Department of Emergency Medicine, University of California Irvine Medical Center, Orange, California, USA.
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
High Alt Med Biol. 2020 Jun;21(2):184-191. doi: 10.1089/ham.2019.0111. Epub 2020 Apr 13.
This study aimed to longitudinally quantify the prevalence of mild cognitive impairment (MCI) in individual trekkers at three different ascending altitudes (Site 1: ∼3500 m, Site 2: ∼4400 m, and Site 3: ∼5100 m). We correlated these findings with the presence of acute mountain sickness (AMS). We performed serial assays using the environmental quick mild cognitive impairment (eQMCI) score on 103 English-speaking 18- to 65-year-old volunteers trekking to Everest Base Camp in Nepal during spring 2016. We defined MCI as a score less than 67 (lower scores indicating more cognitive impairment). Additional data collected included the Lake Louise Score, demographics, and other possible confounders. eQMCI scores significantly decreased with ascent from Site 1 to 2 (a score of 78.95 [SD = 7.96] to 74.67 [SD = 8.8] [Site 1-2 = 0.04]), but then increased on ascent to Site 3 to 83.68 (SD = 8.67) (Site 1-3 = <0.0001, Site 2-3 = <0.0001). However, subjects who fulfilled eQMCI criteria for MCI increased despite the overall improvement in score: 6.8% ( = 7) at Site 1, 18.7% ( = 14) at Site 2, and 3.3% ( = 2) at Site 3. Incidence of AMS at Sites 1, 2, and 3 was 22.3% ( = 23), 21.3% ( = 16), and 48.3% ( = 29), respectively. Of those with MCI, 1.94% met criteria for AMS at Site 1 ( = 0.0017), 2.67% at Site 2 ( = 0.6949), and 3.33% at Site 3 ( = <0.0001). There is a significant incidence of MCI at high altitude, even in those without subjective findings of AMS. Interestingly, subjects with a decline in cognitive function show an increasing trend for developing AMS at higher altitude. Future research on the clinical impact of MCI on a subject's health, judgment, and performance remains to be elucidated.
这项研究旨在对不同海拔高度的个体徒步旅行者中的轻度认知障碍（MCI）患病率进行纵向量化，海拔高度分别为（Site 1：约 3500 米，Site 2：约 4400 米，Site 3：约 5100 米）。我们将这些发现与急性高原病（AMS）的存在相关联。
我们对 103 名 18 至 65 岁的讲英语的志愿者在 2016 年春季前往尼泊尔珠穆朗玛峰大本营进行了连续的环境快速简易认知障碍（eQMCI）评分检测。我们将 MCI 定义为得分低于 67 分（得分越低表示认知障碍越严重）。收集的其他数据包括路易斯湖评分、人口统计学资料和其他可能的混杂因素。
eQMCI 评分随着从 Site 1 到 Site 2 的上升而显著下降（分数从 78.95（SD=7.96）降至 74.67（SD=8.8）[Site 1-2=0.04]），但随后在上升到 Site 3 时增加到 83.68（SD=8.67）（Site 1-3<0.0001，Site 2-3<0.0001）。然而，尽管整体得分有所提高，但符合 eQMCI 标准的 MCI 患者数量却有所增加：Site 1 为 6.8%（=7），Site 2 为 18.7%（=14），Site 3 为 3.3%（=2）。Site 1、2 和 3 的 AMS 发生率分别为 22.3%（=23）、21.3%（=16）和 48.3%（=29）。在 MCI 患者中，1.94%的患者在 Site 1 符合 AMS 标准（=0.0017），2.67%的患者在 Site 2 符合 AMS 标准（=0.6949），3.33%的患者在 Site 3 符合 AMS 标准（<0.0001）。
在高海拔地区，即使没有主观的 AMS 发现，也会出现明显的 MCI 发病率。有趣的是，认知功能下降的患者在更高海拔地区出现 AMS 的趋势增加。关于 MCI 对受试者健康、判断力和表现的临床影响的进一步研究仍有待阐明。
