Gap BMed-105: Given the potentially negative spaceflight associated CNS/cognitive changes and behavioral experiences of stressors during long-duration missions (e.g., isolation, confinement, reduced sensory stimulation, altered gravity, space radiation), what are validated medical or dietary countermeasures to mitigate stressors impacting on CNS / cognition / behavioral health?
Last Published:  07/30/20 02:45:13 PM (Central)
Responsible Element: Human Factors and Behavioral Performance (HFBP)
Status: Open
Future missions will exceed the current ISS duration of six-months, with exploration missions projected to take as long as three years, exposing astronauts to multiple spaceflight hazards and stressors over a much longer timeframe.  Past and current ISS operations from 6-10 month spaceflight missions, as well as longer one-year missions, have been characterized by environmental characteristics (e.g., large habitable space, IP Phone, views of Earth) that have enabled crewmembers to live in space without major behavioral health incidents. In addition, while the ISS provides significant infrastructure, social and operational support, including health, psychological, and technical support, the prevalence of communication delays and distance from Earth will preclude this type of support for future exploration missions.  The impact of these support systems and the psychosocial countermeasures needed for long-duration exploration missions (<6; 6-12; >12 months) beyond low Earth orbit are not known.  Future long-duration missions (e.g., Mars), also will expose crewmembers to prolonged confinement and extreme environmental monotony of a mission of up to 30 months, five times the length of current ISS increments. This environment will result in increased autonomy and isolation from Earth which will impose a strain upon crews of historical significance.  These demands necessitate the requirement for a variety of medical, dietary/nutritional, and on-board system countermeasures to mitigate the negative CNS/cognitive/psychological and behavioral effects of environmental stressors (e.g., space radiation, isolation, confinement, reduced sensory stimulation) likely to be experienced in the long duration spaceflight environment.  Research contributions from environmental psychology, spaceflight analogs, and anecdotal spaceflight evidence show that risks posed by environmental stressors can be mitigated by modifying the vehicle environment (e.g., introduction of novel stimuli, greenhouses, virtual reality, lighting, etc.).  We also need to identify how biomedical and dietary interventions (e.g., exercise, conditioning, nutritional supplements) can serve as countermeasures to help maintain and promote psychological and behavioral health among crewmembers. An important objective is the development of guidelines and management methods for medications, biomedical interventions and other countermeasures related to CNS/cognitive/behavioral health and performance.
Approach: Biomedical countermeasure and biomarker research for CNS/cognitive/behavioral health and performance risks will help set the course for effective countermeasures approaches through establishment of appropriate indexed biomarkers and model systems of change due to spaceflight hazards exposures. The research approach will identify the environmental stressors on CNS/cognitive/behavioral health in long duration spaceflight and will identify and/or develop methods to assess effects of environmental modifications in the context of long-duration habitation. Research will focus on the identification and validation of methods to modify and/or adapt to the spaceflight environment to mitigate the identified risks to behavioral health. Research in this Gap requires working closely with Space Medicine and Pharmacology to evaluate new biomedical and medication approaches.  Countermeasures developed will need to address the pre-, during-, and post-mission phases of exploration missions. From the threats and promoters identified and baselined (in Gaps 1-4)  for Earth-levels, current countermeasures and readiness levels of research deliverables (tools and technologies) will be reviewed and vetted for translation to exploration missions. We will examine the gap between the available information in the extant literature and what is needed for future exploration missions and solicit studies to address those areas; soliciting research to develop and validate countermeasures to fill this gap. These countermeasures will be validated in high fidelity exploration analogs and ultimately the ISS. Periodic tech watches will ensure that the most advanced state-of-the-art technology is in use.  Metrics for Interim Progress:

(1) Work with Medical Operations to identify the most commonly used and projected medications in current spaceflight to determine their potential contributions to CNS/cognitive/behavioral health and performance.

(2) Continue to evaluate effects of biomedical interventions (e.g., sleep medications) on CNS/cognitive/behavioral performance. 
(2a) Provide individualized medication protocols to participating crewmembers.         
(2b) Develop guidelines and educational material for medication testing and for using medications (and other supplements used in spaceflight) that may affect sleep and alertness.  
(2c) Identify relevant mechanisms and  biomarker (indexed metrics) panels to monitor therapeutic efficacy for acute (in-mission) CNS/cognitive/behavioral effects of mission-relevant exposures (e.g., space radiation, isolation, etc.).

(3)  Identify and validate candidate countermeasure for adverse acute (in-mission) CNS/cognition/behavioral performance outcomes.

(4) Define research needs related to medications in current operations and for exploration missions, and consider new medications as they become available (with Pharmacology).

(5) Develop a medical requirement for individually assessing effectiveness and safety of biomedical and sleep-wake medications prior to spaceflight.
Target for Closure
Validated set of psychosocial support countermeasures targeting key indicators of CNS/cognitive/behavioral operationally-relevant performance that maintains individual behavioral health and performance. These countermeasures should be targeted to pre-mission preparation, in-flight adaptation and functional readiness, and post-mission transition/rehabilitation to gain insights for “in-mission” countermeasure efficacy and need:
(1) Identified set of psychosocial support countermeasures targeting key indicators to maintain behavioral health and performance.
(2) Identification of indexed metrics to monitor therapeutic efficacy for acute, in-mission, and post-mission CNS/cognitive/behavioral operationally-relevant effects due to mission-relevant spaceflight hazards exposures (e.g., space radiation, isolation, altered gravity).
(3) Identification and validation of candidate biomedical countermeasures modulating adverse outcome pathways associated with integrated risks.
(4) Verified and validated countermeasures in ground-based analogs with astronaut-like subjects.
(5) Identified and validated methods for how biomedical countermeasures interface with modifications to the habitat/vehicle environment in addressing environmental stressors and mitigate psychological and behavioral risk.
(6) Development of guidelines and standards for implementation of these modifications based on available information related to exploration mission scenarios.
(7) Update flight rules, clinical guidelines, and research plan, as appropriate.
Risk Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders
You are here! Gap BMed-105: Given the potentially negative spaceflight associated CNS/cognitive changes and behavioral experiences of stressors during long-duration missions (e.g., isolation, confinement, reduced sensory stimulation, altered gravity, space radiation), what are validated medical or dietary countermeasures to mitigate stressors impacting on CNS / cognition / behavioral health?

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