title: Lower neurocognitive function in U-2 pilots: Relationship to white matter hyperintensities.
abstract: OBJECTIVE
  Determine whether United States Air Force (USAF) U-2 pilots (U2Ps) with occupational exposure to repeated hypobaria had lower neurocognitive performance compared to pilots without repeated hypobaric exposure and whether U2P neurocognitive performance correlated with white matter hyperintensity (WMH) burden.
  
  
  METHODS
  We collected Multidimensional Aptitude Battery-II (MAB-II) and MicroCog: Assessment of Cognitive Functioning (MicroCog) neurocognitive data on USAF U2Ps with a history of repeated occupational exposure to hypobaria and compared these with control data collected from USAF pilots (AFPs) without repeated hypobaric exposure (U2Ps/AFPs MAB-II 87/83; MicroCog 93/80). Additional comparisons were performed between U2Ps with high vs low WMH burden.
  
  
  RESULTS
  U2Ps with repeated hypobaric exposure had significantly lower scores than control pilots on reasoning/calculation (U2Ps/AFPs 99.4/106.5), memory (105.5/110.9), information processing accuracy (102.1/105.8), and general cognitive functioning (103.5/108.5). In addition, U2Ps with high whole-brain WMH count showed significantly lower scores on reasoning/calculation (high/low 96.8/104.1), memory (102.9/110.2), general cognitive functioning (101.5/107.2), and general cognitive proficiency (103.6/108.8) than U2Ps with low WMH burden (high/low WMH mean volume 0.213/0.003 cm(3) and mean count 14.2/0.4).
  
  
  CONCLUSIONS
  In these otherwise healthy, highly functioning individuals, pilots with occupational exposure to repeated hypobaria demonstrated lower neurocognitive performance, albeit demonstrable on only some tests, than pilots without repeated exposure. Furthermore, within the U2P population, higher WMH burden was associated with lower neurocognitive test performance. Hypobaric exposure may be a risk factor for subtle changes in neurocognition.
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore. smcguire@satx.rr.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McGuire
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: David F
authors.initials: DF
authors.lastname: Tate
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Joe
authors.initials: J
authors.lastname: Wood
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: John H
authors.initials: JH
authors.lastname: Sladky
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Kent
authors.initials: K
authors.lastname: McDonald
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Sherman
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Kawano
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Rowland
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Beenish
authors.initials: B
authors.lastname: Patel
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Wright
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Elliot
authors.initials: E
authors.lastname: Hong
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rasmussen
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Willis
authors.affiliation: From the US Air Force School of Aerospace Medicine (S.A.M., J.W., K.M., E.S.K.), Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH; Department of Neurology (S.A.M., J.R.), University of Texas Health Sciences Center, San Antonio; Departments of Neuroradiology (P.M.S.) and Neurology (S.A.M., J.H.S., A.M.W.), 59th Medical Wing, Lackland AFB; Henry Jackson Foundation for the Advancement of Military Medicine (D.F.T.), San Antonio, TX; and Maryland Psychiatric Research Center (L.M.R., B.P., S.N.W., E.H., P.V.K.), University of Maryland School of Medicine, Baltimore.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Kochunov
mesh_terms: D000328:Adult; D000401:Aircraft; D001469:Barotrauma / Q000150:complications / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D016273:Occupational Exposure; D009929:Organ Size; D014481:United States