | - Delong Zhang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Hailin Ma
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa 85000, China
| | - Yanjie Su
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing 100871, China.
| |
Collapse
|
4
|
McMorris T, Hale BJ, Pine BS, Williams TB. Creatine supplementation research fails to support the theoretical basis for an effect on cognition: Evidence from a systematic review. Behav Brain Res 2024; 466:114982. [PMID: 38582412 DOI: 10.1016/j.bbr.2024.114982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024]
Abstract
Creatine supplementation has been put forward as a possible aid to cognition, particularly for vegans, vegetarians, the elderly, sleep deprived and hypoxic individuals. However, previous narrative reviews have only provided limited support for these claims. This is despite the fact that research has shown that creatine supplementation can induce increased brain concentrations of creatine, albeit to a limited extent. We carried out a systematic review to examine the current state of affairs. The review supported claims that creatine supplementation can increases brain creatine content but also demonstrated somewhat equivocal results for effects on cognition. It does, however, provide evidence to suggest that more research is required with stressed populations, as supplementation does appear to significantly affect brain content. Issues with research design, especially supplementation regimens, need to be addressed. Future research must include measurements of creatine brain content.
Collapse
Affiliation(s)
- Terry McMorris
- Institue of Sport, Nursing and Allied Health, University of Chichester, College Lane, Chichester PO19 6PE, United Kingdom; Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth PO12ER, United Kingdom.
| | - Beverley J Hale
- Institue of Sport, Nursing and Allied Health, University of Chichester, College Lane, Chichester PO19 6PE, United Kingdom
| | - Beatrice S Pine
- Institue of Sport, Nursing and Allied Health, University of Chichester, College Lane, Chichester PO19 6PE, United Kingdom
| | - Thomas B Williams
- Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth PO12ER, United Kingdom
| |
Collapse
|
5
|
Lin Y, Yan J, Guo X, Lin H, Ruan C, Dai Y, Wang S, Cao Y, Xiang Q, Yang M, Liu W, Chen L. Effects of Exercise Training Under Hypoxia Versus Normoxia on Cognitive Function in Clinical and Non-Clinical Populations: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:975-987. [PMID: 37660776 DOI: 10.1016/j.apmr.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare the effects of exercise training under hypoxia versus normoxia on cognitive function in clinical and non-clinical populations. DATA SOURCES From inception to June 13th, 2022, a systematic search was performed on PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized controlled trials comparing the effects of exercise under hypoxic vs normoxic on cognition in clinical and non-clinical populations were included. The systematic search generated 14,894 relevant studies, of which 12 were finally included. DATA EXTRACTION Two reviewers independently extracted data from included studies. Results were expressed as standardized mean difference (SMD). Each included study was assessed using the Cochrane Risk of Bias 1.0 (RoB1.0) tool. Finally, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to rate the certainty of evidence for each outcome. DATA SYNTHESIS Overall, 12 studies with a total of 338 participants met the inclusion criteria. The pooled results suggested that hypoxia exercise had a small but not statistically significant positive effect on overall cognitive function (SMD=0.064, 95% confidence interval (CI): -0.156-0.284, P=.567, very low-certainty evidence), when compared with normoxic exercise. Regarding the domain-specific cognitive functions, there was a medium and significant positive effect on memory (SMD=0.594, 95% CI: 0.068 to 1.120, P=.027, very low-certainty evidence), while effects on visuospatial function (SMD=0.490, 95% CI: -0.030 to 1.010, P=.065, very low-certainty evidence), attention (SMD=0.037, 95% CI: -0.340 to 0.414, P=.847, very low-certainty evidence), executive function (SMD=0.096, 95% CI: -0.268 to 0.460, P=.605, very low-certainty evidence), and processing speed (SMD=-0.145, 95% CI: -0.528 to 0.239, P=.459, very low-certainty evidence) were not statistically significant. CONCLUSIONS The current pooled results revealed that hypoxic exercise was related to improved cognitive performance. Nevertheless, exercise under hypoxia did not have a significant advantage in cognitive promotion when compared with exercise under normoxia.
Collapse
Affiliation(s)
- Yanting Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Jiamin Yan
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Xiaoqin Guo
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Huawei Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Chendong Ruan
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Yaling Dai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Sinuo Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Yajun Cao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Qing Xiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Minguang Yang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Weilin Liu
- The Institute of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Lidian Chen
- The Institute of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
| |
Collapse
|
6
|
Wang NN, Yu SF, Dang P, Su R, Li H, Ma HL, Liu M, Zhang DL. The neuroimmune pathway of high-altitude adaptation: influence of erythrocytes on attention networks through inflammation and the autonomic nervous system. Front Neurosci 2024; 18:1373136. [PMID: 38638694 PMCID: PMC11024340 DOI: 10.3389/fnins.2024.1373136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Many studies have shown that the functional adaptation of immigrants to high-altitude is closely related to oxygen transport, inflammatory response and autonomic nervous system. However, it remains unclear how human attention changes in response to hypoxia-induced neurophysiological activity during high-altitude exposure. Methods In the present study, we analyzed the relationship between hypoxic-induced neurophysiological responses and attention networks in 116 immigrants (3,680 m) using an attention network test to simultaneously record electroencephalogram and electrocardiogram in combination with specific routine blood markers. Results Our analysis revealed that red blood cells exert an indirect influence on the three attention networks, mediated through inflammatory processes and heart rate variability. Discussion The present study provides experimental evidence for the role of a neuroimmune pathway in determining human attention performance at high- altitude. Our findings have implications for understanding the complex interactions between physiological and neurocognitive processes in immigrants adapting to hypoxic environments.
Collapse
Affiliation(s)
- Nian-Nian Wang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
- Key Laboratory of Brain, Cognition, and Education Sciences, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Si-Fang Yu
- Key Laboratory of Brain, Cognition, and Education Sciences, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Peng Dang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Rui Su
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Hao Li
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Hai-Lin Ma
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Ming Liu
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
- Key Laboratory of Brain, Cognition, and Education Sciences, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - De-Long Zhang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
- Key Laboratory of Brain, Cognition, and Education Sciences, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
- School of Educational Sciences, Kashi University, Kashi, China
| |
Collapse
|
7
|
Tonellato MH, Cates VC, Dickenson JA, Day TA, Strzalkowski NDJ. The effects of acute normobaric hypoxia on standing balance while dual-tasking with and without visual input. Eur J Appl Physiol 2024:10.1007/s00421-024-05469-4. [PMID: 38573534 DOI: 10.1007/s00421-024-05469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/09/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To investigate the influence of acute normobaric hypoxia on standing balance under single and dual-task conditions, both with and without visual input. METHODS 20 participants (7 female, 20-31 years old) stood on a force plate for 16, 90-s trials across four balance conditions: single-task (quiet stance) or dual-task (auditory Stroop test), with eyes open or closed. Trials were divided into four oxygen conditions where the fraction of inspired oxygen (FIO2) was manipulated (normoxia: 0.21 and normobaric hypoxia: 0.16, 0.145 and 0.13 FIO2) to simulate altitudes of 1100, 3,400, 4300, and 5200 m. Participants breathed each FIO2 for ~ 3 min before testing, which lasted an additional 7-8 min per oxygen condition. Cardiorespiratory measures included heart rate, peripheral blood oxygen saturation, and pressure of end tidal (PET) CO2 and O2. Center of pressure measures included total path length, 95% ellipse area, and anteroposterior and mediolateral velocity. Auditory Stroop test performance was measured as response accuracy and latency. RESULTS Significant decreases in oxygen saturation and PETO2, and increased heart rate were observed between normoxia and normobaric hypoxia (P < 0.0001). Total path length was higher at 0.13 compared to 0.21 FIO2 for the eyes closed no Stoop test condition (P = 0.0197). No other significant differences were observed. CONCLUSION These findings suggest that acute normobaric hypoxia has a minimal impact on standing balance and does not influence auditory Stroop test or dual-task performance. Further investigation with longer exposure is required to understand the impact and time course of normobaric hypoxia on standing balance.
Collapse
Affiliation(s)
- Marshall H Tonellato
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4826Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Valerie C Cates
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4826Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Jessica A Dickenson
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4826Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4826Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Nicholas D J Strzalkowski
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4826Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada.
| |
Collapse
|
8
|
Liu B, Yuan M, Yang M, Zhu H, Zhang W. The Effect of High-Altitude Hypoxia on Neuropsychiatric Functions. High Alt Med Biol 2024; 25:26-41. [PMID: 37815821 DOI: 10.1089/ham.2022.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Liu, Bo, Minlan Yuan, Mei Yang, Hongru Zhu, and Wei Zhang. The effect of high-altitude hypoxia on neuropsychiatric functions. High Alt Med Biol. 25:26-41, 2024. Background: In recent years, there has been a growing popularity in engaging in activities at high altitudes, such as hiking and work. However, these high-altitude environments pose risks of hypoxia, which can lead to various acute or chronic cerebral diseases. These conditions include common neurological diseases such as acute mountain sickness (AMS), high-altitude cerebral edema, and altitude-related cerebrovascular diseases, as well as psychiatric disorders such as anxiety, depression, and psychosis. However, reviews of altitude-related neuropsychiatric conditions and their potential mechanisms are rare. Methods: We conducted searches on PubMed and Google Scholar, exploring existing literature encompassing preclinical and clinical studies. Our aim was to summarize the prevalent neuropsychiatric diseases induced by altitude hypoxia, the potential pathophysiological mechanisms, as well as the available pharmacological and nonpharmacological strategies for prevention and intervention. Results: The development of altitude-related cerebral diseases may arise from various pathogenic processes, including neurovascular alterations associated with hypoxia, cytotoxic responses, activation of reactive oxygen species, and dysregulation of the expression of hypoxia inducible factor-1 and nuclear factor erythroid 2-related factor 2. Furthermore, the interplay between hypoxia-induced neurological and psychiatric changes is believed to play a role in the progression of brain damage. Conclusions: While there is some evidence pointing to pathophysiological changes in hypoxia-induced brain damage, the precise mechanisms responsible for neuropsychiatric alterations remain elusive. Currently, the range of prevention and intervention strategies available is primarily focused on addressing AMS, with a preference for prevention rather than treatment.
Collapse
Affiliation(s)
- Bo Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
- Zigong Mental Health Center, Zigong, China
| | - Minlan Yuan
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Mei Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China School of Basic Medical Sciences and Forensic Medicine, Chengdu, Sichuan
| | - Hongru Zhu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Keeler JM, Listman JB, Hite MJ, Heeger DJ, Tourula E, Port NL, Schlader ZJ. Arterial oxygen desaturation during moderate hypoxia hinders sensorimotor performance. PLoS One 2024; 19:e0297486. [PMID: 38394255 PMCID: PMC10889874 DOI: 10.1371/journal.pone.0297486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/06/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Moderate hypoxia may impact cognitive and sensorimotor performance prior to self-recognized impairments. Therefore, rapid and objective assessment tools to identify people at risk of impaired function during moderate hypoxia is needed. PURPOSE Test the hypothesis that reductions in arterial oxygen saturation during moderate normobaric hypoxia (FiO2 = 14%) decreases gamified sensorimotor performance as measured by alterations of motor acuity. METHODS Following three consecutive days of practice, thirty healthy adults (25 ± 5 y, 10 females) completed three bouts of the tablet-based gamified assessment (Statespace Labs, Inc.) of motor acuity at Baseline and 60 and 90 min after exposure to 13.8 ± 0.2% (hypoxia) and 20.1 ± 0.4% (normoxia) oxygen. The gamified assessment involved moving the tablet to aim and shoot at targets. Both conditions were completed on the same day and were administered in a single-blind, block randomized manner. Performance metrics included shot time and shot variability. Arterial oxyhemoglobin saturation estimated via forehead pulse oximetry (SpO2). Data were analyzed using linear mixed effects models. RESULTS Compared to normoxia (99±1%), SpO2 was lower (p<0.001) at 60 (89±3%) and 90 (90±2%) min of hypoxia. Shot time was unaffected by decreases in SpO2 (0.012, p = 0.19). Nor was shot time affected by the interaction between SpO2 decrease and baseline performance (0.006, p = 0.46). Shot variability was greater (i.e., less precision, worse performance) with decreases in SpO2 (0.023, p = 0.02) and depended on the interaction between SpO2 decrease and baseline performance (0.029, p< 0.01). CONCLUSION Decreases in SpO2 during moderate hypoxic exposure hinders sensorimotor performance via decreased motor acuity, i.e., greater variability (less precision) with no change in speed with differing decreases in SpO2. Thus, personnel who are exposed to moderate hypoxia and have greater decreases in SpO2 exhibit lower motor acuity, i.e., less precise movements even though decision time and movement speed are unaffected.
Collapse
Affiliation(s)
- Jason M. Keeler
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States of America
| | | | - M. Jo Hite
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States of America
| | - David J. Heeger
- Statespace Labs, Inc. New York, NY, United States of America
| | - Erica Tourula
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States of America
| | - Nicholas L. Port
- School of Optometry, Indiana University, Bloomington, IN, United States of America
| | - Zachary J. Schlader
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States of America
| |
Collapse
|
10
|
Kiuchi M, Uno T, Hasegawa T, Koyama K, Horiuchi M. Influence of short-term hypoxic exposure on spatial learning and memory function and brain-derived neurotrophic factor in rats-A practical implication to human's lost way. Front Behav Neurosci 2024; 18:1330596. [PMID: 38380151 PMCID: PMC10876868 DOI: 10.3389/fnbeh.2024.1330596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
The present study aimed to investigate the effects of a short period of normobaric hypoxic exposure on spatial learning and memory, and brain-derived neurotrophic factor (BDNF) levels in the rat hippocampus. Hypoxic conditions were set at 12.5% O2. We compared all variables between normoxic trials (Norm), after 24 h (Hypo-24 h), and after 72 h of hypoxic exposure (Hypo-72 h). Spatial learning and memory were evaluated by using a water-finding task in an open field. Time to find water drinking fountains was significantly extended in Hypo 24 h (36.2 ± 21.9 s) compared to those in Norm (17.9 ± 12.8 s; P < 0.05), whereas no statistical differences between Norm and Hypo-72 h (22.7 ± 12.3 s). Moreover, hippocampal BDNF level in Hypo-24 h was significantly lower compared to Norm (189.4 ± 28.4 vs. 224.9 ± 47.7 ng/g wet tissue, P < 0.05), whereas no statistically differences in those between Norm and Hypo-72 h (228.1 ± 39.8 ng/g wet tissue). No significant differences in the changes in corticosterone and adrenocorticotropic hormone levels were observed across the three conditions. When data from Hypo-24 h and Hypo-72 h of hypoxia were pooled, there was a marginal negative relationship between the time to find drinking fountains and BDNF (P < 0.1), and was a significant negative relationship between the locomotor activities and BDNF (P < 0.05). These results suggest that acute hypoxic exposure (24 h) may impair spatial learning and memory; however, it recovered after 72 h of hypoxic exposure. These changes in spatial learning and memory may be associated with changes in the hippocampal BDNF levels in rats.
Collapse
Affiliation(s)
- Masataka Kiuchi
- Graduate School Department of Interdisciplinary Research, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Tadashi Uno
- Division of Human Environmental Science, Mount Fuji Research Institute, Fujiyoshida, Yamanashi, Japan
| | - Tatsuya Hasegawa
- Division of Human Environmental Science, Mount Fuji Research Institute, Fujiyoshida, Yamanashi, Japan
| | - Katsuhiro Koyama
- Faculty of Sport Science, Yamanashi Gakuin University, Kofu, Yamanashi, Japan
| | - Masahiro Horiuchi
- Division of Human Environmental Science, Mount Fuji Research Institute, Fujiyoshida, Yamanashi, Japan
- Faculty of Sports and Life Science, National Institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima, Japan
| |
Collapse
|
11
|
Zhang G, Yang G, Zhou Y, Cao Z, Yin M, Ma L, Fan M, Zhao YQ, Zhu L. Intermittent hypoxia training effectively protects against cognitive decline caused by acute hypoxia exposure. Pflugers Arch 2024; 476:197-210. [PMID: 37994929 DOI: 10.1007/s00424-023-02885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
Intermittent hypoxia training (IHT) is a promising approach that has been used to induce acclimatization to hypoxia and subsequently lower the risk of developing acute mountain sickness (AMS). However, the effects of IHT on cognitive and cerebrovascular function after acute hypoxia exposure have not been characterized. In the present study, we first confirmed that the simplified IHT paradigm was effective at relieving AMS at 4300 m. Second, we found that IHT improved participants' cognitive and neural alterations when they were exposed to hypoxia. Specifically, impaired working memory performance, decreased conflict control function, impaired cognitive control, and aggravated mental fatigue induced by acute hypoxia exposure were significantly alleviated in the IHT group. Furthermore, a reversal of brain swelling induced by acute hypoxia exposure was visualized in the IHT group using magnetic resonance imaging. An increase in cerebral blood flow (CBF) was observed in multiple brain regions of the IHT group after hypoxia exposure as compared with the control group. Based on these findings, the simplified IHT paradigm might facilitate hypoxia acclimatization, alleviate AMS symptoms, and increase CBF in multiple brain regions, thus ameliorating brain swelling and cognitive dysfunction.
Collapse
Affiliation(s)
- Guangbo Zhang
- Department of Cognition Sciences and Stress Medicine, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Guochun Yang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Yanzhao Zhou
- Department of Cognition Sciences and Stress Medicine, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing, China
| | | | - Ming Yin
- The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Lin Ma
- The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Ming Fan
- Department of Cognition Sciences and Stress Medicine, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Yong-Qi Zhao
- Department of Cognition Sciences and Stress Medicine, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing, China.
- Anhui Medical University, Hefei, China.
| | - Lingling Zhu
- Department of Cognition Sciences and Stress Medicine, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing, China.
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.
- Anhui Medical University, Hefei, China.
| |
Collapse
|
12
|
Falla M, Hüfner K, Falk M, Weiss EM, Vögele A, Jan van Veelen M, Weber B, Brandner J, Palma M, Dejaco A, Brugger H, Strapazzon G. Simulated Acute Hypobaric Hypoxia Effects on Cognition in Helicopter Emergency Medical Service Personnel - A Randomized, Controlled, Single-Blind, Crossover Trial. HUMAN FACTORS 2024; 66:404-423. [PMID: 35640630 DOI: 10.1177/00187208221086407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate, under replicable, blinded and standardised conditions, the effect of acute exposure to hypobaric hypoxia (HH) (equivalent to 200 or 3000 or 5000 m above sea level (asl)) on selected cognitive domains and physiological parameters in personnel of helicopter emergency medical service (HEMS). METHODS We conducted a randomized clinical trial using a single-blind crossover design in an environmental chamber (terraXcube) to induce HH in 48 HEMS personnel. Participants performed cognitive tests (CT) before the ascent, after 5 min at altitude, and after simulated cardiopulmonary resuscitation (SCR). CT evaluated: sustained attention using the psychomotor vigilance test (PVT) that included measurement of reaction time (RT); risky decision making using the balloon analogue risk task (BART), and attention and speed of processing using the digit symbol substitution test (DSST). CT performance was subjectively rated with a visual analogue scale (VAS). Physiological data were recorded with a physiological monitoring system. Data were analysed using a linear mixed model and correlation analysis. RESULTS Mean reaction time was significantly slower (p = 0.002) at HH (5000 m asl), but there were no independent effects of HH on the other parameters of the PVT, BART or DSST. Participants did not detect subjectively the slower RT at altitude since VAS performance results showed a positive correlation with mean RT (p = 0.009). DSST results significantly improved (p = 0.001) after SCR. CONCLUSION Acute exposure of HEMS personnel to HH induced a slower RT but no changes in any other investigated measures of cognition. The reduced RT was not detected subjectively by the participants. Trial number 3489044136, ClinicalTrials.gov trial registration.
Collapse
Affiliation(s)
- Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, Center for Mind/Brain Sciences, CIMeC, University of Trento, Rovereto (TN), Italy
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Elisabeth M Weiss
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | | | | | - Bernhard Weber
- Department of Psychology, University of Graz, Graz, Austria
| | - Jonas Brandner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Palma
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Alexander Dejaco
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland
| |
Collapse
|
13
|
Williams TB, Badariotti JI, Corbett J, Miller-Dicks M, Neupert E, McMorris T, Ando S, Parker MO, Thelwell RC, Causer AJ, Young JS, Mayes HS, White DK, de Carvalho FA, Tipton MJ, Costello JT. The effects of sleep deprivation, acute hypoxia, and exercise on cognitive performance: A multi-experiment combined stressors study. Physiol Behav 2024; 274:114409. [PMID: 37977251 DOI: 10.1016/j.physbeh.2023.114409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Both sleep deprivation and hypoxia have been shown to impair executive function. Conversely, moderate intensity exercise is known to improve executive function. In a multi-experiment study, we tested the hypotheses that moderate intensity exercise would ameliorate any decline in executive function after i) three consecutive nights of partial sleep deprivation (PSD) (Experiment 1) and ii) the isolated and combined effects of a single night of total sleep deprivation (TSD) and acute hypoxia (Experiment 2). METHODS Using a rigorous randomised controlled crossover design, 12 healthy participants volunteered in each experiment (24 total, 5 females). In both experiments seven executive function tasks (2-choice reaction time, logical relations, manikin, mathematical processing, 1-back, 2-back, 3-back) were completed at rest and during 20 min semi-recumbent, moderate intensity cycling. Tasks were completed in the following conditions: before and after three consecutive nights of PSD and habitual sleep (Experiment 1) and in normoxia and acute hypoxia (FIO2 = 0.12) following one night of habitual sleep and one night of TSD (Experiment 2). RESULTS Although the effects of three nights of PSD on executive functions were inconsistent, one night of TSD (regardless of hypoxic status) reduced executive functions. Significantly, regardless of sleep or hypoxic status, executive functions are improved during an acute bout of moderate intensity exercise. CONCLUSION These novel data indicate that moderate intensity exercise improves executive function performance after both PSD and TSD, regardless of hypoxic status. The key determinants and/or mechanism(s) responsible for this improvement still need to be elucidated. Future work should seek to identify these mechanisms and translate these significant findings into occupational and skilled performance settings.
Collapse
Affiliation(s)
- Thomas B Williams
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Juan I Badariotti
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom; Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Jo Corbett
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Matt Miller-Dicks
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Emma Neupert
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Terry McMorris
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom; Department of Sport and Exercise Sciences, University of Chichester, Chichester, United Kingdom
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Matthew O Parker
- Surrey Sleep Research Centre, School of Biosciences, University of Surrey, Guildford, United Kingdom
| | - Richard C Thelwell
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Adam J Causer
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - John S Young
- National Horizons Centre, Teesside University, Darlington, United Kingdom; School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Harry S Mayes
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Danny K White
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | | | - Michael J Tipton
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Joseph T Costello
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.
| |
Collapse
|
14
|
Cox BD, McHail DG, Blacker KJ. Personal Hypoxia Symptoms Vary Widely Within Individuals. Aerosp Med Hum Perform 2024; 95:54-58. [PMID: 38158567 DOI: 10.3357/amhp.6338.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION: Exposure to high ambient altitudes above 10,000 ft (3048 m) over sea level during aviation can present the risk of hypobaric hypoxia. Hypoxia can impair sensory and cognitive functions, degrading performance and leading to mishaps. Military aircrew undergo regular hypoxia familiarization training to recognize their symptoms and understand the consequences of hypoxia. However, over the years, aviators have come to believe that individuals have a "personal hypoxia signature." The idea is that intraindividual variability in symptom experience during repeated exposure is low. In other words, individuals will experience the same symptoms during hypoxia from day to day, year to year.METHODS: We critically reviewed the existing literature on this hypothesis. Most studies that claim to support the notion of a signature only examine group-level data, which do not inform individual-level consistency. Other studies use inappropriate statistical methods, while still others do not control for accuracy of recall over the period of years. To combat these shortcomings, we present a dataset of 91 individuals who completed nearly identical mask-off, normobaric hypoxia exposures days apart.RESULTS: We found that for every symptom on the Hypoxia Symptom Questionnaire, at least half of the subjects reported the symptom inconsistently across repeated exposure. This means that, at best, 50% of subjects did not report the same symptom across exposures.DISCUSSION: These data provide compelling evidence against the existence of hypoxia signatures. We urge that hypoxia familiarization training incorporate these findings and encourage individuals to expect a wide range of hypoxia symptoms upon repeated exposure.Cox BD, McHail DG, Blacker KJ. Personal hypoxia symptoms vary widely within individuals. Aerosp Med Hum Perform. 2024; 95(1):54-58.
Collapse
|
15
|
Zani A, Crotti N, Marzorati M, Senerchia A, Proverbio AM. Acute hypoxia alters visuospatial attention orienting: an electrical neuroimaging study. Sci Rep 2023; 13:22746. [PMID: 38123610 PMCID: PMC10733389 DOI: 10.1038/s41598-023-49431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Our study investigated the effects of hypoxia on visuospatial attention processing during preparation for a single/double-choice motor response. ERPs were recorded in two sessions in which participants breathed either ambient-air or oxygen-impoverished air. During each session, participants performed four cue-target attention orienting and/or alerting tasks. Replicating the classic findings of valid visuospatial attentional orienting modulation, ERPs to pre-target cues elicited both an Anterior directing attention negativity (ADAN)/CNV and a posterior Late directing attention positivity (LDAP)/TP, which in ambient air were larger for attention orienting than for alerting. Hypoxia increased the amplitude of both these potentials in the spatial orienting conditions for the upper visual hemifield, while, for the lower hemifield, it increased ADAN/CNV, but decreased LDAP/TP for the same attention conditions. To these ERP changes corresponded compensatory enhanced activation of right anterior cingulate cortex, left superior parietal lobule and frontal gyrus, as well as detrimental effects of hypoxia on behavioral overt performance. Together, these findings reveal for the first time, to our knowledge, that (1) these reversed alterations of the activation patterns during the time between cue and target occur at a larger extent in hypoxia than in air, and (2) acute normobaric hypoxia alters visuospatial attention orienting shifting in space.
Collapse
Affiliation(s)
- A Zani
- School of Psychology, Vita-Salute San Raffaele University, Via Olgettina 58-60, 20132, Milan, MI, Italy.
| | - N Crotti
- Department of Psychology, University of Milan-Bicocca, Milan (MI), Italy
| | - M Marzorati
- Institute of Biomedical Technologies, National Research Council (CNR ITB), Segrate, MI, Italy
| | - A Senerchia
- Department of Psychology, University of Milan-Bicocca, Milan (MI), Italy
| | - A M Proverbio
- Department of Psychology, University of Milan-Bicocca, Milan (MI), Italy
| |
Collapse
|
16
|
Ando S, Tsukamoto H, Stacey BS, Washio T, Owens TS, Calverley TA, Fall L, Marley CJ, Iannetelli A, Hashimoto T, Ogoh S, Bailey DM. Acute hypoxia impairs posterior cerebral bioenergetics and memory in man. Exp Physiol 2023; 108:1516-1530. [PMID: 37898979 PMCID: PMC10988469 DOI: 10.1113/ep091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
Hypoxia has the potential to impair cognitive function; however, it is still uncertain which cognitive domains are adversely affected. We examined the effects of acute hypoxia (∼7 h) on central executive (Go/No-Go) and non-executive (memory) tasks and the extent to which impairment was potentially related to regional cerebral blood flow and oxygen delivery (CDO2 ). Twelve male participants performed cognitive tasks following 0, 2, 4 and 6 h of passive exposure to both normoxia and hypoxia (12% O2 ), in a randomized block cross-over single-blinded design. Middle cerebral artery (MCA) and posterior cerebral artery (PCA) blood velocities and corresponding CDO2 were determined using bilateral transcranial Doppler ultrasound. In hypoxia, MCA DO2 was reduced during the Go/No-Go task (P = 0.010 vs. normoxia, main effect), and PCA DO2 was attenuated during memorization (P = 0.005 vs. normoxia) and recall components (P = 0.002 vs. normoxia) in the memory task. The accuracy of the memory task was also impaired in hypoxia (P = 0.049 vs. normoxia). In contrast, hypoxia failed to alter reaction time (P = 0.19 vs. normoxia) or accuracy (P = 0.20 vs. normoxia) during the Go/No-Go task, indicating that selective attention and response inhibition were preserved. Hypoxia did not affect cerebral blood flow or corresponding CDO2 responses to cognitive activity (P > 0.05 vs. normoxia). Collectively, these findings highlight the differential sensitivity of cognitive domains, with memory being selectively vulnerable in hypoxia. NEW FINDINGS: What is the central question of this study? We sought to examine the effects of acute hypoxia on central executive (selective attention and response inhibition) and non-executive (memory) performance and the extent to which impairments are potentially related to reductions in regional cerebral blood flow and oxygen delivery. What is the main finding and its importance? Memory was impaired in acute hypoxia, and this was accompanied by a selective reduction in posterior cerebral artery oxygen delivery. In contrast, selective attention and response inhibition remained well preserved. These findings suggest that memory is selectively vulnerable to hypoxia.
Collapse
Affiliation(s)
- Soichi Ando
- Graduate School of Informatics and EngineeringThe University of Electro‐CommunicationsTokyoJapan
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Faculty of Sports ScienceWaseda UniversitySaitamaJapan
| | - Benjamin S. Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Thomas S. Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Thomas A. Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Christopher J. Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | | | - Shigehiko Ogoh
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| |
Collapse
|
17
|
Bottenheft C, Groen EL, Mol D, Valk PJL, Houben MMJ, Kingma BRM, van Erp JBF. Effects of heat load and hypobaric hypoxia on cognitive performance: a combined stressor approach. ERGONOMICS 2023; 66:2148-2164. [PMID: 36916391 DOI: 10.1080/00140139.2023.2190062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
This study investigates how cognitive performance is affected by the combination of two stressors that are operationally relevant for helicopter pilots: heat load and hypobaric hypoxia. Fifteen participants were exposed to (1) no stressors, (2) heat load, (3) hypobaric hypoxia, and (4) combined heat load and hypobaric hypoxia. Hypobaric hypoxia (13,000 ft) was achieved in a hypobaric chamber. Heat load was induced by increasing ambient temperature to ∼28 °C. Cognitive performance was measured using two multitasks, and a vigilance task. Subjective and physiological data (oxygen saturation, heart rate, core- and skin temperature) were also collected. Mainly heat load caused cognitive performance decline. This can be explained by high subjective heat load and increased skin temperature, which takes away cognitive resources from the tasks. Only the arithmetic subtask was sensitive to hypobaric hypoxia, whereby hypobaric hypoxia caused a further performance decline in addition to the decline caused by heat load.Practitioner summary: Little is known about how multiple environmental stressors interact. This study investigates the combined effects of heat load and hypobaric hypoxia on cognitive performance. An additive effect of heat load and hypobaric hypoxia was found on a arithmetic task, which may be attributed to independent underlying mechanisms.
Collapse
Affiliation(s)
- Charelle Bottenheft
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
- Human Media Interaction, Computer Science, University of Twente, Enschede, Netherlands
| | - Eric L Groen
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Douwe Mol
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Pierre J L Valk
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Mark M J Houben
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Boris R M Kingma
- Department of Human Performance, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Jan B F van Erp
- Human Media Interaction, Computer Science, University of Twente, Enschede, Netherlands
- Department of Human Machine Teaming, Unit Defence, Safety and Security, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
| |
Collapse
|
18
|
Rapin A, Calmus A, Pradeau C, Taiar R, Belassian G, Godefroy O, Carazo-Mendez S, Boyer FC. Effect of oxygen therapy duration on cognitive impairment 12 months after hospitalization for SARS-COV-2 infection. J Rehabil Med 2023; 55:jrm12609. [PMID: 37974332 DOI: 10.2340/jrm.v55.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To identify predictors of persistent cognitive impairment at 12 months after hospitalization due to COVID-19 (SARS-CoV-2) infection. DESIGN Retrospective, single-centre study. SUBJECTS All consecutive patients assessed in physical and rehabilitation medicine consultations at 3 months with a neuropsychiatric testing (NPT) at 6 months. METHODS A Mini Mental State Examination (MMSE) was performed at 3 months and NPT at 6 and 12 months, exploring global cognitive efficiency, attention and processing speed, short-term memory and executive function. Logistic regression and receiver operating characteristic curves were used to identify predictors of persistent cognitive impairment. RESULTS Among 56 patients, 64.3% and 53.6% had 1 or more impaired cognitive functions at 6 and 12 months, respectively, attention and processing speed being the most represented (41.1% at 12 month). Duration of oxygen therapy (odds ratio 0.926 [0.871-0.985], p = 0.015) and MMSE score at 3 months (odds ratio 0.464 [0.276-0.783], p = 0.004) were associated with cognitive impairment at 12 months by multivariable analysis (R² 0.372-0.497). CONCLUSIONS Half of patients have cognitive impairment 12 months after acute SARS-CoV-2 infection requiring hospitalization. The duration of oxygen therapy in acute care could be a protective parameter. Systematic evaluation with the MMSE at 3 months after infection might be an effective tool to detect risk.
Collapse
Affiliation(s)
- Amandine Rapin
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Faculty of Medicine, Reims Champagne-Ardenne University, MATIM, Reims, France VieFra, EA3797, Reims, France.
| | - Arnaud Calmus
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Reims Champagne-Ardenne University, C2S, EA6291, Reims, France
| | - Charles Pradeau
- Physical and Rehabilitation Medicine department, Strasbourg University Hospital, Strasbourg, France
| | - Redha Taiar
- Reims Champagne-Ardenne University, MATIM, Reims, France
| | - Gaël Belassian
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France
| | - Olivier Godefroy
- Functional neuroscience and pathologies laboratory (UR UPJV 4559), Amiens University Hospital , Amiens, France
| | - Sandy Carazo-Mendez
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France
| | - Francois C Boyer
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Faculty of Medicine, Reims Champagne-Ardenne University, MATIM, Reims, France VieFra, EA3797, Reims, France
| |
Collapse
|
19
|
Steinman Y, Groen E, Frings-Dresen MHW. Hypoxia impairs reaction time but not response accuracy in a visual choice reaction task. APPLIED ERGONOMICS 2023; 113:104079. [PMID: 37413961 DOI: 10.1016/j.apergo.2023.104079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
We investigated the effect of hypoxia on the reaction time (RT) and response accuracy of pilots performing a visual choice reaction task that corresponded to the scanning of helmet mounted display (HMD) symbology. Eighteen male military pilots performed the task in a hypobaric chamber at two simulated altitudes (92 m and 4572 m) in a single-blinded repeated measures and counter-balanced design. The visual stimuli were displayed in low and high contrast and at a 30- and 50-degree field of view (FoV). We measured the pilots' RT and response accuracy. Using an eye tracker, we measured the pilot's glance time at each stimulus location. Finally, we collected subjective ratings of alertness. The results show that hypoxia increased the RT and glance time. Lowering the stimulus contrast and increasing the FoV further increased the RT, independent of hypoxia. These findings provide no evidence for hypoxia-induced changes in visual contrast sensitivity or visual field. Instead, hypoxia seemed to affect RT and glance time by reducing alertness. Despite the increased RT, the pilots maintained their accuracy on the visual task, suggesting that visual scanning of HMD symbology may be resistant to the effects of acute hypoxia.
Collapse
Affiliation(s)
- Yuval Steinman
- The Royal Netherlands Air Force, Center for Man in Aviation, Kampweg 53, Soesterberg, the Netherlands; Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health/Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Eric Groen
- TNO, Perceptual and Cognitive Systems, Kampweg 55, Soesterberg, the Netherlands
| | - Monique H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health/Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| |
Collapse
|
20
|
Hutcheon EA, Vakorin VA, Nunes AS, Ribary U, Ferguson S, Claydon VE, Doesburg SM. Comparing neuronal oscillations during visual spatial attention orienting between normobaric and hypobaric hypoxia. Sci Rep 2023; 13:18021. [PMID: 37865721 PMCID: PMC10590435 DOI: 10.1038/s41598-023-45308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
Normobaric hypoxia (NH) and hypobaric hypoxia (HH) are both used to train aircraft pilots to recognize symptoms of hypoxia. NH (low oxygen concentration) training is often preferred because it is more cost effective, simpler, and safer than HH. It is unclear, however, whether NH is neurophysiologically equivalent to HH (high altitude). Previous studies have shown that neural oscillations, particularly those in the alpha band (8-12 Hz), are impacted by hypoxia. Attention tasks have been shown to reliably modulate alpha oscillations, although the neurophysiological impacts of hypoxia during cognitive processing remains poorly understood. To address this we investigated induced and evoked power alongside physiological data while participants performed an attention task during control (normobaric normoxia or NN), NH (fraction of inspired oxygen = 12.8%, partial pressure of inspired oxygen = 87.2 mmHg), and HH (3962 m, partial pressure of inspired oxygen = 87.2 mmHg) conditions inside a hypobaric chamber. No significant differences between NH and HH were found in oxygen saturation, end tidal gases, breathing rate, middle cerebral artery velocity and blood pressure. Induced alpha power was significantly decreased in NH and HH when compared to NN. Participants in the HH condition showed significantly increased induced lower-beta power and evoked higher-beta power, compared with the NH and NN conditions, indicating that NH and HH differ in their impact on neurophysiological activity supporting cognition. NH and HH were found not to be neurophysiologically equivalent as electroencephalography was able to differentiate NH from HH.
Collapse
Affiliation(s)
- Evan A Hutcheon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Vasily A Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Adonay S Nunes
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Urs Ribary
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Sherri Ferguson
- Environmental Physiology and Medicine Unit, Faculty of Science, Simon Fraser University, Burnaby, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Sam M Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- Institute for Neuroscience and Neurotechnology, Simon Fraser University, Burnaby, Canada
| |
Collapse
|
21
|
Post TE, Heijn LG, Jordan J, van Gerven JMA. Sensitivity of cognitive function tests to acute hypoxia in healthy subjects: a systematic literature review. Front Physiol 2023; 14:1244279. [PMID: 37885803 PMCID: PMC10598721 DOI: 10.3389/fphys.2023.1244279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Titiaan E. Post
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
| | - Laurens G. Heijn
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden Academic Centre for Drug Research, Leiden, Netherlands
| | - Jens Jordan
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Joop M. A. van Gerven
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
- Leiden University Medical Center, Leiden, Netherlands
- Central Committee on Research Involving Human Subjects (CCMO), The Hague, Netherlands
| |
Collapse
|
22
|
Lyu G, Nakayama M. Prediction of respiratory failure risk in patients with pneumonia in the ICU using ensemble learning models. PLoS One 2023; 18:e0291711. [PMID: 37733699 PMCID: PMC10513189 DOI: 10.1371/journal.pone.0291711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
The aim of this study was to develop early prediction models for respiratory failure risk in patients with severe pneumonia using four ensemble learning algorithms: LightGBM, XGBoost, CatBoost, and random forest, and to compare the predictive performance of each model. In this study, we used the eICU Collaborative Research Database (eICU-CRD) for sample extraction, built a respiratory failure risk prediction model for patients with severe pneumonia based on four ensemble learning algorithms, and developed compact models corresponding to the four complete models to improve clinical practicality. The average area under receiver operating curve (AUROC) of the models on the test sets after ten random divisions of the dataset and the average accuracy at the best threshold were used as the evaluation metrics of the model performance. Finally, feature importance and Shapley additive explanation values were introduced to improve the interpretability of the model. A total of 1676 patients with pneumonia were analyzed in this study, of whom 297 developed respiratory failure one hour after admission to the intensive care unit (ICU). Both complete and compact CatBoost models had the highest average AUROC (0.858 and 0.857, respectively). The average accuracies at the best threshold were 75.19% and 77.33%, respectively. According to the feature importance bars and summary plot of the predictor variables, activetx (indicates whether the patient received active treatment), standard deviation of prothrombin time-international normalized ratio, Glasgow Coma Scale verbal score, age, and minimum oxygen saturation and respiratory rate were important. Compared with other ensemble learning models, the complete and compact CatBoost models have significantly higher average area under the curve values on the 10 randomly divided test sets. Additionally, the standard deviation (SD) of the compact CatBoost model is relatively small (SD:0.050), indicating that the performance of the compact CatBoost model is stable among these four ensemble learning models. The machine learning predictive models built in this study will help in early prediction and intervention of respiratory failure risk in patients with pneumonia in the ICU.
Collapse
Affiliation(s)
- Guanqi Lyu
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| |
Collapse
|
23
|
Vinetti G, Micarelli A, Falla M, Randi A, Dal Cappello T, Gatterer H, Brugger H, Strapazzon G, Rauch S. Surgical masks and filtering facepiece class 2 respirators (FFP2) have no major physiological effects at rest and during moderate exercise at 3000-m altitude: a randomised controlled trial. J Travel Med 2023; 30:taad031. [PMID: 36881665 PMCID: PMC10481409 DOI: 10.1093/jtm/taad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, the use of face masks has been recommended or enforced in several situations; however, their effects on physiological parameters and cognitive performance at high altitude are unknown. METHODS Eight healthy participants (four females) rested and exercised (cycling, 1 W/kg) while wearing no mask, a surgical mask or a filtering facepiece class 2 respirator (FFP2), both in normoxia and hypobaric hypoxia corresponding to an altitude of 3000 m. Arterialised oxygen saturation (SaO2), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), heart and respiratory rate, pulse oximetry (SpO2), cerebral oxygenation, visual analogue scales for dyspnoea and mask's discomfort were systematically investigated. Resting cognitive performance and exercising tympanic temperature were also assessed. RESULTS Mask use had a significant effect on PaCO2 (overall +1.2 ± 1.7 mmHg). There was no effect of mask use on all other investigated parameters except for dyspnoea and discomfort, which were highest with FFP2. Both masks were associated with a similar non-significant decrease in SaO2 during exercise in normoxia (-0.5 ± 0.4%) and, especially, in hypobaric hypoxia (-1.8 ± 1.5%), with similar trends for PaO2 and SpO2. CONCLUSIONS Although mask use was associated with higher rates of dyspnoea, it had no clinically relevant impact on gas exchange at 3000 m at rest and during moderate exercise, and no detectable effect on resting cognitive performance. Wearing a surgical mask or an FFP2 can be considered safe for healthy people living, working or spending their leisure time in mountains, high-altitude cities or other hypobaric environments (e.g. aircrafts) up to an altitude of 3000 m.
Collapse
Affiliation(s)
- Giovanni Vinetti
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | | | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto (TN), Italy
- Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
| | - Anna Randi
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto (TN), Italy
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano (BZ), Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| |
Collapse
|
24
|
Chen X, Zhang J, Lin Y, Li Y, Wang H, Wang Z, Liu H, Hu Y, Liu L. Mechanism, prevention and treatment of cognitive impairment caused by high altitude exposure. Front Physiol 2023; 14:1191058. [PMID: 37731540 PMCID: PMC10507266 DOI: 10.3389/fphys.2023.1191058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023] Open
Abstract
Hypobaric hypoxia (HH) characteristics induce impaired cognitive function, reduced concentration, and memory. In recent years, an increasing number of people have migrated to high-altitude areas for work and study. Headache, sleep disturbance, and cognitive impairment from HH, severely challenges the physical and mental health and affects their quality of life and work efficiency. This review summarizes the manifestations, mechanisms, and preventive and therapeutic methods of HH environment affecting cognitive function and provides theoretical references for exploring and treating high altitude-induced cognitive impairment.
Collapse
Affiliation(s)
- Xin Chen
- Department of Clinical Laboratory Medicine, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Jiexin Zhang
- Department of Clinical Laboratory Medicine, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
- Faculty of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, Hubei, China
| | - Yuan Lin
- Sichuan Xincheng Biological Co., LTD., Chengdu, Sichuan, China
| | - Yan Li
- Department of General Surgery, The 77th Army Hospital, Leshan, Sichuan, China
| | - Han Wang
- Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zhanhao Wang
- Department of Clinical Laboratory Medicine, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Huawei Liu
- Department of Clinical Laboratory Medicine, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yonghe Hu
- Faculty of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Lei Liu
- Medical Research Center, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| |
Collapse
|
25
|
Lucijanic D, Mihaljevic Peles A, Piskac Zivkovic N, Lucijanic M, Kranjcevic M, Muzinic Marinic L. Relationship of Anxiety, Depression, Stress, and Post-Traumatic Stress Disorder Symptoms with Disease Severity in Acutely Ill Hospitalized COVID-19 Patients. Behav Sci (Basel) 2023; 13:734. [PMID: 37754012 PMCID: PMC10525712 DOI: 10.3390/bs13090734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
We aimed to investigate depression, anxiety, stress, and PTSD symptoms and their relationship with disease severity in acutely ill hospitalized Coronavirus disease 2019 (COVID-19) patients. A single-center cross-sectional observational survey study screening for psychiatric symptoms using the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the Impact of Events Scale-Revised (IES-R) questionnaires was performed including a total of 169 acutely ill COVID-19 patients. All patients were adults and of white race and developed respiratory insufficiency during hospitalization. Demographic, clinical and laboratory data were evaluated as predictors of psychiatric symptoms. We hypothesized that higher intensity of COVID-19 symptoms and higher oxygen requirement would be associated with occurrence of depression, anxiety, stress, and PTSD symptoms. Depressive symptoms were absent in 29%, mild in 16%, moderate in 27.8%, severe in 10.7% and extremely severe in 16.6% patients. Anxiety symptoms were absent in 43.8%, mild in 6.5%, moderate in 17.2%, severe in 5.3% and extremely severe in 27.2% patients. Stress symptoms were absent in 78.7%, mild in 4.7%, moderate in 7.1%, severe in 7.7%, and extremely severe in 1.8% patients. A total of 60.9% patients had no PTSD symptoms, 16% had undiagnosed symptoms, and 23.1% met the criteria for a PTSD diagnosis. All psychiatric symptoms were more pronounced in female patients, depression and anxiety symptoms were associated with prior chronic obstructive pulmonary disease. Only depressive symptoms were significantly associated with higher intensity of COVID-19 symptoms and higher oxygen requirement. Acutely ill hospitalized COVID-19 patients presented a high prevalence of emergent psychiatric sequelae, especially in females, and more severe COVID-19 influenced mostly the severity of depressive symptoms.
Collapse
Affiliation(s)
- Dijana Lucijanic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Alma Mihaljevic Peles
- Clinical Hospital Centre Zagreb, Psychiatric Clinic, Kispaticeva 12, 10000 Zagreb, Croatia
- Department for Chemistry and Biochemistry, School of Medicine, Salata 3, 10000 Zagreb, Croatia
| | | | - Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Matija Kranjcevic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Lana Muzinic Marinic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
- University of Applied Health Sciences in Zagreb, Mlinarska Street 38, 10000 Zagreb, Croatia
| |
Collapse
|
26
|
Shaw DM, Bloomfield PM, Benfell A, Hughes I, Gant N. Recovery from acute hypoxia: A systematic review of cognitive and physiological responses during the 'hypoxia hangover'. PLoS One 2023; 18:e0289716. [PMID: 37585402 PMCID: PMC10431643 DOI: 10.1371/journal.pone.0289716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
Recovery of cognitive and physiological responses following a hypoxic exposure may not be considered in various operational and research settings. Understanding recovery profiles and influential factors can guide post-hypoxia restrictions to reduce the risk of further cognitive and physiological deterioration, and the potential for incidents and accidents. We systematically evaluated the available evidence on recovery of cognitive and basic physiological responses following an acute hypoxic exposure to improve understanding of the performance and safety implications, and to inform post-hypoxia restrictions. This systematic review summarises 30 studies that document the recovery of either a cognitive or physiological index from an acute hypoxic exposure. Titles and abstracts from PubMed (MEDLINE) and Scopus were searched from inception to July 2022, of which 22 full text articles were considered eligible. An additional 8 articles from other sources were identified and also considered eligible. The overall quality of evidence was moderate (average Rosendal score, 58%) and there was a large range of hypoxic exposures. Heart rate, peripheral blood haemoglobin-oxygen saturation and heart rate variability typically normalised within seconds-to-minutes following return to normoxia or hyperoxia. Whereas, cognitive performance, blood pressure, cerebral tissue oxygenation, ventilation and electroencephalogram indices could persist for minutes-to-hours following a hypoxic exposure, and one study suggested regional cerebral tissue oxygenation requires up to 24 hours to recover. Full recovery of most cognitive and physiological indices, however, appear much sooner and typically within ~2-4 hours. Based on these findings, there is evidence to support a 'hypoxia hangover' and a need to implement restrictions following acute hypoxic exposures. The severity and duration of these restrictions is unclear but should consider the population, subsequent requirement for safety-critical tasks and hypoxic exposure.
Collapse
Affiliation(s)
- David M. Shaw
- Aviation Medicine Unit, Royal New Zealand Air Force Base Auckland, Whenuapai, Auckland, New Zealand
| | - Peter M. Bloomfield
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Benfell
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Isadore Hughes
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas Gant
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
27
|
Bakker ME, Djerourou I, Belanger S, Lesage F, Vanni MP. Alteration of functional connectivity despite preserved cerebral oxygenation during acute hypoxia. Sci Rep 2023; 13:13269. [PMID: 37582847 PMCID: PMC10427674 DOI: 10.1038/s41598-023-40321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023] Open
Abstract
Resting state networks (RSN), which show the connectivity in the brain in the absence of any stimuli, are increasingly important to assess brain function. Here, we investigate the changes in RSN as well as the hemodynamic changes during acute, global hypoxia. Mice were imaged at different levels of oxygen (21, 12, 10 and 8%) over the course of 10 weeks, with hypoxia and normoxia acquisitions interspersed. Simultaneous GCaMP and intrinsic optical imaging allowed tracking of both neuronal and hemodynamic changes. During hypoxic conditions, we found a global increase of both HbO and HbR in the brain. The saturation levels of blood dropped after the onset of hypoxia, but surprisingly climbed back to levels similar to baseline within the 10-min hypoxia period. Neuronal activity also showed a peak at the onset of hypoxia, but dropped back to baseline as well. Despite regaining baseline sO2 levels, changes in neuronal RSN were observed. In particular, the connectivity as measured with GCaMP between anterior and posterior parts of the brain decreased. In contrast, when looking at these same connections with HbO measurements, an increase in connectivity in anterior-posterior brain areas was observed suggesting a potential neurovascular decoupling.
Collapse
Affiliation(s)
- Marleen E Bakker
- École d'Optométrie, Université de Montréal, 2500 Chem. De Polytechnique, Montréal, QC, H3T 1J4, Canada.
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Canada.
| | - Ismaël Djerourou
- École d'Optométrie, Université de Montréal, 2500 Chem. De Polytechnique, Montréal, QC, H3T 1J4, Canada
| | | | - Frédéric Lesage
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Canada
- Montréal Heart Institute, Montréal, Canada
| | - Matthieu P Vanni
- École d'Optométrie, Université de Montréal, 2500 Chem. De Polytechnique, Montréal, QC, H3T 1J4, Canada
| |
Collapse
|
28
|
Keeler JM, Tourula E, Hite MJ, Listman JB, Heeger DJ, Port NL, Schlader ZJ. Gamified assessment of cognitive performance during moderate hypoxia. PLoS One 2023; 18:e0288201. [PMID: 37459310 PMCID: PMC10351691 DOI: 10.1371/journal.pone.0288201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION There is a need for rapid and objective assessment tools to identify people at risk of impaired cognitive function during hypoxia. PURPOSE To test the hypotheses that performance on gamified cognitive tests examining the cognitive domains of executive function (Gridshot), working memory (Capacity) and spatial tracking (Multitracker) will be reduced during normobaric exposure to moderate normobaric hypoxia. METHODS Following three consecutive days of practice, twenty-one healthy adults (27 ± 5 y, 9 females) completed five 1-min rounds of the tablet-based games Gridshot, Capacity, and Multitracker (Statespace Labs, Inc.) at Baseline and 60 and 90 min after exposure to 14.0 ± 0.2% (hypoxia) and 20.6 ± 0.3% (normoxia) oxygen. Both conditions were completed on the same day and were administered in a single-blind, block randomized manner. Arterial oxyhemoglobin saturation was estimated via forehead pulse oximetry (SpO2). Data were analyzed using ANCOVA with a covariate of Baseline. RESULTS Compared to normoxia (98 ± 1%), SpO2 was lower (p < 0.001) at 60 (91 ± 3%) and 90 (91 ± 2%) min of hypoxia. No condition x time interaction effects were identified for any gamified cognitive tests (p ≥ 0.32). A main effect of condition was identified for Capacity (p = 0.05) and Multitracker (p = 0.04), but not Gridshot (p = 0.33). Post hoc analyses of the composite scores for both Capacity (p = 0.11) and Multitracker (p = 0.73) demonstrated no difference between conditions. CONCLUSION Performance on gamified cognitive tests was not consistently affected by acute normobaric moderate hypoxic exposure.
Collapse
Affiliation(s)
- Jason M. Keeler
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Erica Tourula
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - M. Jo Hite
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | | | - David J. Heeger
- Statespace Labs, Inc. New York, New York, United States of America
| | - Nicholas L. Port
- School of Optometry, Indiana University, Bloomington, Indiana, United States of America
| | - Zachary J. Schlader
- Department of Kinesiology, H.H. Morris Human Performance Laboratories, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| |
Collapse
|
29
|
Wang H, Tang W, Zhao Y. Acute effects of different exercise forms on executive function and the mechanism of cerebral hemodynamics in hospitalized T2DM patients: a within-subject study. Front Public Health 2023; 11:1165892. [PMID: 37333536 PMCID: PMC10270376 DOI: 10.3389/fpubh.2023.1165892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
Objective This study aimed to investigate the acute effects of aerobic exercise (AE), resistance exercise (RE), and integrated concurrent exercise (ICE; i.e., AE plus RE) on executive function among hospitalized type 2 diabetes mellitus (T2DM) inpatients, and the mechanism of cerebral hemodynamics. Methods A within-subject design was applied in 30 hospitalized patients with T2DM aged between 45 and 70 years in the Jiangsu Geriatric Hospital, China. The participants were asked to take AE, RE, and ICE for 3 days at 48-h intervals. Three executive function (EF) tests, namely, Stroop, More-odd shifting, and 2-back tests, were applied at baseline and after each exercise. The functional near-infrared spectroscopy brain function imaging system was used to collect cerebral hemodynamic data. The one-way repeated measurement ANOVA was used to explore training effects on each test indicator. Results Compared with the baseline data, the EF indicators have been improved after both ICE and RE (p < 0.05). Compared with the AE group, the ICE and RE groups have demonstrated significant improvements in inhibition (ICE: MD = - 162.92 ms; RE: MD = -106.86 ms) and conversion functions (ICE: MD = -111.79 ms; RE: MD = -86.95 ms). Based on the cerebral hemodynamic data, the beta values of brain activation in executive function related brain regions increased after three kinds of exercise, the EF improvements after the ICE showed synchronous activation of blood flow in the dorsolateral prefrontal cortex (DLPFC), the frontal polar (FPA) and orbitofrontal cortex (OFC), the improvement of inhibitory function after RE displayed synchronous activation of DLPFC and FPA, and AE mainly activates DLPFC. The HbO2 concentration in the pars triangularis Broca's area increased significantly after AE, but the EF did not improve significantly. Conclusion The ICE is preferred for the improvements of executive function in T2DM patients, while AE is more conducive to the improvements of refresh function. Moreover, a synergistic mechanism exists between cognitive function and blood flow activation in specific brain regions.
Collapse
Affiliation(s)
- Haolin Wang
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Yanan Zhao
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| |
Collapse
|
30
|
Wu X, Ma L, Yin Q, Liu M, Wu K, Wang D. The impact of wearing a KN95 face mask on human brain function: evidence from resting state functional magnetic resonance imaging. Front Neurol 2023; 14:1102335. [PMID: 37273685 PMCID: PMC10237040 DOI: 10.3389/fneur.2023.1102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background Face masks are widely used in daily life because of the COVID-19 pandemic. The objective of this study was to explore the impact of wearing face masks on brain functions by using resting-state functional MRI (RS-fMRI). Methods Scanning data from 15 healthy subjects (46.20 ± 6.67 years) were collected in this study. Each subject underwent RS-fMRI scans under two comparative conditions, wearing a KN95 mask and natural breathing (no mask). The amplitude of low frequency fluctuation (ALFF) and functional connectivity under the two conditions were analyzed and then compared using the paired t-test. Results Compared with those of the no-mask condition, the ALFF activities when wearing masks were increased significantly in the right middle frontal gyrus, bilateral precuneus, right superior marginal gyrus, left inferior parietal gyrus, and left supplementary motor area and decreased significantly in the anterior cingulate gyrus, right fusiform gyrus, left superior temporal gyrus, bilateral lingual gyrus, and bilateral calcarine cortex (p < 0.05). Taking the posterior cingulate cortex area as a seed point, the correlations with the occipital cortex, prefrontal lobe, and motor sensory cortex were sensitive to wearing masks compared with not wearing masks (p < 0.05). Taking the medial prefrontal cortex region as a seed point, the functional connectivity with the bilateral temporal lobe, bilateral motor sensory cortex, and occipital lobe was influenced by wearing a KN95 mask (p < 0.05). Conclusion This study demonstrated that wearing a KN95 face mask can cause short-term changes in human resting brain function. Both local neural activities and functional connectivity in brain regions were sensitive to mask wearing. However, the neural mechanism causing these changes and its impact on cognitive function still need further investigation.
Collapse
Affiliation(s)
- Xiaomeng Wu
- Philips (China) Investment Co., Ltd, Shanghai, China
| | - Lifei Ma
- Philips (China) Investment Co., Ltd, Shanghai, China
| | - Qiufeng Yin
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kyle Wu
- Philips (China) Investment Co., Ltd, Shanghai, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
31
|
Song R, Tao G, Guo F, Ma H, Zhang J, Wang Y. The change of attention network functions and physiological adaptation during high-altitude hypoxia and reoxygenation. Physiol Behav 2023; 268:114240. [PMID: 37201691 DOI: 10.1016/j.physbeh.2023.114240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/09/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Previous studies have not reached a definitive conclusion regarding the effect of high-altitude hypoxia and reoxygenation on attention. To clarify the influence of altitude and exposure time on attention and the relations between physiological activity and attention, we conducted a longitudinal study to track attention network functions in 26 college students. The scores on the attention network test and physiological data, including heart rate, percutaneous arterial oxygen saturation (SpO2), blood pressure, and vital capacity in pulmonary function measurement, were collected at five time-points: two weeks before arriving at high altitude (baseline), within 3 days after arriving at high altitude (HA3), 21 days after arriving at high altitude (HA21), 7 days after returning to sea level (POST7) and 30 days after returning to sea level (POST30). The alerting scores at POST30 were significantly higher than those at baseline, HA3 and HA21; the orienting scores at HA3 were lower than those at POST7 and POST30; the executive control scores at POST7 were significantly lower than those at baseline, HA3, HA21, and POST30; and the executive control scores at HA3 were significantly higher than those at POST30. The change in SpO2 during high-altitude acclimatization (from HA3 to HA21) was positively correlated with the orienting score at HA21. Vital capacity changes during acute deacclimatization positively correlated with orienting scores at POST7. Attention network functions at the behavioral level did not decline after acute hypoxia exposure compared with baseline. Attention network functions after returning to sea level were improved compared with those during acute hypoxia; additionally, alerting and executive function scores were improved compared with those at baseline. Thus, the speed of physiological adaptation could facilitate the recovery of orienting function during acclimatization and deacclimatization.
Collapse
Affiliation(s)
- Rui Song
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Getong Tao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Fumei Guo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Hailin Ma
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Guangzhou/Tibet, China
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, China
| | - Yan Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
32
|
Hutcheon EA, Vakorin VA, Nunes A, Ribary U, Ferguson S, Claydon VE, Doesburg SM. Associations between spontaneous electroencephalogram oscillations and oxygen saturation across normobaric and hypobaric hypoxia. Hum Brain Mapp 2023; 44:2345-2364. [PMID: 36715216 PMCID: PMC10028628 DOI: 10.1002/hbm.26214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
High-altitude indoctrination (HAI) trains individuals to recognize symptoms of hypoxia by simulating high-altitude conditions using normobaric (NH) or hypobaric (HH) hypoxia. Previous studies suggest that despite equivalent inspired oxygen levels, physiological differences could exist between these conditions. In particular, differences in neurophysiological responses to these conditions are not clear. Our study aimed to investigate correlations between oxygen saturation (SpO2 ) and neural responses in NH and HH. We recorded 5-min of resting-state eyes-open electroencephalogram (EEG) and SpO2 during control, NH, and HH conditions from 13 participants. We applied a multivariate framework to characterize correlations between SpO2 and EEG measures (spectral power and multiscale entropy [MSE]), within each participant and at the group level. Participants were desaturating during the first 150 s of NH versus steadily desaturated in HH. We considered the entire time interval, first and second half intervals, separately. All the conditions were characterized by statistically significant participant-specific patterns of EEG-SpO2 correlations. However, at the group level, the desaturation period expressed a robust pattern of these correlations across frequencies and brain locations. Specifically, the first 150 s of NH during desaturation differed significantly from the other conditions with negative absolute alpha power-SpO2 correlations and positive MSE-SpO2 correlations. Once steadily desaturated, NH and HH had no significant differences in EEG-SpO2 correlations. Our findings indicate that the desaturating phase of hypoxia is a critical period in HAI courses, which would require developing strategies for mitigating the hypoxic stimulus in a real-world situation.
Collapse
Affiliation(s)
- Evan A Hutcheon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vasily A Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Adonay Nunes
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Urs Ribary
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sherri Ferguson
- Environmental Physiology and Medicine Unit, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sam M Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
33
|
Bloomfield PM, Green H, Fisher JP, Gant N. Carbon dioxide protects simulated driving performance during severe hypoxia. Eur J Appl Physiol 2023:10.1007/s00421-023-05151-1. [PMID: 36952086 DOI: 10.1007/s00421-023-05151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE We sought to determine the effect of acute severe hypoxia, with and without concurrent manipulation of carbon dioxide (CO2), on complex real-world psychomotor task performance. METHODS Twenty-one participants completed a 10-min simulated driving task while breathing room air (normoxia) or hypoxic air (PETO2 = 45 mmHg) under poikilocapnic, isocapnic, and hypercapnic conditions (PETCO2 = not manipulated, clamped at baseline, and clamped at baseline + 10 mmHg, respectively). Driving performance was assessed using a fixed-base motor vehicle simulator. Oxygenation in the frontal cortex was measured using functional near-infrared spectroscopy. RESULTS Speed limit exceedances were greater during the poikilocapnic than normoxic, hypercapnic, and isocapnic conditions (mean exceedances: 8, 4, 5, and 7, respectively; all p ≤ 0.05 vs poikilocapnic hypoxia). Vehicle speed was greater in the poikilocapnic than normoxic and hypercapnic conditions (mean difference: 0.35 km h-1 and 0.67 km h-1, respectively). All hypoxic conditions similarly decreased cerebral oxyhaemoglobin and increased deoxyhaemoglobin, compared to normoxic baseline, while total hemoglobin remained unchanged. CONCLUSIONS These findings demonstrate that supplemental CO2 can confer a neuroprotective effect by offsetting impairments in complex psychomotor task performance evoked by severe poikilocapnic hypoxia; however, differences in performance are unlikely to be linked to measurable differences in cerebral oxygenation.
Collapse
Affiliation(s)
- Peter Michael Bloomfield
- Exercise Neurometabolism Laboratory, University of Auckland, Building 907, 368 Khyber Pass Road, Newmarket, Auckland, 1023, New Zealand
| | - Hayden Green
- Exercise Neurometabolism Laboratory, University of Auckland, Building 907, 368 Khyber Pass Road, Newmarket, Auckland, 1023, New Zealand
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, Manaaki Mānawa-The Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Nicholas Gant
- Exercise Neurometabolism Laboratory, University of Auckland, Building 907, 368 Khyber Pass Road, Newmarket, Auckland, 1023, New Zealand.
- Centre for Brain Research, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
34
|
Prete G, Bondi D, Mammarella N, Verratti V, Tommasi L. Investigating Auditory Perception at Europe's Highest Mountain Lodge. Percept Mot Skills 2023; 130:929-937. [PMID: 36939848 DOI: 10.1177/00315125231165165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Altitude hypoxia can impair sensory and cognitive functions, from causing slowed responses to sensory hallucinations. In a field study, we tested 12 expeditioners at varied altitudes (low: 1696 m; high: 4556 m) with a simple auditory detection task and a dichotic listening paradigm in which a voice was presented, lateralized, within a binaural white noise stream. Slower reaction times and a reduced right ear advantage might be expected at high (vs. low) altitude, due to hypoxia. The participants' performances on both tasks did not differ between conditions, revealing that these functions are resistant to short-term hypoxia in young healthy adults.
Collapse
Affiliation(s)
- Giulia Prete
- Department of Psychological, Health and Territorial Sciences, 9301"G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, 9301"G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Nicola Mammarella
- Department of Psychological, Health and Territorial Sciences, 9301"G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, 9301"G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Luca Tommasi
- Department of Psychological, Health and Territorial Sciences, 9301"G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
35
|
Alvear-Catalán M, Montiglio C, Perales I, Viscor G, Araneda OF. An Igor Pro 8.01 Procedure to Analyze Pulse Oximetry during Acute Hypoxia Test in Aircrews. SENSORS (BASEL, SWITZERLAND) 2023; 23:2327. [PMID: 36850925 PMCID: PMC9966371 DOI: 10.3390/s23042327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
The recognition of hypoxia symptoms is a critical part of physiological training in military aviation. Acute exposure protocols have been designed in hypobaric chambers to train aircrews to recognize hypoxia and quickly take corrective actions. The goal of the acute hypoxia test is to know the time of useful consciousness and the minimal arterial oxygen saturation tolerated. Currently, there is no computer system specifically designed to analyze the physiological variables obtained during the test. This paper reports the development and analytical capabilities of a computational tool specially designed for these purposes. The procedure was designed using the Igor Pro 8.01 language, which processes oxygen saturation and heart rate signals. To accomplish this, three functional boards are displayed. The first allows the loading and processing of the data. The second generates graphs that allow for a rapid visual examination to determine the validity of individual records and calculate slopes on selected segments of the recorded signal. Finally, the third can apply filters to generate data groups for analysis. In addition, this tool makes it possible to propose new study variables that are derived from the raw signals and can be applied simultaneously to large data sets. The program can generate graphs accompanied by basic statistical parameters and heat maps that facilitate data visualization. Moreover, there is a possibility of adding other signals during the test, such as the oxygenation level in vital organs, electrocardiogram, or electroencephalogram, which illustrates the test's excellent potential for application in aerospace medicine and for helping us develop a better understanding of complex physiological phenomena.
Collapse
Affiliation(s)
- Manuel Alvear-Catalán
- Centro de Medicina Aeroespacial (CMAE), Fuerza Aérea de Chile, Santiago 7550000, Chile
| | - Claudio Montiglio
- Centro de Medicina Aeroespacial (CMAE), Fuerza Aérea de Chile, Santiago 7550000, Chile
| | - Ignacio Perales
- Facultad de Ciencias, Universidad de Chile, Santiago 783090, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Oscar F. Araneda
- Integrative Laboratory of Biomechanics and Physiology of Effort, (LIBFE), School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago 7620001, Chile
| |
Collapse
|
36
|
Samaja M, Ottolenghi S. The Oxygen Cascade from Atmosphere to Mitochondria as a Tool to Understand the (Mal)adaptation to Hypoxia. Int J Mol Sci 2023; 24:ijms24043670. [PMID: 36835089 PMCID: PMC9960749 DOI: 10.3390/ijms24043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Hypoxia is a life-threatening challenge for about 1% of the world population, as well as a contributor to high morbidity and mortality scores in patients affected by various cardiopulmonary, hematological, and circulatory diseases. However, the adaptation to hypoxia represents a failure for a relevant portion of the cases as the pathways of potential adaptation often conflict with well-being and generate diseases that in certain areas of the world still afflict up to one-third of the populations living at altitude. To help understand the mechanisms of adaptation and maladaptation, this review examines the various steps of the oxygen cascade from the atmosphere to the mitochondria distinguishing the patterns related to physiological (i.e., due to altitude) and pathological (i.e., due to a pre-existing disease) hypoxia. The aim is to assess the ability of humans to adapt to hypoxia in a multidisciplinary approach that correlates the function of genes, molecules, and cells with the physiologic and pathological outcomes. We conclude that, in most cases, it is not hypoxia by itself that generates diseases, but rather the attempts to adapt to the hypoxia condition. This underlies the paradigm shift that when adaptation to hypoxia becomes excessive, it translates into maladaptation.
Collapse
Affiliation(s)
- Michele Samaja
- MAGI GROUP, San Felice del Benaco, 25010 Brescia, Italy
- Correspondence:
| | - Sara Ottolenghi
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
| |
Collapse
|
37
|
Gong F, Ai Y, Zhang L, Peng Q, Zhou Q, Gui C. Relationship between PaO 2/FiO 2 and delirium in intensive care: A cross-sectional study. JOURNAL OF INTENSIVE MEDICINE 2023; 3:73-78. [PMID: 36789362 PMCID: PMC9923991 DOI: 10.1016/j.jointm.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/24/2022] [Accepted: 08/10/2022] [Indexed: 12/23/2022]
Abstract
Background To investigate the relationship between partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) and the probability of delirium in intensive care units (ICUs). Methods The investigation was a cross-sectional study that involved the collection of data from patients admitted to the Xiang Ya Hospital Cardiothoracic Surgical Care Unit and Comprehensive Intensive Care Unit from 01 September 2016 to 10 December 2016. Delirium was diagnosed using the simplified version of the Chinese Confusion Assessment Method (CAM) for the ICU. Demographic and medical data were obtained within 24 h of each patient admitted in the ICU. The PaO2/FiO2 of each patient was recorded 24 h after admission in the ICU. The patients were divided into three groups according to PaO2/FiO2 data : normal (PaO2/FiO2 ≥300 mmHg), slightly low (200 ≥PaO2/FiO2 <300 mmHg), and severely low (PaO2/FiO2 <200 mmHg). Baseline characteristics were compared in the three groups. Results of the unadjusted model, minimally adjusted model, and fully adjusted model are presented. Results A total of 403 participants were included in the study, of which 184 (45.7%) developed delirium. Age (P <0.001), Sequential Organ Failure Assessment (SOFA) score (P <0.001), Acute Physiology and Chronic Health Evaluation (APACHE) II score (P <0.001), mechanical ventilation time (P <0.001), history of hypertension (P=0.040), heart disease (P=0.040), sedation (P=0.001), and PaO2/FiO2 (P=0.006) were significantly associated with delirium in univariate analysis. Multivariate regression analysis models were used to further analyze the associations between PaO2/FiO2 and delirium. In the crude model, for 1 standard deviation (SD) increase in PaO2/FiO2, the odds ratio (OR) of delirium was 0.8 (95% confidence interval [CI]: 0.6-0.9), but there was no significant correlation in the fully adjusted model. There was a non-linear relationship between the PaO2/FiO2 and delirium in a generalized additive model. A two-piecewise linear regression model was used to calculate a PaO2/FiO2 threshold of 243 mmHg. On the left side of the threshold, the OR was 0.9 and the 95% CI was 0.9-1.0 (P=0.013) when PaO2/FiO2 increased by 1 SD. Conclusions PaO2/FiO2 was negatively associated with delirium when PaO2/FiO2 was below the identified threshold. As a readily available laboratory indicator, PaO2/FiO2 has potential value in the clinical evaluation of risk of delirium in ICU patients.
Collapse
Affiliation(s)
- Fang Gong
- Department of Intensive Care Unit, The First People's Hospital of Changde, Changde, Hunan 415000, China
| | - Yuhang Ai
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lina Zhang
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Qianyi Peng
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Quan Zhou
- Department of Intensive Care Unit, The First People's Hospital of Changde, Changde, Hunan 415000, China
| | - Chunmei Gui
- Department of Intensive Care Unit, The First People's Hospital of Changde, Changde, Hunan 415000, China
| |
Collapse
|
38
|
Reiser AE, Furian M, Lichtblau M, Buergin A, Schneider SR, Appenzeller P, Mayer L, Muralt L, Mademilov M, Abdyraeva A, Aidaralieva S, Muratbekova A, Akylbekov A, Sheraliev U, Shabykeeva S, Sooronbaev TM, Ulrich S, Bloch KE. Effect of acetazolamide on visuomotor performance at high altitude in healthy people 40 years of age or older-RCT. PLoS One 2023; 18:e0280585. [PMID: 36662903 PMCID: PMC9858039 DOI: 10.1371/journal.pone.0280585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Altitude travel is increasingly popular also for middle-aged and older tourists and professionals. Due to the sensitivity of the central nervous system to hypoxia, altitude exposure may impair visuomotor performance although this has not been extensively studied. Therefore, we investigated whether a sojourn at moderately high altitude is associated with visuomotor performance impairments in healthy adults, 40y of age or older, and whether this adverse altitude-effect can be prevented by acetazolamide, a drug used to prevent acute mountain sickness. METHODS In this randomized placebo-controlled parallel-design trial, 59 healthy lowlanders, aged 40-75y, were assigned to acetazolamide (375 mg/day, n = 34) or placebo (n = 25), administered one day before ascent and while staying at high altitude (3100m). Visuomotor performance was assessed at 760m and 3100m after arrival and in the next morning (post-sleep) by a computer-assisted test (Motor-Task-Manager). It quantified deviation of a participant-controlled cursor affected by rotation during target tracking. Primary outcome was the directional error during post-sleep recall of adaptation to rotation estimated by multilevel linear regression modeling. Additionally, adaptation, immediate recall, and correct test execution were evaluated. RESULTS Compared to 760m, assessments at 3100m with placebo revealed a mean (95%CI) increase in directional error during adaptation and immediate recall by 1.9° (0.2 to 3.5, p = 0.024) and 1.1° (0.4 to 1.8, p = 0.002), respectively. Post-sleep recall remained unchanged (p = NS), however post-sleep correct test execution was 14% less likely (9 to 19, p<0.001). Acetazolamide improved directional error during post-sleep recall by 5.6° (2.6 to 8.6, p<0.001) and post-sleep probability of correct test execution by 36% (30 to 42, p<0.001) compared to placebo. CONCLUSION In healthy individuals, 40y of age or older, altitude exposure impaired adaptation to and immediate recall and correct execution of a visuomotor task. Preventive acetazolamide treatment improved visuomotor performance after one night at altitude and increased the probability of correct test execution compared to placebo. CLINICALTRIALS.GOV IDENTIFIER ClinicalTrials.gov NCT03536520.
Collapse
Affiliation(s)
- Aurelia E. Reiser
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Aline Buergin
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Simon R. Schneider
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Paula Appenzeller
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Laura Mayer
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Maamed Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Ainura Abdyraeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Shoira Aidaralieva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Aibermet Muratbekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Azamat Akylbekov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Ulan Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Saltanat Shabykeeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Talant M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
- Department of Respiratory Medicine, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| | - Konrad E. Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland/ Bishkek, Kyrgyz Republic
| |
Collapse
|
39
|
Zhang J, Tang S, Chen C, Jiang H, Liao H, Liu H, Wang L, Chen X. A bibliometric analysis of the studies in high-altitude induced sleep disturbances and cognitive impairment research. Front Physiol 2023; 14:1133059. [PMID: 36860517 PMCID: PMC9968939 DOI: 10.3389/fphys.2023.1133059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Background: The two main symptoms at high altitude, sleep abnormalities and cognitive impairments, interact with each other. These two dysfunctions are also closely related to systemic multisystem diseases, including cerebrovascular diseases, psychiatric disorders, and immune regulatory diseases. Purpose: To systematically analyze and visualize research on sleep disturbances and cognitive impairment at high altitudes using a bibliometrics method, and to determine future research directions by analyzing research trends and the latest hotspots. Methods: Publications from 1990 to 2022 on sleep disturbances and cognitive impairment at high altitudes were retrieved from the Web of Science. Using the R Bibliometrix software and Microsoft Excel, all data were examined statistically and qualitatively. For network visualization, the data were later exported into VOSviewer 1.6.17 and CiteSpace 6.1.R6. Results: A total of 487 articles in this area were published from 1990 to 2022. In this period, there was an overall increase in the number of publications. The United States has shown considerable importance in this sector. Bloch Konrad E was the most prolific and valuable author. The most prolific journal was High Altitude Medicine & Biology, and it has been the first choice for publishing in this field in recent years. Analysis of keyword co-occurrences suggested that research interest in the clinical manifestations of sleep disturbances and cognitive impairment caused by altitude hypoxia was mainly focused on "acute mountain-sickness," "insomnia," "apnea syndrome," "depression," "anxiety," "Cheyne-strokes respiration," and "pulmonary hypertension." The mechanisms of disease development related to "oxidative stress," "inflammation," "hippocampus," "prefrontal cortex," "neurodegeneration," and "spatial memory" in the brain have been the focus of recent research. According to burst detection analysis, "mood" and "memory impairment," as terms with high strength, are expected to remain hot topics in the coming years. High-altitude-induced pulmonary hypertension is also in the emerging stage of research, and the treatments will continue to receive attention in the future. Conclusion: More attention is being focused on sleep disturbances and cognitive impairment at high altitudes. This work will serve as a useful reference for the clinical development of treatments for sleep disturbances and cognitive impairment induced by hypobaric hypoxia at high altitudes.
Collapse
Affiliation(s)
- Jiexin Zhang
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Songyuan Tang
- Faculty of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Chao Chen
- Department of Osteology, The 5th People’s Hospital of Jinan, Jinan, Shandong, China
| | - Hezhong Jiang
- Faculty of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Hai Liao
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Huawei Liu
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Li Wang
- Sichuan Baicheng Chinese Medicine Technology Co., Chengdu, Sichuan, China
| | - Xin Chen
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China,*Correspondence: Xin Chen,
| |
Collapse
|
40
|
Zhang Q, Haselden WD, Charpak S, Drew PJ. Could respiration-driven blood oxygen changes modulate neural activity? Pflugers Arch 2023; 475:37-48. [PMID: 35761104 PMCID: PMC9794637 DOI: 10.1007/s00424-022-02721-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 01/31/2023]
Abstract
Oxygen is critical for neural metabolism, but under most physiological conditions, oxygen levels in the brain are far more than are required. Oxygen levels can be dynamically increased by increases in respiration rate that are tied to the arousal state of the brain and cognition, and not necessarily linked to exertion by the body. Why these changes in respiration occur when oxygen is already adequate has been a long-standing puzzle. In humans, performance on cognitive tasks can be affected by very high or very low oxygen levels, but whether the physiological changes in blood oxygenation produced by respiration have an appreciable effect is an open question. Oxygen has direct effects on potassium channels, increases the degradation rate of nitric oxide, and is rate limiting for the synthesis of some neuromodulators. We discuss whether oxygenation changes due to respiration contribute to neural dynamics associated with attention and arousal.
Collapse
Affiliation(s)
- Qingguang Zhang
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - William D Haselden
- Medical Scientist Training Program, College of Medicine, The Pennsylvania State University, Hershey, PA, 17033, USA
| | - Serge Charpak
- Institut de La Vision, INSERM, CNRS, Sorbonne Université, Paris, France
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Patrick J Drew
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA.
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
- Department of Neurosurgery, The Pennsylvania State University, University Park, PA, 16802, USA.
| |
Collapse
|
41
|
Cognition and Neuropsychological Changes at Altitude-A Systematic Review of Literature. Brain Sci 2022; 12:brainsci12121736. [PMID: 36552195 PMCID: PMC9775937 DOI: 10.3390/brainsci12121736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
High-altitude (HA) exposure affects cognitive functions, but studies have found inconsistent results. The aim of this systematic review was to evaluate the effects of HA exposure on cognitive functions in healthy subjects. A structural overview of the applied neuropsychological tests was provided with a classification of superordinate cognitive domains. A literature search was performed using PubMed up to October 2021 according to PRISMA guidelines. Eligibility criteria included a healthy human cohort exposed to altitude in the field (at minimum 2440 m [8000 ft]) or in a hypoxic environment in a laboratory, and an assessment of cognitive domains. The literature search identified 52 studies (29 of these were field studies; altitude range: 2440 m-8848 m [8000-29,029 ft]). Researchers applied 112 different neuropsychological tests. Attentional capacity, concentration, and executive functions were the most frequently studied. In the laboratory, the ratio of altitude-induced impairments (64.7%) was twice as high compared to results showing no change or improved results (35.3%), but altitudes studied were similar in the chamber compared to field studies. In the field, the opposite results were found (66.4 % no change or improvements, 33.6% impairments). Since better acclimatization can be assumed in the field studies, the findings support the hypothesis that sufficient acclimatization has beneficial effects on cognitive functions at HA. However, it also becomes apparent that research in this area would benefit most if a consensus could be reached on a standardized framework of freely available neurocognitive tests.
Collapse
|
42
|
Fabries P, Gomez-Merino D, Sauvet F, Malgoyre A, Koulmann N, Chennaoui M. Sleep loss effects on physiological and cognitive responses to systemic environmental hypoxia. Front Physiol 2022; 13:1046166. [PMID: 36579023 PMCID: PMC9792101 DOI: 10.3389/fphys.2022.1046166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
In the course of their missions or training, alpinists, but also mountain combat forces and mountain security services, professional miners, aircrew, aircraft and glider pilots and helicopter crews are regularly exposed to altitude without oxygen supplementation. At altitude, humans are exposed to systemic environmental hypoxia induced by the decrease in barometric pressure (<1,013 hPa) which decreases the inspired partial pressure of oxygen (PIO2), while the oxygen fraction is constant (equal to approximately 20.9%). Effects of altitude on humans occur gradually and depend on the duration of exposure and the altitude level. From 1,500 m altitude (response threshold), several adaptive responses offset the effects of hypoxia, involving the respiratory and the cardiovascular systems, and the oxygen transport capacity of the blood. Fatigue and cognitive and sensory disorders are usually observed from 2,500 m (threshold of prolonged hypoxia). Above 3,500 m (the threshold for disorders), the effects are not completely compensated and maladaptive responses occur and individuals develop altitude headache or acute altitude illness [Acute Mountain Sickness (AMS)]. The magnitude of effects varies considerably between different physiological systems and exhibits significant inter-individual variability. In addition to comorbidities, the factors of vulnerability are still little known. They can be constitutive (genetic) or circumstantial (sleep deprivation, fatigue, speed of ascent.). In particular, sleep loss, a condition that is often encountered in real-life settings, could have an impact on the physiological and cognitive responses to hypoxia. In this review, we report the current state of knowledge on the impact of sleep loss on responses to environmental hypoxia in humans, with the aim of identifying possible consequences for AMS risk and cognition, as well as the value of behavioral and non-pharmacological countermeasures.
Collapse
Affiliation(s)
- Pierre Fabries
- REF-Aero Department, French Armed Forces Biomedical Research Institute—IRBA, Brétigny-sur-Orge, France,Laboratoire de Biologie de l’Exercice pour la Performance et la Santé (LBEPS), UMR, Université Paris-Saclay, IRBA, Evry-Courcouronnes, France,French Military Health Academy—Ecole du Val-de-Grâce, Place Alphonse Laveran, Paris, France,*Correspondence: Pierre Fabries,
| | - Danielle Gomez-Merino
- REF-Aero Department, French Armed Forces Biomedical Research Institute—IRBA, Brétigny-sur-Orge, France,Vigilance Fatigue Sommeil et Santé Publique (VIFASOM) URP 7330, Université de Paris Cité, Paris, France
| | - Fabien Sauvet
- REF-Aero Department, French Armed Forces Biomedical Research Institute—IRBA, Brétigny-sur-Orge, France,French Military Health Academy—Ecole du Val-de-Grâce, Place Alphonse Laveran, Paris, France,Vigilance Fatigue Sommeil et Santé Publique (VIFASOM) URP 7330, Université de Paris Cité, Paris, France
| | - Alexandra Malgoyre
- REF-Aero Department, French Armed Forces Biomedical Research Institute—IRBA, Brétigny-sur-Orge, France,Laboratoire de Biologie de l’Exercice pour la Performance et la Santé (LBEPS), UMR, Université Paris-Saclay, IRBA, Evry-Courcouronnes, France
| | - Nathalie Koulmann
- Laboratoire de Biologie de l’Exercice pour la Performance et la Santé (LBEPS), UMR, Université Paris-Saclay, IRBA, Evry-Courcouronnes, France,French Military Health Academy—Ecole du Val-de-Grâce, Place Alphonse Laveran, Paris, France
| | - Mounir Chennaoui
- REF-Aero Department, French Armed Forces Biomedical Research Institute—IRBA, Brétigny-sur-Orge, France,Vigilance Fatigue Sommeil et Santé Publique (VIFASOM) URP 7330, Université de Paris Cité, Paris, France
| |
Collapse
|
43
|
Wang L, Sang L, Cui Y, Li P, Qiao L, Wang Q, Zhao W, Hu Q, Zhang N, Zhang Y, Qiu M, Chen J. Effects of acute high-altitude exposure on working memory: A functional near-infrared spectroscopy study. Brain Behav 2022; 12:e2776. [PMID: 36321845 PMCID: PMC9759148 DOI: 10.1002/brb3.2776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Inadequate oxygen availability may lead to impairment of neurocognitive functions. The aim of the present study was to investigate the effect of acute high-altitude exposure on the cerebral hemodynamic response and working memory. METHODS The same subjects performed working memory exercises with forward and backward digit span tasks both under normal oxygen conditions and in large simulated hypobaric hypoxia chambers, and a series of physiological parameters were evaluated. Functional near-infrared spectroscopy was used to measure cerebral blood flow changes in the dorsolateral prefrontal cortex (DLPFC) during the tasks. RESULTS Compared with normoxic conditions, under hypoxic conditions, the heart rate and blood pressure increased, blood oxygen saturation decreased significantly, and the forward task had similar accuracy and response time, while the backward task had lower accuracy and longer response time. Neuroimaging analysis showed increased activation in the DLPFC during the forward task and deactivation during the backward task under hypobaric hypoxia conditions. CONCLUSION Acute high-altitude exposure leads to physiological adaptations. The abnormal hemodynamic responses of the DLPFC to hypoxia at low pressure reveal the disruption of neurocognitive function by acute high-altitude exposure, which compromises complex cognitive functions, and provides a promising application for functional near infrared spectroscopy in the exploration of neural mechanisms in the brain during high-altitude exposure.
Collapse
Affiliation(s)
- Li Wang
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China.,Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Linqiong Sang
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Yu Cui
- Department of High Altitude Physiology and Pathology, College of High Altitude Military Medicine, Army Medical University, Chongqing, China
| | - Pengyue Li
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Liang Qiao
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Qiannan Wang
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Wenqi Zhao
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China.,Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, China
| | - Qiu Hu
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China.,Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, China
| | - Najing Zhang
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Ye Zhang
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Mingguo Qiu
- Department of Medical Imaging, College of Biomedical Engineering, Army Medical University, Chongqing, China
| | - Jian Chen
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China.,Institute of Medicine and Equipment for High Altitude Region, College of High Altitude Military Medicine, Army Medical University, Chongqing, China
| |
Collapse
|
44
|
Vento KA, Borden CK, Blacker KJ. Sex comparisons in physiological and cognitive performance during hypoxic challenge. Front Physiol 2022; 13:1062397. [PMID: 36505049 PMCID: PMC9727089 DOI: 10.3389/fphys.2022.1062397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Within the tactical aviation community, human performance research lags in considering potential psychophysiological differences between male and female aviators due to little inclusion of females during the design and development of aircraft systems. A poor understanding of how male and female aviators differ with respect to human performance results in unknown potential sex differences on aeromedically relevant environmental stressors, perchance leading to suboptimal performance, safety, and health guidelines. For example, previous hypoxia studies have excluded female participants or lacked a sizeable sample to examine sex comparisons. As such, progress toward sensor development and improving hypoxia familiarization training are stunted due to limited knowledge of how individual differences, including sex, may or may not underlie hypoxia symptoms and performance impairment. Investigating sex differences bridges the gap between aerospace medicine and operational health, and addressing hypoxia is one of many facets yet to be studied. In the current study, we retrospectively examined N = 6 hypoxia studies with male-female participant samples (total, N = 189; male, n = 118; female, n = 71). We explored sex as a predictor of physiological response, sensory deficits, the severity of cognitive performance declines, and symptom manifestation via linear and binary logistic regression models. We found that the female sex predicted lower peripheral oxygen saturation and the likelihood of headache reporting in response to hypoxic challenge, yet explained little variance when combined with age and body mass index. The sensory and cognitive performance models did not converge, suggesting high intra-individual variability. Together, sex, age, and body mass index were not the most robust predictors in responses to hypoxic challenge; we cannot infer this for sensory deficits and cognitive performance within an experimentally induced hypoxic environment. The findings have implications for improving hypoxia familiarization training, monitoring sensor development, and emergency response and recovery protocols in case of a hypoxia occurrence suitable for all aircrew. We recommend continuing to elucidate the impact of sex and intrapersonal differences in hypoxia and other aeromedically relevant stressors in tactical aviation.
Collapse
Affiliation(s)
- Kaila A. Vento
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Cammi K. Borden
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Kara J. Blacker
- Naval Medical Research Unit-Dayton Wright-Patterson Air Force Base, Dayton, OH, United States,*Correspondence: Kara J. Blacker,
| |
Collapse
|
45
|
The effects of normobaric and hypobaric hypoxia on cognitive performance and physiological responses: A crossover study. PLoS One 2022; 17:e0277364. [DOI: 10.1371/journal.pone.0277364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
This partially randomised controlled, crossover study sought to investigate the effects of normobaric hypoxia (NH) and hypobaric hypoxia (HH) on cognitive performance, the physiological response at rest and after a 3-min step-test. Twenty healthy participants (10 females and 10 males, 27.6±6.2yrs, 73.6±13.7kg, 175.3±8.9cm) completed a cognitive performance test, followed by the modified Harvard-step protocol, in four environments: normobaric normoxia (NN; PiO2: 146.0±1.5mmHg), NH (PiO2: 100.9±1.3mmHg), HH at the first day of ascent (HH1: PiO2 = 105.6±0.4mmHg) and HH after an overnight stay (HH2: PiO2 = 106.0±0.5mmHg). At rest and/or exercise, SpO2, NIRS, and cardiovascular and perceptual data were collected. The cerebral tissue oxygenation index and the cognitive performance (throughput, accuracy, and reaction time) were not different between the hypoxic conditions (all p>0.05). In NH, SpO2 was higher compared to HH1 (ΔSpO2 NH vs HH1: 1.7±0.5%, p = 0.003) whilst heart rate (ΔHR NH vs HH2: 5.8±2.6 bpm, p = 0.03) and sympathetic activation (ΔSNSi NH vs HH2: 0.8±0.4, p = 0.03) were lower in NH compared to HH2. Heart rate (ΔHR HH1 vs HH2: 6.9±2.6 bpm, p = 0.01) and sympathetic action (ΔSNSi HH1 vs HH2: 0.9±0.4, p = 0.02) were both lower in HH1 compared to HH2. In conclusion, cognitive performance and cerebral oxygenation didn’t differ between the hypoxic conditions. SpO2 was only higher in NH compared to HH1. In HH2, heart rate and sympathetic activation were higher compared to both NH and HH1. These conclusions account for a PiO2 between 100–106 mmHg.
Collapse
|
46
|
Gu C, Ma M, Xu J, Yuan W, Li R, Guo H, Gao H, Feng W, Guo H, Zheng L, Zhang Y. Association between pulmonary ventilatory function and mild cognitive impairment: A population-based study in rural China. Front Public Health 2022; 10:1038576. [PMID: 36408049 PMCID: PMC9666756 DOI: 10.3389/fpubh.2022.1038576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mild cognitive impairment (MCI), a reversible intermediate state, plays an important role in the development and prevention of dementia. The relationship between pulmonary function and MCI risk has not yet been well-elucidated. Methods We included 2,947 rural Chinese residents aged ≥35 years who were free from a history of stroke, dementia, or other brain diseases and measured pulmonary ventilatory function using calibrated spirometry according to the recommended method. MCI was assessed with the Montreal Cognitive Assessment-Basic for Chinese scale. Logistic regression models and restricted cubic splines with covariate adjustment were performed to explore the association between pulmonary function and MCI risk. Results The prevalence of MCI increased with decreasing pulmonary function, from the lowest quartile to the highest quartile of pulmonary function: 63.9, 50.5, 43.8, and 43.6%, respectively. After adjustment for confounding factors, participants in the first quartile had a significantly increased risk of MCI (ORs, 1.691, 95% CI, 1.267-2.258), with the highest quartile as the reference. In the subgroup analysis, a significant association of pulmonary function and MCI was found in females and those with low physical activity. Meanwhile, we observed an L-shaped relationship between pulmonary function and MCI (P non-linear = 0.032). Conclusions Poor pulmonary function was associated with an increased risk of MCI among rural Chinese adults, and presented a non-linear relationship. These findings remind us of the need for early cognitive assessment in local populations with lower pulmonary function.
Collapse
Affiliation(s)
- Cuiying Gu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingfeng Ma
- Department of Cardiology, Fenyang Hospital of Shanxi Province, Fenyang, China
| | - Jiahui Xu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Wei Yuan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Ruixue Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Hui Guo
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Hanshu Gao
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Wenjing Feng
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Haiqiang Guo
- Department of Health Statistics, China Medical University, Shenyang, China
| | - Liqiang Zheng
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Liqiang Zheng
| | - Yao Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China,Yao Zhang
| |
Collapse
|
47
|
Neurocognitive Outcome Following Recovery from Severe Acute Respiratory Syndrome - Coronavirus-1 (SARS-CoV-1). J Int Neuropsychol Soc 2022; 28:891-901. [PMID: 34488921 DOI: 10.1017/s1355617721001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002-2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. METHOD Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. RESULTS Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed-accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants' subjective ratings of Everyday Task-Oriented Memory. CONCLUSIONS These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.
Collapse
|
48
|
Liu J, Li S, Liu M, Xu X, Zhang Y, Cheng J, Zhang W. Impaired brain networks functional connectivity after acute mild hypoxia. Medicine (Baltimore) 2022; 101:e30485. [PMID: 36197178 PMCID: PMC9509199 DOI: 10.1097/md.0000000000030485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the changes in brain networks functional connectivity of pilots exposed to simulated hypoxia using resting-state functional magnetic resonance imaging (fMRI). A total of 35 healthy male pilots exposed to 14.5% oxygen concentration (corresponding to an altitude of 3000 m) underwent resting-state fMRI scans. The independent component analysis (ICA) approach was used to analyze changes in the resting-state brain networks functional connectivity of pilots after hypoxic exposure, and 9 common components in brain functional networks were identified. In the functional connections that showed significant group differences, linear regression was used to examine the association between functional connectivity and clinical characteristics. The brain networks functional connectivity after hypoxia exposure decreased significantly, including the left frontoparietal network and visual network 1-area, left frontoparietal network and visual network 2-area, right frontoparietal network and visual network 2-area, dorsal attention network and ventral attention network, dorsal attention network and auditory network, and ventral attention network and visual network 1-area. We found no correlation between the altered functional connectivity and arterial oxygen saturation level. Our findings provide insights into the mechanisms underlying hypoxia-induced cognitive impairment in pilots.
Collapse
Affiliation(s)
- Jie Liu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujian Li
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingxi Liu
- Department of Radiology, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xianrong Xu
- Department of Air Duty, Air Force General Hospital, Beijing, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * Correspondence: Jingliang Cheng, Department of MRI, the First Affiliated Hospital of Zhengzhou University, 1 East Construction Road, Erqi District, Zhengzhou 450052, Henan Province, China (e-mail: )
| | - Wanshi Zhang
- Department of Radiology, Air Force General Hospital, Beijing, China
| |
Collapse
|
49
|
Scheiwiller PM, Furian M, Buergin A, Mayer LC, Schneider SR, Mademilov M, Lichtblau M, Muralt L, Sheraliev U, Sooronbaev TM, Ulrich S, Bloch KE. Visuomotor performance at high altitude in COPD patients. Randomized placebo-controlled trial of acetazolamide. Front Physiol 2022; 13:980755. [PMID: 36160864 PMCID: PMC9493049 DOI: 10.3389/fphys.2022.980755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: We evaluated whether exposure to high altitude impairs visuomotor learning in lowlanders with chronic obstructive pulmonary disease (COPD) and whether this can be prevented by acetazolamide treatment.Methods: 45 patients with COPD, living <800 m, FEV1 ≥40 to <80%predicted, were randomized to acetazolamide (375 mg/d) or placebo, administered 24h before and during a 2-day stay in a clinic at 3100 m. Visuomotor performance was evaluated with a validated, computer-assisted test (Motor-Task-Manager) at 760 m above sea level (baseline, before starting the study drug), within 4h after arrival at 3100 m and in the morning after one night at 3100 m. Main outcome was the directional error (DE) of cursor movements controlled by the participant via mouse on a computer screen during a target tracking task. Effects of high altitude and acetazolamide on DE during an adaptation phase, immediate recall and post-sleep recall were evaluated by regression analyses. www.ClinicalTrials.gov NCT03165890.Results: In 22 patients receiving placebo, DE at 3100 m increased during adaptation by mean 2.5°, 95%CI 2.2° to 2.7° (p < 0.001), during immediate recall by 5.3°, 4.6° to 6.1° (p < 0.001), and post-sleep recall by 5.8°, 5.0 to 6.7° (p < 0.001), vs. corresponding values at 760 m. In 23 participants receiving acetazolamide, corresponding DE were reduced by −0.3° (−0.6° to 0.1°, p = 0.120), −2.7° (−3.7° to −1.6°, p < 0.001) and −3.1° (−4.3° to −2.0°, p < 0.001), compared to placebo at 3100 m.Conclusion: Lowlanders with COPD travelling to 3100 m experienced altitude-induced impairments in immediate and post-sleep recall of a visuomotor task. Preventive acetazolamide treatment mitigated these undesirable effects.
Collapse
Affiliation(s)
- P. M. Scheiwiller
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - M. Furian
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - A. Buergin
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - L. C. Mayer
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - S. R. Schneider
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - M. Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - M. Lichtblau
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - L. Muralt
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - U. Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - T. M. Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, Bishkek, Kyrgyz Republic
| | - S. Ulrich
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - K. E. Bloch
- University Hospital of Zurich, Department of Respiratory Medicine, Sleep Disorders Center, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- *Correspondence: K. E. Bloch,
| |
Collapse
|
50
|
Clinical phenotypes of delirium in patients admitted to the cardiac intensive care unit. PLoS One 2022; 17:e0273965. [PMID: 36054128 PMCID: PMC9439246 DOI: 10.1371/journal.pone.0273965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Limited data are available on clinical phenotype for delirium that occurs frequently among patients admitted to the cardiac intensive care unit (CICU). The objective of this study was to investigate the clinical pictures of delirium, and their association with clinical outcomes in CICU patients. Methods A total of 4,261 patients who were admitted to the CICU between September 1 2012 to December 31 2018 were retrospectively registered. Patients were excluded if they were admitted to the CICU for less than 24 hours or had missed data. Ultimately, 2,783 patients were included in the analysis. A day of delirium was defined as any day during which at least one CAM-ICU assessment was positive. The clinical risk factors of delirium were classified by the delirium phenotype, as follows; hypoxic, septic, sedative-associated, and metabolic delirium. Results The incidence of delirium was 24.4% at the index hospitalization in all CICU patients, and 22.6% within 7 days after CICU admission. The most common delirium phenotype was septic delirium (17.2%), followed by hypoxic delirium (16.8%). Multiple phenotypes were observed during most delirium days. Delirium most frequently occurred in patients with heart failure. Of all patients affected by delirium within 7 days, both ICU and hospital mortality significantly increased according to the combined number of delirium phenotypes. Conclusions Delirium occurred in a quarter of patients admitted to the modern CICU and was associated with increased in-hospital mortality. Therefore, more efforts are needed to reduce the clinical risk factors of delirium, and to prevent it in order to improve clinical outcomes in the CICU.
Collapse
|