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Brain Health Initiative Protects Service Members

MAY 28, 2025 – The Defense Department’s Warfighter Brain Health Initiative aims to identify changes in cognitive performance to provide an opportunity for interventions to restore deficits and enhance cognition or “thinking skills.”

DOD’s Cognitive Monitoring Program is charged with evaluating service members’ cognition — how they acquire and process information — and monitoring how it changes throughout their careers. The program uses a computer-based assessment tool that evaluates 10 cognitive domains related to memory, attention, focus and judgment. The evaluation also includes a questionnaire about mood, sleep, post-traumatic stress disorder and traumatic brain injury symptoms.

The goal is to evaluate service members early in their careers to establish a cognitive baseline, with follow-up evaluations scheduled every five years, or more frequently, to enable proactive monitoring, facilitate accurate comparisons in case of injury, and support timely clinical interventions to optimize health, readiness and performance.

In June 2024, DOD started conducting cognitive assessments on every new service member during initial military training. To establish baselines for those already serving, DOD has begun conducting cognitive assessments for high-risk service members. They will be completed by the end of September 2025. The total force is projected to have a cognitive baseline assessment completed by the end of fiscal year 2027.

Monitoring brain health is essential for service members, as exposure to blast overpressure can lead to brain injuries that impair critical cognitive and motor functions — including speed, dexterity, reasoning and decision-making — ultimately impacting operational effectiveness and long-term well-being.

“A lot of our human performance work is trying to help warfighters be faster and more lethal — more ready,” said Kathy Lee, director of WBHI. “And that can be enhanced by having a faster reaction time or cognitively processing in a faster way, through repetition, sets and reps.”

Lee said establishing a cognitive baseline for all service members and then evaluating them regularly can help catch changes early on. The assessment can also identify changes in cognition that may be unrelated to blast or even brain injury, allowing medical professionals to help service members address issues before they affect their warfighting ability.

“We really need to capture the baseline for each individual, and our concept for monitoring is that over the course of that service member’s career, we’re going to be reassessing them to try and identify if they have a cognitive change for any reason,” said Army Col. Jama VanHorne-Sealy, director of the Army’s Occupational Health Directorate. She noted that a change in cognition may be caused by injury, but it could also result from other things, such as sleep deprivation or stress at home.

“This is going to give us the opportunity to identify cognitive change early and hopefully intervene so that we can get that individual back to their baseline [cognitive ability] and maintain their readiness for the Department of Defense consistently throughout their career,” VanHorne-Sealy said.

Lee added that these tests do more than just serve a purpose later on. They can be used immediately because when a service member completes an assessment, the results can be measured against others in their peer group.

“When you take your first baseline, you are compared by gender and by a four-year age group in military norms … so you can also pop out, if you will, of a norm when you take that assessment,” she said. “It’ll also flag it and say, something looks off … that it’s not in alignment with the norms now. A retake or clinical evaluation is indicated. Maybe they didn’t sleep well the night before the assessment. There is value even in the baseline assessment — you don’t have to wait until the second comparison, three years or five years later.”

Blast Overpressure Risks on Brain Health
Blast overpressure occurs when weapons systems detonate, generating pressure waves that propagate through the air. These waves may have effects on brain health, impacting not only the service members operating the systems but also those in the surrounding area. For example, in training environments, drill instructors standing near trainees as they repeatedly fire certain weapons may experience frequent exposure, potentially increasing their risk of brain health impacts over time. Understanding and mitigating these effects is critical to protecting cognitive function and long-term well-being.

The department is working to identify and track all at-risk populations affected by blast overpressure while prioritizing those at the highest risk. Rather than focusing on occupational specialties, the department is focused on assessing specific job tasks and actual exposure levels to accurately determine risk and inform targeted mitigation efforts. This data-driven approach ensures that risk management actions are based on measurable exposure, allowing for more precise protection strategies across all personnel who may be affected.

DOD developed the Blast Overpressure Reference and Information Guide as a key resource for establishing practical and feasible stand-off distances for service members operating priority weapons systems. By synthesizing data on the effects of blast overpressure, the guide provides evidence-based recommendations to mitigate risks associated with exposure to pressure waves from explosive weapons. These stand-off distances help protect personnel while ensuring operational effectiveness, particularly for those in high-risk environments where repeated exposure may pose long-term brain health concerns. By leveraging this guide, military leaders can make informed decisions that balance mission requirements with protective measures, enhancing force readiness and safeguarding service members from the adverse effects of blast overpressure.

Additionally, the department is prioritizing the use of simulators to reduce blast exposure, recognizing their effectiveness in minimizing risks while maintaining combat readiness. By incorporating advanced training technologies, service members can refine their skills without repeated exposure to blast overpressure. The Marine Corps and the Ranger Regiment have already implemented these strategies, leveraging simulators to enhance training while reducing potential brain health impacts. This approach underscores the department’s commitment to protecting personnel while sustaining operational effectiveness.

In addition to cognitive monitoring and weapon training changes, VanHorne-Sealy said redesigning weapons systems is another way to reduce or prevent exposures.

“The special operations community actually redesigned a tool that will reshape that breaching blast wave away from the breachers themselves,” she said. “So, we’re trying to identify and [integrate] engineering solutions to reduce that blast overpressure in any environment, not just the training environment.”

Lee said the goal is for service members to avoid unnecessary blast exposures in order to keep them at peak performance, adding that cognitive monitoring is not just about assessments. Instead, it ensures that service members can process information, visually scan faster and make expedient decisions more quickly. All of that falls under the umbrella of the Warfighter Brain Health Initiative, with the goal of optimizing brain health on and off the battlefield.

By C. Todd Lopez, DOD News

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