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Appropriate Screening Tests to Assess Post-COVID-19 Cognitive Dysfunction in Aeromedical Settings.

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Post-COVID-19 Neurocognitive Screening in Routine Pilot Aeromedical Evaluations.

Solomon G Beka, Robin F Griffiths, Julia A Myers

    Aerospace Medicine and Human Performance
    |October 3, 2025
    PubMed
    Summary

    Screening pilots for post-COVID-19 neurocognitive impairments using the Trail Making Test (TMT) and Symbol Digit Modalities Test (SDMT) is crucial for flight safety. These tests effectively identify cognitive deficits affecting pilot performance, supporting routine aeromedical evaluations.

    Keywords:
    aeromedical examinationspilotspost-COVID-19screening implications

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    Area of Science:

    • Aerospace Medicine
    • Neuroscience
    • Aviation Psychology

    Background:

    • Subtle post-COVID-19 neurocognitive impairments pose a risk to flight safety by potentially going undetected during aeromedical examinations.
    • The Trail Making Test (TMT) and Symbol Digit Modalities Test (SDMT) are recognized tools for assessing cognitive domains vital for pilot performance.

    Purpose of the Study:

    • To evaluate the effectiveness and clinical utility of the TMT and SDMT as screening tools for post-COVID-19 neurocognitive impairments in pilots.
    • To assess the acceptability and feasibility of implementing these cognitive screening tools in routine aeromedical evaluations.

    Main Methods:

    • A mixed-methods approach was employed to compare the performance of TMT and SDMT between post-COVID-19 cases and healthy controls.
    • Diagnostic accuracy was analyzed using receiver operating characteristic (ROC) curve analyses.

    Main Results:

    • The TMT (Part B: AUC=0.853, Part A: AUC=0.769) and SDMT (SDC version: AUC=0.817) demonstrated significant diagnostic accuracy in identifying neurocognitive impairments.
    • Post-COVID-19 neurocognitive deficits were found to impact skills critical for safe pilot operation.
    • Airline pilots recognized cognitive screening as an essential flight safety intervention.

    Conclusions:

    • Airline pilots, aviation psychologists, and medical experts support the critical role of screening for post-COVID-19 neurocognitive impairments.
    • Routine screening of pilots for these impairments is recommended to enhance flight safety.
    • Further research with larger sample sizes is required to validate these preliminary findings and recommendations.