Gap BMed-107: What are the long-term changes and risks to astronaut health post-mission that, when using a continuity of care model, helps retrospectively identify and understand individual susceptibility (e.g., hereditary, dose, thresholds) to mitigate adverse CNS, cognitive, and behavioral health changes resulting from long-duration exploration missions, promoting the behavioral health of current and future crews?
Last Published:  07/30/20 02:45:13 PM (Central)
Responsible Element: Human Factors and Behavioral Performance (HFBP)
Status: Open
Description
Presently we do not know the post-mission cognitive and behavioral health effects of long duration exploration missions on astronauts. Understanding the likelihood and consequences of the operationally-relevant changes to CNS/cognitive/behavioral risk and how these changes, whether occurring in-mission and/or post-mission, may adversely impact on long-term astronaut health.  It is therefore important to quantify and mitigate this “in-mission” risk for exploration class missions, as well as assess how post-mission findings may reveal what would have been small, cumulative, and preventable in-mission changes. This provides the need for validated monitoring, assessment, and implementation of countermeasures to promote individual CNS/cognitive/behavioral health and performance during exploration missions. The countermeasures identified will need to consider anticipated mission constraints. 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 stressors over a much longer timeframe. While astronauts generally thrive on these ISS missions, there has been anecdotal evidence and research reports of psychosocial issues occurring in spaceflight, both on the ISS and in other environments. Currently, ISS missions are supported by significant infrastructure from social and operational support, including health, psychological, and technical support. The type of support provided for ISS operations will not be possible for future exploration missions owing to communication delays and distance from Earth. 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.  Additionally, the increased autonomy and isolation from Earth may impose a significant psychological strain upon crews, necessitating more targeted, individualized assessment and mitigation strategies. 
Approach: Research requirements tasks will be used to summarize the literature on how “in-mission” CNS/cognitive/behavioral health relates to, predicts, and can mitigate post-mission behavioral health. Additionally, ground-based, peer-reviewed research using cell and animal models will be conducted to acquire necessary knowledge for accurate risk calculation and uncertainty reduction for acute adverse CNS/cognitive/behavioral health outcome measures due to space radiation exposure. A better understanding of the types of cognitive and behavioral health decrements, illnesses, or events will be important to understanding the nature of this risk for long-duration exploration class missions. Subsequently, a post-mission behavioral health assessment and monitoring tool suite will be developed along with countermeasures to promote and enhance post-mission behavioral health.  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. We will solicit studies to develop and validate countermeasures to fill this gap. These countermeasures will be validated in high fidelity exploration analogs and ultimately ISS. Periodic tech watches will ensure that the most advanced state-of-the-art technology is in use.  Where feasible, we will identify biomarkers of disease pathophysiology and/or progression for use in monitoring adverse acute, “in-mission” CNS/cognitive/behavioral health outcomes and for use in continuity of care perspective relative to spaceflight. A systems biology approach for individual CNS/cognitive/behavioral health and performance adverse changes may be needed to form a basis for animal to human extrapolation, and will rely on understanding of molecular and physiological changes in the CNS/cognitive/behavioral performance caused by mission- relevant exposures (e.g., space radiation, isolation, altered gravity) and how these changes relate to acute, “in-mission” and post-flight CNS/cognitive adverse outcomes.  Countermeasures developed will address the pre-, during-, and post-mission phases of exploration missions. Pre-mission vulnerabilities and resiliency, in-mission exposures, and post-mission impacts will be identified and baselined for Earth-levels.  Post-mission assessments will help demonstrate long-term health consequences of long-duration spaceflight, and help assess efficacy of current countermeasures and readiness levels of research deliverables (tools and technologies).
Target for Closure
An understanding of the of post-mission CNS/cognitive/behavioral health of astronauts with identified linkages to “in-mission” exposures and “pre-mission” vulnerabilities/resiliency. Define risk domains and appropriate metrics that encompass operationally-relevant performance decrements of concern (e.g. cognitive and executive function, attention deficits, neuropsychological, neurobehavioral, circadian rhythms, reaction time, motor skills, etc.). Develop intermediate CNS/cognitive/behavioral health models of important outcome brain performance pathways and processes that contribute to operationally-relevant CNS/cognitive/behavioral health and performance risks, including synaptic dysfunction, impaired neurogenesis, neurodegeneration, neuro-inflammation, etc. Validated Monitoring tools for post-mission behavioral health.
(1) Identify and incorporate standard exposure conditions and reference measures (e.g., performance outcomes levels and Permissible Exposures Limits) of operationally-relevant performance measures in collaboration with BHP Operations.
(2) Quantify the particle spectrum and dose responses for “acute”, in-mission, and post-mission (mission timescale) on functional CNS/cognitive/behavioral performance changes from mission-relevant exposures (e.g., space radiation, isolation, altered gravity).
(3) Organize CNS/cognitive/behavioral performance reactions to mission-relevant exposures into adverse outcome pathway(s) and brain performance pathways related to known diseases and biomarkers.
(4) Combine CNS/cognitive/behavioral health integrated process models to create model for acute, mission-relevant CNS/cognitive/behavioral risk assessment via model validation and documentation for in-mission risk related to post-mission risk results.
(5) Determine the operational significance of adverse changes elicited by mission-relevant exposures.
(6) Identified set of psychosocial support countermeasures targeting key indicators to maintain CNS/cognitive/behavioral health and performance.
(7) Verified and validated countermeasures in ground-based analogs with astronaut-like subjects.
Validated set of countermeasures to promote post-mission behavioral health. These countermeasures should be targeted to pre-mission preparation, in-flight adaptation and functional readiness, and post-mission transition/rehabilitation.
Mappings
Risk Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders
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