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Maintaining intact cognitive performance is a high priority for space exploration. This review seeks to summarize the cumulative results of existing studies of cognitive performance in spaceflight and analogue environments. We focused on long-duration (>21 d) studies for which no review has previously been conducted. There were 11 published studies identified for long-duration spaceflight (N = 42 subjects) as well as 21 shorter spaceflight studies (N = 70 subjects). Overall, spaceflight cognitive studies ranged from 6-438 d in duration. Some 55 spaceflight analogue studies were also identified, ranging from 6 to 520 d. The diverse nature of experimental procedures and protocols precluded formal meta-analysis. In general, the available evidence fails to strongly support or refute the existence of specific cognitive deficits in low Earth orbit during long-duration spaceflight, which may be due in large part to small numbers of subjects. The studies consistently suggest that novel environments (spaceflight or other) induce variable alterations in cognitive performance across individuals, consistent with known astronaut experiences. This highlights the need to better quantify the magnitude and scope of this interindividual variability, and understand its underlying factors, when predicting in-flight cognitive functioning for extended periods.

Future long-duration spaceflights are now being planned to the Moon and Mars as a part of the "Vision for Space Exploration" program initiated by NASA in 2004. This report describes the design reference missions for the International Space Station, Lunar Base, and eventually a Mars Expedition. There is a need to develop more stringent preflight medical screening for crewmembers to minimize risk factors for diseases which cannot be effectively treated in flight. Since funding for space life sciences research and development has been eliminated to fund program development, these missions will be enabled by countermeasures much like those currently in use aboard the International Space Station. Artificial gravity using centrifugation in a rotating spacecraft has been suggested repeatedly as a "universal countermeasure" against deconditioning in microgravity and could be an option if other countermeasures are found to be ineffective. However, the greatest medical unknown in interplanetary flight may be the effects of radiation exposure. In addition, a Mars expedition would lead to a far greater level of isolation and psychological stress than any space mission attempted previously; because of this, psychiatric decompensation remains a risk. Historically, mortality and morbidity related to illness and injury have accounted for more failures and delays in new exploration than have defective transportation systems. The medical care system on a future Mars expedition will need to be autonomous and self-sufficient due to the extremely long separation from definitive medical care. This capability could be expanded by the presence of a physician in the crew and including simple, low-technology surgical capability.

The Space Flight Cognitive Assessment Tool for Windows (WinSCAT) is used on the International Space Station to evaluate cognitive functioning after physical insult or trauma. The current study uses WinSCAT to assess cognitive functioning in a space flight analog (bed rest) environment where intermittent artificial gravity (AG) is being tested as a countermeasure. Fifteen male subjects (8 treatment, 7 control), who participated in 21 days of 6 degree head-down tilt bed rest, were assessed during the acclimatization phase, bed rest phase, and recovery phase. Individual differences were found within both the treatment and control groups. The treatment group accounted for more off-nominal WinSCAT scores than the control group. The length of time spent in bed rest was not associated with a change in cognitive function. Individual differences in underlying cognitive ability and motivation level are other possible explanations for the current findings.

The Spaceflight Cognitive Assessment Tool for Windows (WinSCAT) was developed by an integrated product team as a tool to support medical operations at NASA Johnson Space Center and as way to monitor the neurocognitive status of space crews. It is based on 20 yr of experience in performance and cognitive testing within the U.S. Department of Defense. As a result, WinSCAT development has benefited from diverse efforts supporting its technical reliability and validation. The rationale, background, and development of WinSCAT are described, research supporting its use is summarized, and recommendations are made for its continued development.

In a recent article in Aviation, Space, and Environmental Medicine, Navathe and Singh proposed new "operational" definitions for spatial disorientation (SD) and loss of situation(al) awareness (LSA). The major feature of their new scheme was to treat the two phenomena as distinct, with SD attributable to physiologically based (peripheral) illusions and LSA to psychological (central) factors. The present commentary argues in favor of traditional views of SD that consider spatial orientation to be a subset of overall situation awareness.

There were 29 (80%) subjects from a squadron of 36 F-16 pilots who voluntarily participated in a newly developed anonymous, self-administered, computerized testing protocol. The test battery consisted of two 2.5-h blocks that gathered demographic information and measured personality (MMPI-2), cognitive capacity (MAB), crew coordination skills (PCI), and history of psychiatric diagnoses (C-DIS). The test battery also included a peer rating survey that collected information about the squadron's top performers and their personal qualities. Results indicated that aviators can agree who are top performers and what personal qualities are important in top performers. This pilot project demonstrated the success of the battery to gather aircrew information in a field location. Test data are presented.

The Adaptability Rating for Military Aviation (ARMA) is that portion of the initial flight physical that assesses an aviator candidate's motivation for and potential adaptability toward an aviation career. A survey was mailed to all USAF operational flight surgeons in the continental U.S. to describe the frequency and distribution of ARMA usage and attitudes. Descriptive statistics suggest that the ARMA is used suboptimally in accordance with current USAF regulation. ARMA training, flight surgeon satisfaction and lack of regulation clarity are described and discussed. More flight surgeons are dissatisfied with the ARMA than are satisfied, and the regulation is perceived as unclear in the area of final disposition for candidates with equivocal ARMA's. A post-hoc analysis to rule out the influences of rank, gender, experience and residency training was performed. Residency training in Aerospace Medicine is beneficial in terms of doing an ARMA, when required, and covering recommended areas. Females and those with less than 1 year experience perform an ARMA more frequently than males and experienced flight surgeons. Despite the limitations of the current ARMA, it should not be abandoned. Recommendations to improve it are provided. Doing better ARMA's can lead to decreased illness, injury, accidents, and attrition.