CTE and Dementia: Brain Health Awareness

By Thomas Lehrich, President, Traumatic Brain Injury Foundation, Plus One Foundation of Seattle

A groundbreaking study from researchers at Boston University’s Chronic Traumatic Encephalopathy (CTE) Center has provided the evidence that many of us in the brain-injury advocacy community have long suspected: severe CTE isn’t just associated with dementia, it can be a cause of it.

For numerous decades, families of individuals exposed to repetitive head trauma, from contact sports, military service, domestic violence, and other causes, have watched loved ones struggle with memory loss, confusion, and cognitive decline.

The scientific community has debated whether CTE causes these clinical symptoms or if it’s merely an incidental finding at autopsy.

The Boston University work, published in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, is the largest and most definitive of its kind.

Researchers studied 614 donated brains from individuals exposed to repetitive impacts and found those with advanced CTE had four to four-and-a-half times greater odds of having dementia compared with those without CTE pathology.

Importantly, the study isolated CTE from other neurodegenerative conditions, showing that this connection is not merely a correlation but a strong, independent association with cognitive decline and dementia.

Why This Matters

For too long, patients had unclear messages about CTE’s relevance to symptoms. This study of over 600 brains shifts how we think about repetitive brain trauma and its long-term consequences.

CTE should be formally recognized as one of the causes of dementia. Just as Alzheimer’s disease and other neurodegenerative conditions are classified within the realm of “Alzheimer’s disease-related dementias,” so too should severe CTE. This recognition matters, not only for research and clinical diagnosis but for families struggling to understand why their loved one’s cognition deteriorated.

Think About It

At Plus One, we have long championed education as one of the most powerful tools for helping our stakeholders 

Our signature initiative, Think About It, is designed to reach the neurological communities with evidence-based education about concussion, repetitive head impacts, and long-term brain health.

Studies have shown that repeated subconcussive and concussive impacts — even those that don’t cause immediate blackout symptoms — contribute over time to cumulative brain injury. CTE pathology is characterized by abnormal tau protein accumulation in specific brain regions, likely driven by repetitive trauma.

Now, with a clearer link to dementia, the message of Think About It is more urgent than ever: brain health matters across the lifespan. Early education, timely recognition, and a culture that prioritizes neurological safety can change outcomes for countless individuals.

Thomas Lehrich, Board President, discusses PBA and traumatic brain injuries

Pseudobulbar affect, also called PBA, is a brain condition in which a person suddenly starts to laugh or cry and can't manage the reaction. It is a serious neurological condition and the etiology is unknown.

The term pseudobulbar means a condition in the brainstem's corticobulbar pathways that control facial and emotional expression. The corticobulbar tract is composed of the upper motor neurons of the cranial nerves. The muscles of the face, head and neck are controlled by the corticobulbar system. 

PBA usually occurs in individuals with certain neurological conditions or injuries that affect how the brain controls emotions. 

A major risk factor is traumatic brain injuries.

One of the main signs of pseudobulbar affect is suddenly beginning to cry or laugh when you don't feel sad or find something funny; or those behaviors may be an overreaction to the situation. The reaction may happen at any time and may last for several minutes. You may start laughing, but it often turns into tears. Crying appears to be more common than laughing. 

With PBA, you often cannot manage when you laugh or cry. For example, you might laugh too much in response to a mildly amusing comment, or you might laugh or cry at something others don't see as funny or sad. These emotional responses are not how brains would typically react.

Pseudobulbar affect is often mistaken for depression because of the crying. While some people with PBA also may have depression, the two conditions are different. With PBA, crying lasts only a short time. Depression is a feeling of sadness that doesn't go away. People with PBA also do not have problems sleeping or eating, which are common signs of depression.  

The exact cause of pseudobulbar affect is not completely understood. While further research is needed, a possible cause of PBA may be an injury to the pathways in the brain that manage how you show emotions. Increases and decreases in certain brain chemicals that send messages between nerve cells also play a role in PBA.

People with certain neurological conditions or injuries have a higher risk of pseudobulbar affect.

Early diagnosis is important. If you or someone you know experiences sudden laughing or crying that doesn't match emotions, talk with a healthcare professional about PBA. Early treatment can help manage symptoms.

Think aBout It

Brain research is one of the last frontiers in medical research. Plus One Foundation's education campaign Think aBout It features educational information and outreach on contemporary neurological topics. Education is at the heart of what we do; our Think aBout It campaign aims to dig deeper into all aspects of TBIs and neurological conditions.

Thomas Lehrich, President of the Board recognizes January as National Mentoring Month

Did you know that the Plus One Foundation mentors students and volunteers through our student programs? Whether a student with the University of Washington or a member of our university chapter we have been mentoring students from the very beginning. 

January is best known for National Mentoring Month. 

Plus One knows that success comes with learning and learning is what mentoring is all about. 

The custom of mentoring is so traditional it dates back before Greek mythology. In the book, The Odyssey, there is a character—called the mentor—whose sole purpose is to guide others in life. Mentoring  includes professional development and learning life skills and how to tackle challenges.

The Plus One Foundation thanks our mentors and mentees for their work in delivering programming to those with TBIs and neurological conditions. 

Thomas Lehrich discusses New TBI Assessment Protocols

A Paradigm Shift in Brain Injury Care 

By Thomas Lehrich, President of the Board, Plus One Foundation

Traumatic Brain Injury (TBI) remains one of the most challenging and medical conditions treated in trauma centers today. 

Recognizing the complexity and long-term impact of TBIs, trauma centers across the nation are implementing a new, comprehensive approach to assessing TBIs. It is a framework that moves beyond traditional measurement tools to capture a fuller picture of brain injury and optimize outcomes.

Change

For more than five decades, the Glasgow Coma Scale (GCS) has been the cornerstone of TBI assessment in emergency and trauma settings. While revolutionary in its time, the GCS categorizes injury based on eye, verbal, and motor responses.

Recognizing GCS had limitations a coalition of experts, clinicians, and researchers collaborated with the National Institutes of Health (NIH) to design a more holistic model known as CBI-M.

This framework reflects the latest brain injury science and expands traditional assessment practices by incorporating four pillars:

• Clinical: Retains the core strengths of the Glasgow Coma Scale while broadening symptom evaluation to include amnesia, dizziness, headache severity, and other indicators of neurological dysfunction.

  Biomarkers: Utilizes objective blood-based markers of brain injury to complement clinical findings, helping detect subtle structural damage that might be missed in early assessment.

• Imaging: Advances in CT, MRI, and potentially future imaging modalities provide detailed views of brain structures, identifying contusions, microbleeds, and diffuse injury patterns that influence management decisions. 

• Modifiers: Considers patient-specific factors — including age, pre-existing conditions, mechanism of injury, and other contextual elements — that affect both immediate presentation and long-term recovery.

By uniting these pillars, the CBI-M framework offers clinicians a multidimensional profile of injury severity, enabling more precise triage and tailored care.

What This Means for Trauma Centers

The adoption of these expanded TBI assessment protocols represents a significant evolution in trauma care. Instead of relying solely on consciousness level at presentation, providers now have tools to:

Stratify patients more accurately, reducing under-triage and ensuring that subtle but serious injuries are not overlooked.

Tailor early interventions, including decisions about neurosurgical consultation, monitoring intensity, and rehabilitation planning.

Improve communication among multidisciplinary trauma teams by standardizing how injury severity is defined and shared.

While ongoing research continues to refine the role of biomarkers and advanced imaging in acute care, early adoption of the CBI-M framework across pilot trauma centers highlights a growing consensus:

Education and the Think aBout It Program

Alongside clinical innovation, education remains central to improving outcomes for individuals affected by TBI. The Think aBout It educational program, developed by the Plus One Foundation, seeks to bridge gaps in public understanding and clinical knowledge by highlighting emerging research and practical insights into neurological health — including expanded TBI assessment protocols.

Looking Ahead

As trauma centers continue to evaluate and refine these updated protocols, the healthcare community moves closer to a future where TBI assessment is less about assigning a category and more about understanding a patient’s unique neurobiological profile. This evolution promises not only improved acute care, but also more effective long-term strategies for rehabilitation, recovery, and quality of life following brain injury. 

Thomas Lehrich