The Mediating Role of Cognitive Function in the Relationship Between Acute High-Altitude Stress and Casualty Care Capability Following Rapid Ascent

Abstract

Du, Tianjing, Haoqing Shi, Linlin Liu, and Zeyu Yang. The mediating role of cognitive function in the relationship between acute high-altitude stress and casualty care capability following rapid ascent. High Alt Med Biol. 00:00–00, 2026.

Background:

The impact of high-altitude rescue missions on medical personnel’s cognitive function and casualty care capabilities remains unclear.

Methods:

This multicenter, randomized, sham-controlled clinical trial established high-altitude intervention (HAI), high-altitude (HA), and sea level (SL) groups (n = 92 per group). The HAI group received an integrated cognitive-stress management training, and the HA group implemented a sham training regimen before rapid ascent to high altitude (RAHA). The SL group served as a blank control group. Primary outcomes included casualty care capability score, plasma cortisol level, and cognitive ability score. Longitudinal mediation analysis examined the role of cognitive function in stress and casualty care capabilities.

Results:

In the HA group, cognitive ability mediated strong negative indirect effects at 24 hours, alongside a positive direct effect of stress. At 48 hours, the negative indirect effect remained dominant, whereas the direct effect of stress was not significant. At 72 hours, the indirect effect weakened but remained significant, whereas the direct effect of stress became significantly negative. By 96 hours, the indirect effect disappeared, with the total effect explained by stress. In the HAI group, the total and indirect effects were significant at 24 and 48 hours, whereas the direct effects were not. At 72 and 96 hours, no effects were statistically significant.

Conclusion:

During the initial phase of RAHA, cognitive ability serves as a mediating factor through which stress impairs casualty care capabilities. Over time, the mediating effect of cognition gradually diminishes, while the direct negative impact of the stress response continues to strengthen. The integrated cognitive-stress training can effectively preserve cognitive function and mitigate the stress response, thereby enhancing medical personnel’s casualty care capabilities.