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

Introduction: One crucial aspect of flight safety is being able to detect medical or neuropsychological conditions during aeromedical examinations. However, subtle but safety-significant post-COVID-19 neurocognitive impairments may go unreported or undetected. The Trail Making Test (TMT) and Symbol Digit Modalities Test (SDMT) can detect these impairments in domains essential to pilot performance, though further investigation is needed to assess their effectiveness and clinical utility in routine pilot aeromedical examinations. This short communication presents preliminary findings for using these tests.

Methods: A study identified the TMT and SDMT as appropriate screening tools for evaluating pilot neurocognitive performance after COVID-19. Mixed methods were then used to compare the screening tools' performance between post-COVID-19 cases and healthy controls, while also assessing their acceptability and feasibility in routine aeromedical examinations for pilots.

Results: Post-COVID-19 neurocognitive disorders affect skills that are essential for pilot performance. Receiver operating characteristic curve analyses showed the diagnostic accuracy of the screening tests, with area under the curve values of 0.853 for TMT Part B, 0.817 for the SDC version of SDMT, and 0.769 for TMT Part A, indicating their effectiveness in identifying cognitive impairments. Airline pilots considered screening an important flight safety intervention.

Discussion: Airline pilots, together with international aviation psychologists and aviation medicine experts, endorsed the safety-critical importance and value of screening pilots for post-COVID-19 impairments. Given the numerous practical implications of implementing such a strategy, we recommend that pilots be screened for potential post-COVID-19 neurocognitive impairments. A larger study is necessary to validate these preliminary findings and recommendations. Beka SG, Griffiths RF, Myers JA, Skirrow PM. Post-COVID-19 neurocognitive screening in routine pilot aeromedical evaluations. Aerosp Med Hum Perform. 2025; 96(10):931-935.