A gamified assessment does not identify alterations in cross‐domain cognitive performance with acute moderate hypoxia
Authors: Kerr Payton M. , Keeler Jason M. , Tourula Erica , Hite Jo , Baker Tyler B. , Port Nicholas , Schlader Zachary J. 
Published: May 2022

INTRODUCTIONThe acute effect of hypoxia on cognition is dependent on the magnitude and duration of the hypoxia, and the assessed cognitive domain. For example, there is little effect of ~1 h exposure to a fraction of inspired oxygen (FiO2) of ~14% on simple cognitive tasks that measure reaction time. However, complex or novel cognitive tasks can be hindered under the same conditions. These possible cognitive alterations are recognized by the use of supplemental oxygen when flying in unpressurized aircraft for >1 h at altitudes >3048 m. Notably, people often cannot recognize their own hypoxia‐induced symptoms. Thus, there is a need to develop objective assessment tools to consistently identify potential detrimental cognitive effects of moderate hypoxia. One potential solution is the use of gamified cognitive assessments, whereby electronic games can provide metrics of changes in cognitive functioning. However, the effect of moderate hypoxia on gamified cognitive performance has never been explored.PURPOSETest the hypothesis that moderate normobaric hypoxia decreases gamified cross‐domain cognitive performance.METHODSFollowing three consecutive days of practice, twenty‐one healthy adults (27 ± 5 y, 9 females) completed five 1 min rounds of the tablet‐based game Gridshot (Statespace Labs, Inc.) at Baseline and 60 and 90 min after exposure to a chamber with an FiO2 = 14.0 ± 0.2% (hypoxia) and FiO2 = 20.6 ± 0.3% (normoxia). Both conditions were completed on the same day and were administered in a single‐blind, block randomized manner. Gridshot is a novel first‐person shooter style assessment in which a participant’s performance is measured as hits (#), misses (#), hit rate (%), hits per second (#/s), shots per second (#/s), median time to hit (s), and shot precision (i.e., the variability of shot locations relative to the center of targets). Arterial oxyhemoglobin saturation was estimated via forehead pulse oximetry (SpO2). Data were analyzed using ANCOVA with a covariate of Baseline and are presented as adjusted means (95% confidence intervals).RESULTSCompared to normoxia (98 ± 1%), SpO2 was lower (p < 0.001) at 60 (91 ± 3%) and 90 (90 ± 3%) min of hypoxia. A main effect of time was identified for average hits (p = 0.039) and hits per second (p = 0.039), such that, independent of condition, average hits [114 (112, 116) vs. 116 (114, 118)] and hits per second [1.89 (1.86, 1.94) vs. 1.93 (1.89, 1.97)] increased from 60 to 90 min. However, no effect of condition or a condition x time interaction was identified for either average hits (p ≥ 0.255) or hits per second (p ≥ 0.255). There were no condition, time, or condition x time interaction effects identified for average misses (p ≥ 0.138), hit rate (p ≥ 0.057), shots per second (p ≥ 0.247), median time to hit (p ≥ 0.220), and shot precision (p ≥ 0.145).CONCLUSIONThese preliminary findings indicate that, compared to normoxia, 90 min of moderate hypoxia does not elicit measurable alterations in metrics of a first‐person shooter stylistic cross‐domain cognitive assessment. More research is required to better understand the ability of gamified cognitive assessments to detect cognitive alterations caused by environmental stressors.