Abstract
Humans exposed to cold environments for leisure or occupational activities may experience cold stress. Cold-related physical and mental stress can negatively affect cognitive performance. A recent literature review has pointed out that a single acute exposure to cold under controlled laboratory conditions (e.g., cold air or cold water) induces cognitive impairment with attention, processing speed, memory, and executive function being the most affected cognitive domains. Males and females seem to respond differently to short-term cold exposure, although results are not consistent. The aim of the study was to investigate the effect of acute and brief (15 min) exposure to low ambient temperatures of -10 °C compared with 5 °C and 20 °C on selected cognitive performance (reaction time, processing speed, and risky decision-making). We hypothesized that cognitive performance decreases at low temperatures with a sex difference, before core temperature changes. This randomized, controlled, crossover study was conducted in an environmental chamber (terraXcube) under controlled, replicable, and safe conditions in twenty-four healthy volunteers, females and males, aged between 18 and 60 years. Measurements included Psychomotor Vigilance Test (PVT), Balloon Analogue Risk Task (BART), and Digit Symbol Substitution Test (DSST). Cognitive performance, stress, and cold were subjectively rated with a visual analogue scale (VAS). Physiological data (including core and skin temperatures) were continuously recorded with a physiological monitoring system. Data were analysed using repeated measures analysis of variance (ANOVA), Friedman test, Generalised Estimating Equations (GEE), and correlation analysis. We identified transient impairments in cognitive performance in individuals wearing appropriate clothing. Cold exposure (-10 °C) affected attention by slowing response times and increasing the lapses, and decision-making by reducing risky behaviour. Heart rate, cold sensation, and stress, as well as thermal sensation and comfort, but not core temperature were different in the three experimental temperature exposures. No differences were found between male and female subjects in their cognitive performance. Our data support the distraction theory in the decline of cognitive performance even during a short exposure to cold temperatures. Such impairment should be carefully considered in people performing different activities in cold environments, even for a short time.
Similar content being viewed by others
Data availability
Data is available upon reasonable request to the corresponding author.
References
Paal, P., Brugger, H. & Strapazzon, G. Accidental hypothermia. Handb. Clin. Neurol. 157, 547–563. https://doi.org/10.1016/B978-0-444-64074-1.00033-1 (2018).
Castellani, J. W. & Young, A. J. Human physiological responses to cold exposure: acute responses and acclimatization to prolonged exposure. Auton. Neurosci. Basic. Clin. 196, 63–74. https://doi.org/10.1016/j.autneu.2016.02.009 (2016).
Srámek, P., Simecková, M., Janský, L., Savlíková, J. & Vybíral, S. Human physiological responses to immersion into water of different temperatures. Eur. J. Appl. Physiol. 81, 436–442. https://doi.org/10.1007/s004210050065 (2000).
Solianik, R., Skurvydas, A., Vitkauskienė, A. & Brazaitis, M. Gender-specific cold responses induce a similar body-cooling rate but different neuroendocrine and immune responses. Cryobiology 69, 26–33. https://doi.org/10.1016/j.cryobiol.2014.04.015 (2014).
Weiss, B., Laties, V. G. & Behavioral thermoregulation Science ;133:1338–1344. https://doi.org/10.1126/science.133.3461.1338 (1961).
Falla, M., Micarelli, A., Hüfner, K. & Strapazzon, G. The effect of cold exposure on cognitive performance in healthy adults: A systematic review. Int. J. Environ. Res. Public. Health. 18, 9725. https://doi.org/10.3390/ijerph18189725 (2021).
Firth, P. G. et al. Mortality on Mount Everest, 1921–2006: descriptive study. BMJ 337, a2654. https://doi.org/10.1136/bmj.a2654 (2008).
Teichner, W. H. Reaction time in the cold. J. Appl. Psychol. 42, 54. https://doi.org/10.1037/h0049145 (1958).
Muller, M. D. et al. Acute cold exposure and cognitive function: evidence for sustained impairment. Ergonomics 55, 792–798. https://doi.org/10.1080/00140139.2012.665497 (2012).
Mengel, L. A. et al. Gender differences in the response to Short-term cold exposure in young adults. J. Clin. Endocrinol. Metab. 105, dgaa110. https://doi.org/10.1210/clinem/dgaa110 (2020).
Enander, A. Effects of moderate cold on performance of psychomotor and cognitive tasks. Ergonomics 30, 1431–1445. https://doi.org/10.1080/00140138708966037 (1987).
Kong, Y. et al. Sex differences in autonomic functions and cognitive performance during cold-air exposure and cold-water partial immersion. Front. Physiol. 15, 1463784. https://doi.org/10.3389/fphys.2024.1463784 (2024).
Mahoney, C. R., Castellani, J., Kramer, F. M., Young, A. & Lieberman, H. R. Tyrosine supplementation mitigates working memory decrements during cold exposure. Physiol. Behav. 92, 575–582. https://doi.org/10.1016/j.physbeh.2007.05.003 (2007).
Schulz, K. F., Altman, D. G., Moher, D. & Group, C. O. N. S. O. R. T. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340, c332. https://doi.org/10.1136/bmj.c332 (2010).
Hendrix, J. M., Garmon, E. H. & American Society of Anesthesiologists Physical Status Classification System. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Aug 25]. http://www.ncbi.nlm.nih.gov/books/NBK441940/. Accessed 25 Aug 2025.
Julious, S. A. Sample size of 12 per group rule of thumb for a pilot study. Pharm. Stat. 4, 287–291. https://doi.org/10.1002/pst.185 (2005).
Strapazzon, G. et al. Influence of low ambient temperature on epitympanic temperature measurement: a prospective randomized clinical study. Scand. J. Trauma. Resusc. Emerg. Med. 23, 90. https://doi.org/10.1186/s13049-015-0172-5 (2015).
Lei, T-H. et al. Autonomic and perceptual thermoregulatory responses to voluntarily engaging in a common thermoregulatory behaviour. Physiol. Behav. 215, 112768. https://doi.org/10.1016/j.physbeh.2019.112768 (2020).
Pasquier, M. et al. Esophageal temperature measurement. N Engl. J. Med. 383, e93. https://doi.org/10.1056/NEJMvcm1900481 (2020).
Yeung, A. W. K. & Wong, N. S. M. The historical roots of visual analog scale in psychology as revealed by reference publication year spectroscopy. Front. Hum. Neurosci. 13, 86. https://doi.org/10.3389/fnhum.2019.00086 (2019).
ISO 10551. 1995 [Internet]. ISO. [cited 2025 Aug 25]. https://www.iso.org/standard/18636.html. Accessed 25 Aug 2025.
Falla, M. et al. A prospective evaluation of the acute effects of high altitude on cognitive and physiological functions in lowlanders. Front. Physiol. 12, 670278. https://doi.org/10.3389/fphys.2021.670278 (2021).
Falla, M. et al. Simulated acute hypobaric hypoxia effects on cognition in helicopter emergency medical service Personnel - A Randomized, Controlled, Single-Blind, crossover trial. Hum. Factors. 66, 404–423. https://doi.org/10.1177/00187208221086407 (2024).
Basner, M. & Dinges, D. F. Maximizing sensitivity of the psychomotor vigilance test (PVT) to sleep loss. Sleep 34, 581–591. https://doi.org/10.1093/sleep/34.5.581 (2011).
Lejuez, C. W. et al. Evaluation of a behavioral measure of risk taking: the balloon analogue risk task (BART). J. Exp. Psychol. Appl. 8, 75–84. https://doi.org/10.1037//1076-898x.8.2.75 (2002).
Wechsler, D. Wechsler Adult Intelligence Scale: WAIS-IV; Technical and Interpretive Manual (Pearson Assessment, 2008).
LIANG K-Y, ZEGER, S. L. Longitudinal data analysis using generalized linear models. Biometrika 73, 13–22. https://doi.org/10.1093/biomet/73.1.13 (1986).
Yang, L., Wu, J., Hu, Z., Gao, F. & Hu, X. Effects of workload on human cognitive performance of exposure to extremely cold environment. Physiol. Behav. 230, 113296. https://doi.org/10.1016/j.physbeh.2020.113296 (2021).
Watkins, S. L. et al. The effect of different environmental conditions on the decision-making performance of soccer goal line officials. Res. Sports Med. Print. 22, 425–437. https://doi.org/10.1080/15438627.2014.948624 (2014).
Adam, G. E. et al. Hydration effects on cognitive performance during military tasks in temperate and cold environments. Physiol. Behav. 93, 748–756. https://doi.org/10.1016/j.physbeh.2007.11.028 (2008).
Mäkinen, T. M. et al. Effect of repeated exposures to cold on cognitive performance in humans. Physiol. Behav. 87, 166–176. https://doi.org/10.1016/j.physbeh.2005.09.015 (2006).
Kanai, M., Kamiizawa, R., Hitora-Imamura, N. & Minami, M. Exposure to hot and cold environments activates neurons projecting from the paraventricular thalamic nucleus to brain regions related to approach and avoidance behaviors. J. Therm. Biol. 103, 103157. https://doi.org/10.1016/j.jtherbio.2021.103157 (2022).
Wallace, P. J., Gagnon, D. D., Hartley, G. L., Taber, M. J. & Cheung, S. S. Effects of skin and mild core cooling on cognitive function in cold air in men. Physiol. Rep. 11, e15893. https://doi.org/10.14814/phy2.15893 (2023).
Tikuisis, P., Jacobs, I., Moroz, D., Vallerand, A. L. & Martineau, L. Comparison of thermoregulatory responses between men and women immersed in cold water. J. Appl. Physiol. Bethesda Md. 1985. 89, 1403–1411. https://doi.org/10.1152/jappl.2000.89.4.1403 (2000).
Lemire, B. B., Gagnon, D., Jay, O. & Kenny, G. P. Differences between sexes in rectal cooling rates after exercise-induced hyperthermia. Med. Sci. Sports Exerc. 41, 1633–1639. https://doi.org/10.1249/MSS.0b013e31819e010c (2009).
Giesbrecht, G. G. Cold stress, near drowning and accidental hypothermia: a review. Aviat. Space Environ. Med. 71, 733–752 (2000).
Tipton, M., Eglin, C., Gennser, M. & Golden, F. Immersion deaths and deterioration in swimming performance in cold water. Lancet Lond. Engl. 354, 626–629. https://doi.org/10.1016/S0140-6736(99)07273-6 (1999).
Anttonen, H., Pekkarinen, A. & Niskanen, J. Safety at work in cold environments and prevention of cold stress. Ind. Health. 47, 254–261. https://doi.org/10.2486/indhealth.47.254 (2009).
Avakian, E. V., Horvath, S. M. & Colburn, R. W. Influence of age and cold stress on plasma catecholamine levels in rats. J. Auton. Nerv. Syst. 10, 127–133. https://doi.org/10.1016/0165-1838(84)90051-1 (1984).
Jones, D. M., Bailey, S. P., Roelands, B., Buono, M. J. & Meeusen, R. Cold acclimation and cognitive performance: A review. Auton. Neurosci. Basic. Clin. 208, 36–42. https://doi.org/10.1016/j.autneu.2017.11.004 (2017).
Jones, D. M. et al. Evaluation of cognitive performance and neurophysiological function during repeated immersion in cold water. Brain Res. 1718, 1–9. https://doi.org/10.1016/j.brainres.2019.04.032 (2019).
Perović, M. & Mack, M. L. Menstrual cycle and perceived stress predict performance on the mnemonic similarity task. PloS One. 20, e0322652. https://doi.org/10.1371/journal.pone.0322652 (2025).
Ronca, F. et al. Attentional, anticipatory and Spatial cognition fluctuate throughout the menstrual cycle: potential implications for female sport. Neuropsychologia 206, 108909. https://doi.org/10.1016/j.neuropsychologia.2024.108909 (2025).
Cheung, S. S. & Sleivert, G. G. Multiple triggers for hyperthermic fatigue and exhaustion. Exerc. Sport Sci. Rev. 32, 100–106. https://doi.org/10.1097/00003677-200407000-00005 (2004).
Acknowledgements
We thank Bernard Weber and Elisabeth Margarete Weiss for support in the development and data extraction of the cognitive-test batteries, and Eliane Thomaser for the support in data collection. We thank the colleagues from the terraXcube facility (Eurac Research, Italy) for support in experimental setting preparation. The authors thank the Department of Innovation, Research, University and Museums of the Autonomous Province of Bozen/Bolzano, Italy for covering the Open Access publication costs.
Funding
FESR Program 2014–2020 of the Autonomous Province of Bolzano – Alto Adige, under Grant Agreement [513/2019]/Project number [FESR 1114], [Development of innovative sensors for monitoring vital parameters in emergency medicine, MedSENS].
Author information
Authors and Affiliations
Contributions
MF and GS conceived the study idea. MF, GS, MM, and AM designed the study. MF, GS, MM, AM, GR, and MJvV collected the data. MF, TDC, MM, and GS analysed the data. MF and GS wrote the first draft of the article. All the authors reviewed and approved the final manuscript.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
This randomized, controlled, crossover study was approved by the Ethics Committee review board of Bolzano (protocol number 42-2021 BZ). We conducted the study according to the Declaration of Helsinki. All participants were informed about the possible risks and gave written informed consent prior to enrolment. Additionally, they gave an informed consent for the publication of images in an online open-access publication.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Falla, M., Masè, M., Cappello, T.D. et al. Cold stress impacts cognitive performance in healthy volunteers: results from a randomized, controlled, cross-over study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38048-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-38048-y
