Transforming Health Care through Innovative and Impactful Research

March 23, 2026

The Congressionally Directed Medical Research Programs support research in detection, diagnosis and intervention approaches to mitigate short- and long-term consequences of traumatic brain injury. During training or in combat missions, Service Members may experience TBI following direct impacts to the head, or TBI may result from repetitive exposure to explosives or waves of high pressure following a blast, known as blast overpressure, impacting force readiness.

Consequences from TBI may include short-term symptoms like headache or nausea as well as long-term effects to Warfighter cognitive and physical performance. Improving detection of TBI and assessment of risk following blast exposures or head impacts can help reduce or prevent negative consequences and improve brain health for Service Members, Veterans and all Americans.

Predicting Consequences of Blast Exposure

Previous efforts by the Naval Medical Research Command developed the blast exposure threshold survey, or BETS, which estimates cumulative blast exposure from a variety of weapons categories including explosive and non-explosive charges. Creators of the BETS also developed an algorithm to calculate a composite index, called the generalized blast exposure value, or GBEV, which estimates the likelihood of developing blast-related symptoms, such as poor concentration, dizziness and post-traumatic stress disorder. Surveying the total blast exposure history with the BETS and estimating the cumulative effects of blast exposure on brain health with the GBEV can help prevent injury and preserve Warfighters' brain health.

James Stone, M.D., Ph.D., at the University of Virginia, leads a fiscal year 2024 Health Services Research Award from the Traumatic Brain Injury and Psychological Health Research Program to expand the predictive power of the GBEV. By combining data from other studies that used the BETS and GBEV tools on over 16,000 subjects, including data from psychological assessments, functional assessments, fluid biomarkers and neuroimaging, his team seeks to develop a more precise, individualized prediction model for potential consequences following blast exposure.

"A more accurate and evidence-based exposure metric will support decision-making related to training practices, occupational health monitoring, and return-to-duty or recovery timelines," Stone said. "By improving our understanding of cumulative exposure effects, this work has the potential to influence guidelines, risk mitigation strategies and long-term follow-up practices that strengthen brain health protection across multiple communities."

Determining Risk of Developing Post-Traumatic Epilepsy

Following TBI, patients may experience seizures. Seizures can begin or continue to occur weeks or years after the injury, at which time patients receive a specific diagnosis of post-traumatic epilepsy, or PTE. Risk of developing PTE following TBI ranges from 2% to 50%. While the type and severity of the injury contribute significantly to this risk, genetic factors may also play a role. Genetic risk scores already exist for some epilepsies, but the diverse factors and unique biological mechanisms contributing to risk for PTE necessitate additional research.

Marissa Kellogg, M.D., at the Portland VA Medical Center, leads a fiscal year 2024 Virtual Post-Traumatic Epilepsy Research Center – Faculty Award from the Epilepsy Research Program to help define risk of PTE following TBI.

"We know TBI increases risk for seizures, but we do not currently have good ways of predicting who will be affected, so our research will help uncover those at greater risk for seizures and potentially help us better understand the genetic susceptibility to any complications of TBI," Kellogg said.

Kellogg uses genetic data from the Million Veterans Program, as well as clinical data from Veterans Health Affairs electronic health records, to identify genetic biomarkers of PTE in Veterans with and without a history of TBI and/or epilepsy, including PTE. Kellogg will combine the genetic findings with medical history and lifestyle factors to determine which genetic factors contribute specifically to risk of PTE following TBI.

"If we can uncover genetic susceptibility for certain complications of TBI, we can work to prevent or mitigate seizures or other complications," Kellogg said. "If we can identify Veterans who had genetic susceptibility but were unaffected by seizures, we may be able to identify protective factors, environmental or genetic, that may help us identify new therapies to treat or prevent TBI and PTE."

Assessing Impact of TBI on Sleep

According to the Department of Veterans Affairs, 30% to 70% of patients report difficulties sleeping after a TBI. Continuous disrupted sleep leads to cognitive issues and neurodegeneration, increasing the potential for other long-term health effects. To better understand the connections between disrupted sleep and long-term cognitive effects following TBI, the Peer Reviewed Medical Research Program supported a fiscal year 2019 Discovery Award led by J. Kent Werner, Jr., M.D., Ph.D., at the Uniformed Services University.

"Earlier in my Navy career, I served as a Surface Warfare Officer, serving in the operational line, working alongside Marines and SEALs who routinely experienced TBI," Werner said. "We all also routinely experienced sleep deprivation, and the effects of these exposures impacted our readiness and performance in the short and long term."

Werner's team hypothesized that TBI damages the glymphatic system, a process that removes neurological waste and toxins from the brain during sleep. To date, only contrast-enhanced magnetic resonance imaging can reliably measure glymphatic flow in humans, a method impractical for use in sleep studies.

To effectively measure glymphatic flow during sleep, Werner and team developed a wearable headset with a noninvasive sensor that uses multiple wavelengths of near-infrared light. By also equipping it with sensors for recording the brain's electrical activity, the headset can detect changes in both blood and glymphatic flow matched to specific stages of sleep.

"This project will enable scalable measurement of glymphatic activity for larger population studies to better understand the impact of glymphatics dysfunction on Service Members and Veterans, particularly with comorbidities of TBI and post-traumatic stress disorder," Werner said.

Initial results comparing healthy controls and TBI patients show that individuals with mild TBI may have disrupted glymphatic function, particularly during deep sleep, a critical phase for neurological waste clearance.

Werner also quantified the effects of sleep deprivation by assessing changes in circadian rhythm, blood biomarkers and cognitive performance. These findings could lead to improved measurements of cognitive resilience, a major component in long-term brain health.

Evaluating Long-Term Cognitive Effects of TBI

Veterans with a TBI are up to two times more likely to develop Alzheimer's disease and related dementias than those without a TBI diagnosis. While TBI is a known risk factor, researchers continue to investigate exactly how TBI contributes to development of Alzheimer's disease and related dementias.

Lisa Delano-Wood, M.D., at the Veterans Medical Research Foundation of San Diego, led a fiscal year 2020 Convergence Science Research Award from the Alzheimer's Research Program to identify specific biological mechanisms that contribute to development of Alzheimer's disease and related dementias. Her team used novel brain imaging techniques to evaluate blood flow and white matter integrity in regions of the brain associated with early Alzheimer's disease and related dementias in Vietnam-era Veterans with or without TBI. By combining brain imaging data with cognitive evaluations, they are determining how damage to certain brain regions affects risk of developing Alzheimer's disease and related dementias.

Initial findings suggest that TBI disrupts both blood flow and the structural integrity of white matter in the brain. White matter is critical for efficient communication between different parts of the brain, and damage to it can lead to impairments in executive function and memory. Delano-Wood's team is also exploring changes in protein levels as potential blood-based biomarkers to predict risk for Alzheimer's disease and related dementias based on their imaging and cognitive findings.

Beyond risk for Alzheimer's disease and related dementias, understanding the impacts of TBI on brain structure and cognition could make advances for other neurodegenerative disorders associated with cognitive dysfunction and overall brain health.

FY26 Funding Opportunities Forthcoming

For fiscal year 2026, the U.S. Congress appropriated $1.27 billion in funding for 34 CDMRP research programs, including the Alzheimer's, Epilepsy, Peer Reviewed Medical, and Traumatic Brain Injury and Psychological Health Research Programs, for support of research dedicated to improving Warfighter brain health and the lives of Service Members, Veterans, their Families and the American public. The CDMRP will release funding opportunities as soon as available for each program.

To receive updates regarding fiscal year 2026 CDMRP funding opportunity announcements, please subscribe to email notifications through the electronic Biomedical Research Application Portal. You can also visit the homepage of the CDMRP website for updates and other organizational publications and news releases.

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Last updated Monday, March 23, 2026