What is TBI and How Can We All Help?

By Alex Cohen

During National Brain Injury Awareness Month — and All Year Long — Let’s Recognize the Seriousness of Traumatic Brain Injury and Post-Traumatic Stress

Traumatic brain injury (TBI) is sometimes a misnomer — even what appears to be a mild injury to the head can actually be, or develop into, something far worse.

For military veterans, TBIs may not always be apparent. In fact, it has been called the “silent epidemic.” Repeated exposure to bomb blasts takes its toll on the brain. Blast-related concussions are frequent. And what’s worse, if not treated effectively, TBI can lead to other serious neurological and psychiatric consequences like post traumatic stress (PTS), depression and anxiety.

When I look back on my years treating veterans with PTS, I remember one in particular, a veteran of one of the Pacific campaigns, who returned from war holding on to an ugly encounter in which he killed an adversary. For deeply personal reasons, this veteran could never shake the horrors of his war experience. For the next 40 years, he worked and raised his family. But he continued to suffer from nightmares, PTS, depression and bouts of binge drinking. In fact, he had a recurring dream in which the daughter of his adversary appeared to him, blaming him for her father’s death. It wasn’t until we enrolled him in treatment many years later that he was able to come to greater acceptance of what occurred and how it affected his life.

If this older veteran — like those returning from our recent military campaigns in the Middle East — had the opportunity to work with our team at the Steven & Alexandra Cohen Veterans Center and our Military Family Clinic, we would have been able to enroll him in comprehensive psychotherapy and pharmacotherapy programs and address his addiction problems through our dual diagnosis program. Within six months, we could have returned him to a more normal state of mind.

The Steven & Alexandra Cohen Foundation realized early on the significance and seriousness of TBI and PTS. Because of their generosity, we were able to establish our Cohen Veterans Center, which also includes the Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury. Their support allows us to conduct a novel five-year study – already well underway — that has the potential to transform the way TBIs and PTS are diagnosed and treated.

We are looking at thousands of Iraq and Afghanistan war veterans in order to develop a panel of biological markers (biomarkers) to classify an individual as having TBI or PTS, or both. We expect that, in the not so distant future, this will result in lab tests that can definitively detect these conditions and advance treatments tailored to the individual. The study will also include athletes of contact sports.

The study, which, in addition to the Cohen Veterans Center, also includes researchers from Emory University School of Medicine, Stanford University School of Medicine, SRI International and Fort Detrick, is already bearing fruit. Research on eye tracking technology, conducted by neurosurgeon Uzma Samadani, MD, PhD, co-director of the Cohen Veterans Center, has shown effectiveness as a biological marker for assessing brain function and monitoring recovery for patients with brain injuries.

During National Brain Injury Awareness Month, we should take a moment to think about the millions of people suffering from traumatic brain injury – from military veterans to children injured at the playground – and vow to do better in the way we diagnose and treat them.

Charles R. Marmar, MD
Chairman, Dept. of Psychiatry, NYU Langone Medical Center
Director, Steven & Alexandra Cohen Veterans Center at NYU Langone