As the Army colonel stands in the front of the room at his retirement ceremony in the presence of his family, friends, and colleagues with his right hand raised in salute, he is reminded of the many years of dedicated service that he provided to his country. Although, he has given numerous salutes over his military career, this would be the last, making him a retired veteran. After devoting so many years to the military service, he is ready to transition from an active duty Soldier to a veteran. While preventative and job-related medical care was provided throughout his service, he can be reassured that as a newly-retired veteran, his healthcare and well-being, including issues related to brain injury and mental health, are still a top priority for Army medicine.

The Congressionally Directed Medical Research Programs works to transform healthcare through innovative and impactful research. Since 2013, approximately 12,423 awards have been made to advance health care solutions through extramural grants, contracts, and cooperative agreements. These awards advance groundbreaking medical research in program areas directed by Congress to meet the needs of Service Members, veterans and the American public. This includes current efforts in psychological health and traumatic brain injury.

BRAIN INJURY RESEARCH

The incidence of TBI within the military community has become a focus in recent years, as it can be an injury resulting from both training and combat environments. However, TBI can also affect civilians who participate in certain recreational activities and sports, and even simple day-to-day activities.

"A number of individuals with concussions experience long term psychological and physiological symptoms which do not resolve over time," said Dr. Christie Vu, CDMRP program manager. "These individuals may face a lifetime of healthcare burdens which may interfere with daily life."

A current interest in medical research is the possible link between multiple concussive and sub-concussive head events over a lifetime and whether those events increase susceptibility to other neurological problems. A TBI may represent an injury spectrum which creates a challenge of understanding the long term outcomes.

"There may be a connection between neurodegenerative disease and mild TBI, but we really don't know," said Dr. Dwayne Taliaferro, CDMRP health science program manager. "Recent reports show an association but at the moment we have more questions than answers. Currently, there are no U.S. Food and Drug Administration-approved drug or device treatments for acute or chronic mild TBI."

THE CHRONIC EFFECTS OF NEUROTRAUMA CONSORTIUM

The Chronic Effects of Neurotrauma Consortium, or CENC, represents a major research collaboration between the Department of Veterans Affairs and the Department of Defense, addressing the long-term consequences of TBI in Service Members and veterans, involving over 50 academic, military and VA sites and 70 researchers across 20 states.

"Initial results of this multi-year, longitudinal and epidemiologic project have some significant short-term clinical effects of combat concussion in nearly one-third of Service Members and veterans, and some alarming long-term associations between these mild TBIs and common neurodegenerative disorders, such as Parkinsons disease and other dementia-related conditions, as well as opioid usage in chronic pain," said Dr. David Cifu, principal investigator for CENC, at the Virginia Commonwealth University.

Cifu explained that the overarching goal of the CENC is to understand the lifetime impacts of military service, combat-related concussions, and veteran status, with respect to the development of co-morbid neurological, psychological, neurosensory, neuroendocrine and other related neurodegenerative diseases.

"The CENC research team has identified unique 'diagnostic fingerprints' of Service Members and veterans who have sustained combat-associated concussion by using blood biomarkers, computerized balance testing and eye tracking, and specialized electroencephalogram assessment," said Cifu.

The CENC efforts are coordinated through Virginia Commonwealth University and RTI International with combined support from the VA and DOD and has successfully recruited more than 1,800 Service Members and veterans who have experienced combat in Iraq and/or Afghanistan.

Cifu explained that this partnership bridges the research worlds of the VA, DOD, academia and industry to develop and produce practical and clinically meaningful findings that are being disseminated and implemented in the field.

"CENC represents a concerted effort to understand long-term effects of mild traumatic brain injury. While there is a significant military and veteran focus to the CENC, the knowledge generated will add to our overall understanding of the chronic effects of neurotrauma, regardless of injury mechanism," said Taliaferro.

Cifu explained that there are few known therapies that limit the potential for additional injury after experiencing a TBI, or therapies that can help someone to rehabilitate once the immediate danger has passed or to prevent long-term consequences such as post-traumatic stress disorder or post-concussive syndrome. Linkages have been identified between elevated lifetime risks for neuro-degeneration, including Alzheimer's dementia and Parkinson's disease, chronic pain, opioid misuse, and PTSD in Service Members and veterans who have experienced TBI.

"Multi-modal research assessment techniques have been developed that allow for more accurate diagnoses and clinical characterization," said Cifu. "As of yet, these techniques and technologies such as biomarker, imaging, eye-tracking, quantitative EEG are not appropriate for every-day, clinical usage."

HOPE FOR THE FUTURE

The human brain is the center of intellectual and nervous system activity, responsible for our ability to think, talk and breathe; it creates our personality, manages our movement and holds our memories. This vital organ needs to be protected whenever possible, and when injury occurs, it needs the very best treatment and rehabilitative therapies available. We all have one brain, and brain injury awareness is important as brain injuries can affect anyone, at any stage in life, and with a wide range of consequences.

The CDMRP is working with its DOD and VA partners to support the advancement of medical research efforts in order to prevent, diagnose and treat TBI. The ability to respond rapidly to a brain injury with technologies that can adequately diagnose the severity and interventions that can provide a successful corresponding treatment is what makes this research so invaluable.

From that young West Point cadet to the retired Army veteran, there are medical professionals dedicated to ensuring the health and readiness of our Service Members. Prevention and appropriate treatment on the battlefield may be the difference between the success and failure of the mission. Support during training maintains a ready force that is prepared when needed. The health of all of our Service Members, veterans and the American public is the focus for the CDMRP and its medical research endeavors.

Brain injury awareness month is a time to take notice of the significant and wide-ranging effects of brain injuries, as well as the important research being conducted to find medical solutions that alleviate these effects.