Early Detection of Hypoxia-Induced Cognitive Impairment Using the King-Devick Test

Štěpánek, Jan; Cocco, Daniela; Pradhan, Gaurav N.; Smith, Benn E.; Bartlett, Jennifer; Studer, Marc; Kühn, Fabian; Cevette, Michael J.

doi:10.3357/asem.3616.2013

Cited by 30 publications

(20 citation statements)

References 12 publications

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“…Construct validity of the K-D test as an instrument to capture meaningful neurologic events, such as concussion, has been explored with formal computerized eye movement recordings of individuals with hypoxia-induced impairment. In these studies, worsening of K-D performance was associated with changes in quantitative eye movement metrics [ 61 , 62 ]. Furthermore, performance on other cognitive measures such as the SAC and a similar tool called the MACE has correlated with K-D test outcomes both at baseline and postinjury [ 29 , 30 , 47 , 48 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…These tasks involve the integration of functions of the brainstem, cerebellum and cerebral cortex. Performance on the K-D test has been shown to correlate with suboptimal brain function in concussion [ 29 , 30 , 47–56 ], Parkinson's disease [ 57 ], multiple sclerosis (MS) [ 58 ], amyotrophic lateral sclerosis [ 59 ], sleep deprivation [ 60 ] and hypoxia [ 61 , 62 ]. Patients with Parkinson's disease and those with amyotrophic lateral sclerosis have been found to have slower (worse) K-D times than healthy controls [ 57 , 59 ].…”

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confidence: 99%

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The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature

et al. 2016

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Background:Vision encompasses a large component of the brain's pathways, yet is not represented in current sideline testing.Objectives:We performed a meta-analysis of published data for a vision-based test of rapid number naming (King-Devick [K-D] test).Studies & methods:Pooled and meta-analysis of 15 studies estimated preseason baseline K-D scores and sensitivity/specificity for identifying concussed versus nonconcussed control athletes.Result:Baseline K-D (n = 1419) showed a weighted estimate of 43.8 s (95% CI: 40.2, 47.5; I2 = 0.0%; p=0.85 – indicating very little heterogeneity). Sensitivity was 86% (96/112 concussed athletes had K-D worsening; 95% CI: 78%, 92%); specificity was 90% (181/202 controls had no worsening; 95% CI: 85%, 93%).Conclusion:Rapid number naming adds to sideline assessment and contributes a critical dimension of vision to sports-related concussion testing.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature

et al. 2016

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“…To insure accurate tracking of eye movements, equipment calibration was performed for each subject prior to data collection. A mental workload task was created using a cognitive test [the King-Devick (K-D) test] ( 7 ) which was recently studied in a hypoxic environment ( 24 ). This test requires reading numbers aloud arranged from left to right on sequential lines shown on three different test cards (or screens).…”

Section: Equipment and Proceduresmentioning

confidence: 99%

Acute Hypoxic Hypoxia and Isocapnic Hypoxia Effects on Oculometric Features

Štěpánek¹,

Pradhan²,

Cocco³

et al. 2014

aviat space environ med

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These results suggest that oculometric changes are indicators of hypoxia, which can be monitored using compact, portable, noninvasive eye-tracking devices in a cockpit analogous environment to detect hypoxia-induced physiological changes in aircrew. Comparative results between HH and IH support the potential role of carbon dioxide in augmenting cerebral perfusion and hence improved tissue oxygen delivery.

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“…This was unexpected as the DANA battery has been sensitive in previous field studies in sea level residents exposed to higher altitudes over a longer time frame (E. B. Roach et al., 2014; Subudhi et al., 2014). Additionally, the KD test has been shown to be sensitive to acute hypoxia (Stepanek et al., 2013), yet again with a more severe degree of hypoxia (equivalent to ∼7100 m). It is thus possible that our null findings are the result of reduced sensitivity of the tests when subjects acclimatized to ∼1650 m are acutely exposed to ∼4875 m (change of ∼3275 m).…”

Section: Discussionmentioning

confidence: 99%

Combined methazolamide and theophylline improves oxygen saturation but not exercise performance or altitude illness in acute hypobaric hypoxia

Subudhi

Evero

Reitinger

et al. 2020

Experimental Physiology

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A limited number of small studies have suggested that methazolamide and theophylline can independently reduce symptoms of acute mountain sickness (AMS) and, if taken together, can improve aerobic exercise performance in normobaric hypoxia. We performed a randomized, double-blind, placebo-controlled, cross-over study to determine if the combination of oral methazolamide and theophylline could provide prophylaxis against AMS and improve aerobic performance in hypobaric hypoxia (∼4875 m). Volunteers with histories of AMS were screened at low altitude (1650 m) and started combined methazolamide (100 mg BID) and theophylline (300 mg BID) treatment, or placebo, 72 h prior to decompression. Baseline AMS (Lake Louise Questionnaire), blood (haemoglobin, haematocrit), cognitive function, ventilatory and pulse oximetry (S pO 2) measures were assessed at low altitude and repeated between 4 and 10 h of exposure to hypobaric hypoxia (P B = 425 mmHg). Aerobic exercise performance was assessed during a 12.5 km cycling time trial (TT) after 4 h of hypobaric hypoxia. Subjects repeated all experimental procedures after a 3-week washout period. Differences between drug and placebo trials were evaluated using repeated measures ANOVA (= 0.05). The drugs improved resting S pO 2 by ∼4% (P < 0.01), but did not affect the incidence or severity of AMS or cognitive function scores relative to placebo. Subjects' performance on the 12.5 km TT was ∼3% worse when taking the drugs (P < 0.01). The combination of methazolamide and theophylline in the prescribed dosages is not recommended for use at high altitude as it appears to have no measurable effect on AMS and can impair aerobic performance. K E Y W O R D S acute mountain sickness, carbonic anhydrase, cognitive function, cycling time trial, methylxanthine 1 INTRODUCTION Despite advances in our understanding of the physiological responses to high altitude, there are few effective pharmacological countermeasures to offset associated symptoms of acute mountain sickness (AMS) and reductions in aerobic exercise performance upon rapid ascent. The most common and effective prophylactic treatments for

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Early Detection of Hypoxia-Induced Cognitive Impairment Using the King-Devick Test

Abstract: In this study the K-D test has been shown to be an effective neurocognitive test to detect hypoxic impairment at early presymptomatic stages. The K-D test may also be used to afford a reassessment of traditional measures used to determine hypoxic reserve time.

Cited by 30 publications

References 12 publications

The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature

The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature

Acute Hypoxic Hypoxia and Isocapnic Hypoxia Effects on Oculometric Features

Combined methazolamide and theophylline improves oxygen saturation but not exercise performance or altitude illness in acute hypobaric hypoxia

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