title: Association of Cognitive Performance with Time at Altitude, Sleep Quality, and Acute Mountain Sickness Symptoms.
abstract: OBJECTIVE
  It is well documented that cognitive performance may be altered with ascent to altitude, but the association of various cognitive performance tests with symptoms of acute mountain sickness (AMS) is not well understood. Our objective was to assess and compare cognitive performance during a high-altitude expedition using several tests and to report the association of each test with AMS, headache, and quality of sleep.
  
  
  METHODS
  During an expedition to Mount Everest, 3 cognitive tests (Stroop, Trail Making, and the real-time cognitive assessment tool, an in-house developed motor accuracy test) were used along with a questionnaire to assess health and AMS. Eight team members were assessed pre-expedition, postexpedition, and at several time points during the expedition.
  
  
  RESULTS
  There were no significant differences (P >.05) found among scores taken at 3 time points at base camp and the postexpedition scores for all 3 tests. Changes in the Stroop test scores were significantly associated with the odds of AMS (P <.05). The logistic regression results show that the percent change from baseline for Stroop score (β = -5.637; P = .032) and Stroop attempts (β = -5.269; P = .049) are significantly associated with the odds of meeting the criteria for AMS.
  
  
  CONCLUSIONS
  No significant changes were found in overall cognitive performance at altitude, but a significant relationship was found between symptoms of AMS and performance in certain cognitive tests. This research shows the need for more investigation of objective physiologic assessments to associate with self-perceived metrics of AMS to gauge effect on cognitive performance.
authors.affiliation: Mayo Clinic, Rochester, MN. Electronic address: issa.amine@mayo.edu.
authors.forename: Amine N
authors.initials: AN
authors.lastname: Issa
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Herman
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wentz
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Taylor
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Doug C
authors.initials: DC
authors.lastname: Summerfield
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D006261:Headache / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009051:Mountaineering / Q000502:physiology / Q000523:psychology*; D012890:Sleep / Q000502:physiology*; D057190:Stroop Test; D013997:Time Factors
keywords: AMS; altitude; cognition; cognitive performance; expedition; hypoxia