Dysexecutive Symptoms in Acute/Chronic High-Altitude Hypoxia: Assessment Battery

Description

The questionnaire is designed to assess dysexecutive symptoms associated with both acute and chronic exposure to high-altitude hypoxia. It investigates multiple cognitive domains related to dorsolateral prefrontal cortex functioning, including attention, planning, working memory, cognitive flexibility, and judgment, through targeted questions focused on climbers’ subjective experiences in extreme environments. As well known, executive functions and higher-order cognitive control are critically supported by prefrontal cortex networks (Badre & Nee, 2018; Knight & D’Esposito, 1999; Knight et al., 1995; Miller & Cohen, 2001; Jiang et al., 2025), and are particularly vulnerable to environmental stressors such as hypoxia. Environmental hypoxia, resulting from reduced oxygen supply, poses a significant risk of dysfunctioning and damaging the neurocognitive system, particularly in relation to anxiety and stress. Inadequate oxygenation can lead to acute and chronic brain damage. Scholars used behavioral, hemodynamic, and electromagnetic neurofunctional techniques to investigate the effects of normobaric and hypobaric hypoxia on neurocognitive systems. They found a correlation between hypoxia, altered psychomotor responses, and changes in neurocognitive functions Borden et al., 2024; Huang et al., 2026; Suzin et al., 2020; Wang et al., 2021; Yan et al., 2011). Prolonged exposure exacerbates these effects, resulting in compensatory delayed behavioral responses and alterations in behavioral monitoring and conflict inhibitory control. Thus, neurocognitive function and integrity are under stress. These changes illustrate the spectrum from sensory detection to more complex cognitive processing, highlighting the brain efficiency in managing information (McMorris et al., 2017; Zani et al., 2023, 2024, 2025). The present project proposes that high altitude (HA) level reached, repetitions of such reaching, and the duration of permanence at a specific HA, may be positively related to impairments and alterations of both neurocognitive structures and functions. We shall examine whether the proposed relationships among the mentioned variables really exist studying the self-reported, subjectively perceived experiences of skilled mountaineers who summited at least high altitude (HA) peaks of at least 6,500 m. The present battery comprises 43 brief situational and environmental scenarios administered via Google Forms, each requiring the selection of a single response option. All scenarios are designed to be mutually independent. With the exception of scenarios #13 and #19, which each provide five response options, all other scenarios offer three alternatives. The battery requires approximately 10 minutes to complete. Inclusion criteria for participating to data collection: having summited at least three peaks exceeding 6,500 m (including at least one ascent exceeding 8,000 m) within the past 10 years without the use of supplemental oxygen.

Steps to reproduce

For a scientific discussion of the items, see Zani, A. & Proverbio, A.M. (2026). Breathless: The Science of Oxygen Deprivation and Its Neurocognitive Consequences. Foreword by Marco Confortola, Milan University Press. The questionnaire is available online and can be completed via the web at this link (for eligible participants): https://forms.gle/dyMVA8jB8hj8t1STA

Institutions

• University of Milano-Bicocca

  Lombardy, Milan

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