After more than a decade of impactful work, and with the most robust and well-characterized concussion cohort ever collected, researchers in the NCAA-Department of Defense (now Department of War) Concussion Assessment, Research and Education, known as CARE, Service Academy Longitudinal mTBI Outcomes Study Integrated (CSI) Study are entering an exciting new phase — studying long-term brain health in service members and athletes. The goal: identify early warning signs to help protect brain health for years to come.
The study is testing biomarkers, or measurable signals in blood and/or imaging, that may reveal how the brain responds to concussions, repeated head impacts, and other health risk factors. These include advanced scans like MRI and PET (positron emission tomography), as well as blood-based markers that show inflammation or damage long before symptoms appear.
“This is about detecting the earliest signals — clues that may predict who is at greater risk for long-term problems, and who is more resilient,” explained Dr. Michael McCrea, co-principal investigator of the CSI Study and professor of neurosurgery at the Medical College of Wisconsin. “If we can detect changes early, we can take action early.”
The overarching goal is to combine brain scans, blood tests, genetics, and cognitive assessments into a single risk scale. A current prototype that this risk scale could be modeled from — called the Alzheimer’s Disease Relative-Risk and Resilience Scale — could identify individuals at higher risk of brain-related condition like Alzheimer’s disease, even decades before they show signs of memory loss.
To build this model, the team is analyzing imaging studies and blood samples from 500 military service members and former collegiate student athletes. Their analysis will look at more than 100 markers of various pathological processes associated with brain function and disease. Early results are expected in October 2025.
“This work builds on years of progress,” said Ms. Kathy Lee, director of Warfighter Brain Health Policy, Office of the Secretary of War for Health Affairs. “In the first phase, the CARE Consortium focused on acute injuries — studying what happens in the hours, days, and months after a concussion. Those efforts helped shape a new international framework for classifying traumatic brain injury.”
In 2025, CSI is breaking new ground by asking: What happens multiple months or years later? Can blood biomarkers, MRI scans, or genetic testing give us insights as to who may face long-term challenges?
Early results are promising. Some markers remain elevated long after an injury — suggesting they could play a role in tracking recovery and predicting outcomes.
“This research could reshape how doctors, coaches, and commanders think about brain health,” added Lee. “For service members, it may guide policies that protect and enhance readiness across a career of blast exposures and concussion. For the medical community, it could open the door to targeted treatments and prevention strategies and closer clinical follow up for those who may be at greater risk for long-term issues.”
Researchers stress that this is not about diagnosing Alzhemier’s disease in 20 year olds. Instead, it’s about spotting the earliest, most subtle signs of brain change — well before disease takes hold – and promoting resilience and long-range brain health.
“This is careful, detailed work,” added McCrea. “We’re not swinging a hammer — it’s more like we’re using tweezers. But the potential is enormous.”
With the addition and support of new partners such as Cure Alzheimer’s Fund and Bright Focus Foundation, and the backing of the DOW and the NCAA, CSI has access to a comprehensive dataset ever assembled on brain health in young adults.
“This is one of the most powerful opportunities we’ve ever had to understand brain health across the lifespan,” concluded Lee. “The findings could change the way we predict, prevent, and treat brain disease — not just in the military and athletic populations, but for society as a whole.”