This week, our lead article, Brain imaging and biomarkers can predict sleep disorders in concussion patients, is in the Pathophysiology category.

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In this newsletter: Opportunities, Welcoming our Interns, Pathophysiology, Statistics, Women’s Health

Writers: John Rosseel, Sam Chen, Marina Oljaca, & Conor Gormally

Editors: Conor Gormally & Malayka Gormally

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Opportunities

Wednesdays starting July 9, 11–12:15 pm EST: A free, virtual program, MindSet for Veterans, provides group discussion and gentle yoga for veterans, active service duty, and military families who've been affected by brain injury. Hosted by the nonprofit LoveYourBrain. Register in advance; space is limited.

Monday, July 21, 12-2 pm EDT: A webinar, Minds Matter Concussion Model: Acute Clinical Concussion Management, "is open to anyone responsible for implementing a concussion protocol following injury," and all participants will receive an evaluation and treatment toolkit. Presenters include Christina L. Master, MD, who is considered one of the top clinician–researchers in this field. General admission (no continuing education credits) is $30. CEUs are available for ATs, Nurses, PTs, and Physicians; tickets range from $45 to $75.

Welcome Summer Interns!

Concussion Alliance welcomes six interns for its 6th-annual Summer Concussion Education & Advocacy Internship

We’re already in our third week of our Concussion Education & Advocacy Internship program! This year, we have six fantastic interns joining us for eight weeks to learn about concussions from the lens of biology, psychology, neuroscience, medicine, and public health. For the next six weeks, we’ll be publishing weekly newsletters written by our interns as they hone their science writing skills.

These wonderful undergraduates are also making several of our resources more accessible and building new public health-oriented advocacy resources. Read about our internship program here, and our 2025 interns and Expert Guest Speakers here

Pathophysiology

Brain imaging and biomarkers can predict sleep disorders in concussion patients

A study by Rui Du et al. found that sleep disorders in concussion patients can be predicted three months in advance by combining two techniques: monitoring the presence of a pro-inflammatory chemical messenger in the blood (TNF-α) and observing changes in white matter (WM) brain structure. In the study published in the Journal of Inflammation Research, 215 patients presenting mild traumatic brain injury (mTBI) symptoms were evaluated one month and three months after injury. During the one-month visit, researchers tested participants’ blood for chemical messengers, including TNF-α, and used a diffusion tensor imaging (DTI) MRI scan to map their white matter. Their sleep quality was tested using the Pittsburgh Sleep Quality Index (PSQI). The study found that the presence of TNF-α and changes in WM structure one month post-injury individually predicted sleep disorders in patients three months after their mTBI. While each method individually could predict the patient’s outcome, the authors emphasize that testing for both TNF-α and WM structural changes produces a greater degree of certainty.

The first marker, TNF-α, is a chemical messenger released into the bloodstream that promotes inflammation. While inflammation is beneficial for recovery over short periods of time, prolonged inflammation (indicated by the presence of TNF-α three months post-injury) inhibits the repair of brain cells (neurons) and disrupts sleep by interrupting melatonin production.

The second predictive indicator was WM structure changes in a region of the brain called OLF.L, which “regulates melatonin secretion and receptor signaling” and is part of the ‘rich club.’ The rich club is a highly interconnected network of brain hubs that “represents efficient communication hubs within the entire brain network,” and, according to the authors, the connection strength and energy cost of this network are valuable tools for tracking WM network changes. Among the mTBI patients who’d developed a sleep disorder at 3 months, researchers found decreases in a WM measure called nodal efficiency in the OLF.L region, indicating decreased connectivity to other brain regions. Both prolonged TNF-α activation and decreased OLF.L nodal efficiency inhibit healthy sleep, likely leading to sleep disorders and, as the authors argue, inhibit the healthy function of the brain.

While the findings provide “a more objective and effective method for predicting [sleeping disorders] following mTBI,” the authors note that the testing methods have limited viability due to the inability to study asymptomatic patients (whose mTBI produced no initial symptoms) and the limited knowledge surrounding the creation of sleep disorders from mTBI. The authors recommend further research beyond three months to observe how sleep disorders continue to develop, as well as more research into inflammation and connections within the brain.

Statistics

National survey exposes critical gaps in concussion understanding

A recent nationwide survey of 2,084 individuals, initiated by the Brain Injury Association of America (BIAA) and conducted by the Harris Poll, revealed critical and surprising gaps in public understanding of concussions. In a press release, Dr. John D. Corrigan, National Research Director at BIAA, emphasized the significance of these findings, stating, “Detection and treatment for brain injury is incredibly important. Misconceptions persist and must be addressed.” Nearly 40% of adults in the U.S. reported having experienced symptoms of traumatic brain injury over their lifetime “as a result of a blow or jolt to the head.” Equally concerning, 81% of adults were unaware that concussions are classified as a traumatic brain injury. Only 18% of participants could correctly identify falls as the leading cause of brain injury, and nearly half misidentified unrelated symptoms, such as facial droop or hallucinations, as signs of concussion. While 81% of parents expressed confidence in knowing when their child would need medical care for a potential head injury, many still had difficulty identifying concussion symptoms accurately. In fact, 55% of parents of children under 18 “incorrectly selected at least one non-symptom” as a concussion symptom, indicating ongoing confusion about how to recognize concussions accurately. The widespread misunderstanding of concussion knowledge among the general public points to a need for improved public education and awareness efforts around recognizing and responding to traumatic brain injuries, including concussions.

The survey also found that “fewer than 1 in 4 American adults report they have been asked by a healthcare provider about [their] brain injury” history. Additionally, there are gender disparities in how medical professionals inquire about brain injuries. Men (29%) were nearly twice as likely as women (16%) to be asked about their history of brain injuries. Financial barriers, lack of insurance, and underestimation of injury severity were the main reasons people did not seek care, with 35% of respondents choosing not to pursue medical attention after a head injury. These findings point to the need for targeted efforts at multiple levels: healthcare providers need to improve training and protocols to identify and address traumatic brain injuries, including concussions, during routine care. At the same time, public education campaigns are needed to help individuals recognize concussions and their symptoms, seek appropriate care, and understand the potential long-term consequences.

Editor’s Note: The BIAA survey finding of 39% of people (4 out of 10 people) having experienced symptoms of a brain injury “after a blow or a jolt to the head" is much higher than findings from a related study, the pilot study by the CDC National Concussion Surveillance System, which asked individuals about their history of TBI. However, this study’s findings that many people are unable to identify TBIs could be a contributing factor to the difference in self-reported injury history between these two studies.

Women’s Health

Hormonal fluctuations in women exacerbate TBI recovery time and outcomes

A recent review article by Greiss et al. in Physical Medicine and Rehabilitation Clinics of North America found that all-severity traumatic brain injury (TBI) recovery time and health outcomes in female patients can be exacerbated by hormonal fluctuations associated with menstrual cycles, pregnancy, and life stage transitions. Hormones like progesterone and estrogen have neuroprotective functions that reduce inflammation. When TBIs, which cause a drop in progesterone, occur during the luteal phase when progesterone levels are naturally lower, the combined drop in progesterone is associated with longer recoveries and more symptoms. In an article for NeurologyLive, lead author Dr. Greiss highlights that the compounding effect of brain injury and premenstrual syndrome (PMS) could result in changes in “mood and behavior patterns, but also in cognitive patterns” brought on by both slower nerve signal transmission and hormonal fluctuations. During pregnancy, reduced progesterone, increased clotting factors, and physiological changes that occur to support fetal growth may introduce additional risk in combination with the effects of a TBI. Later in life, menopausal women experience a decline in progesterone and estrogen, putting them at greater risk following brain injury.

Tailoring treatment for women who have sustained a traumatic brain injury must involve “individualized rehabilitation programs that include early screening, hormonal monitoring, and lifestyle modifications” to achieve comprehensive care. Thus, understanding the impact of hormonal and physiological changes (and how these changes can impact the severity of TBI outcomes) can significantly contribute to diagnosis and treatment.

Along with physiological influences, women experience health conditions that present differently than their male counterparts, impacting recovery time and compounding with external factors in the patient’s life. In particular, the study emphasized that females have a higher prevalence of post-TBI anxiety, depression, and PTSD compared to males. These differences are largely attributable to changes in neurotransmitter levels following injury and unique environmental influences that can impact gene expression.

Also, women have unique social, vocational, and sexual challenges that necessitate greater care and social support following a TBI. In fact, higher rates of post-TBI mood disorders influence social well-being, while insufficient educational and employment resources affect sexual health and employment status. One example of a vocational support program that particularly supported women with a mild TBI is the Compensatory Cognitive Training-supported Employment intervention, a program that supported patients in returning to work through cognitive rehabilitation, with 59% of participants being women and 94% having a mTBI.

In addition to specific issues related to hormones, higher rates of domestic violence (DV) among women influence concussion diagnosis and treatment. In particular, research regarding intimate partner violence and brain injury in the LGBTQIA+ community is particularly lacking, indicating a need to fill this gap.

The screening process must consider all aspects and identities of a patient’s life to make an accurate diagnosis, which is the foundation of effective, individualized treatment — a task that falls to the multidisciplinary care team assisting the patient on their road to recovery.

You Can Support Concussion Patients

Become a Concussion Ally

Join our community of monthly donors committed to improving how concussions are prevented, managed, and treated, thereby supporting long-term brain health for all. Learn more.

Other Ways to Support

You can also make an impact with a one-time gift or tax-friendly options such as Donor Advised Funds (DAFs), IRA Charitable Rollovers, and Planned Giving: leave a gift in your will. Learn more.