PSYC 3P19 Research Proposal 1

Brain Injury and Aging

Caroline Shama

5656442

PSYC 3P19

Brock University

Monday, April 2nd, 2018

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Among the many experiences older adults go through, the most consistent and

noticeable in their population are the individual changes that occur as they age, including

cognitive, social, physical, and psychological changes. These changes tend to mostly

show declines in cognitive and physical abilities, which later affect their social skills as

well as their psychological well being. The fact that many factors can play a role in the

cognitive decline older adults tend to experience, arises the question, how can a brain

injury affect the process of aging? This question will be discussed in great detail in the

following paper by looking at aging with a brain injury and how it affects older adults’

cognitive, social, and physical abilities. As it will become known while reading this

paper, this topic is majorly understudied which is why 8 peer-reviewed articles will be

expanded on giving as much detail about this issue as possible and later discussing this

issue in a current study that will better predict accurate outcomes, which will further

better the knowledge of this topic.

Among all the cognitive declines that occur with old age, memory declines can

majorly affect an individual’s life. With memory declines, they begin to forget physical

abilities, how to have conversations with people, and in some cases they begin to forget

their own family members, memory declines basically makes them feel as if they were

children again needing adult assistance and supervision so that they are able to do the

right thing and not hurt themselves or others. By reviewing a total of 18 studies out of the

841 they found, Julien, Joubert, Ferland, Frenette, Boudreau-Duhaime, Malo-Veronneau,

and de Guise (2017) could not determine if traumatic brain injury could be associated

with, or cause Alzheimer’s disease, but they did find that the severity and the time of

which the traumatic brain injury occurs is a great outcome predictor of the brain function.
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They showed that the more sever the brain injury is and the later in life it happens, the

more negative the outcomes will be in regards to memory and cognitive abilities. On the

positive side, they reviewed how education could affect that outcome and it turns out that

the more education an individual has the better the outcome will be for memory and

cognitive functioning in general.

Another study that focused on memory in regards to brain injury was conducted by

Wammes, Good, and Fernandes (2017), where they focused on deficits in

autobiographical and episodic memory. Their study included 42 older adults of which

half had previously suffered from a mild brain injury and the other half did not, and

compared these 2 groups with 39 undergraduate students where half also suffered from a

mild brain injury and the other half did not. By completing a series of neuropsychological

tests to test their memories and general cognitive abilities, the researchers found that for

the undergraduates group with a mild brain injury, they performed worse on the free-

recall tasks that were associated with episodic details. Interestingly enough, the older

adult group performed the same as the younger group but their strategies differed in the

sense that the older group relied more on their general semantic knowledge, which could

also be known as their cognitive reserve. It is also important to note that this study

showed how structural damages to the brain that causes cognitive declines from a mild

brain injury could not be observable on conventional scans. This study show that

cognitive declines that were caused by a mild brain injury cannot be observable by

doctors but still experienced by patients and the only way to test them is by doing

neuropsychological tests and comparing them with people who did not suffer a brain

injury.
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Neuropsychological evaluations were also used in another study conducted by

Hershaw, Barry, and Ettenhofer (2017), where they compared a group with 27

participants who suffered a mild traumatic brain injury with another group including 54

participants who did not suffer any type of brain injury. By assessing visual attention,

memory, speed, and executive functioning the researchers concluded that participants

who were older with a mild traumatic brain injury showed slower response times

compared with the control group, which shows that the cognitive reserve they would

normally rely on as they age was somehow affected by the brain injury. In their study,

they also mentioned that great predictors of how negative their cognitive outcome will be

is based on the timing and severity of the injury, consistent with the study mentioned

above, as well as how many head injuries they experienced and at what age.

Continuing the focus on cognitive decline in older adults with brain injuries, Wood

(2017) conducted a combined review of 134 studies, which he found to be related to this

issue and found that it is very understudied. The studies that have been done, the

researchers mostly focused on cognitive declines that already occurred with old age not

paying close attention to how these declines may differ when these individuals had

previously suffered from brain injuries. An explanation to why this issue is understudied

is the fact that researchers who look at the cognitive declines in elders, automatically

relate it to aging because these declines are so common in old age, but some individuals

may differ in a sense that they might be experiencing these declines earlier in their aging

process due to that brain injury that they suffered so many years ago, otherwise known as

pre-mature aging.
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Pre-mature aging could be a starting point in further researching how a brain injury

could affect older adults’ cognitive performance. In an editorial, Peters (2016) compared

older adults that had previously suffered a traumatic brain injury with individuals who

have recently suffered a brain injury in their old age. He made it notable that when a

person ages with a traumatic brain injury they have fewer resources that they can count

on as in cognitive reserve. He also mentioned that older adults who have recently suffer a

mild brain injury showed a stronger association with the increased development of

dementia. And most importantly, he concluded that if an individual had a genetic

predisposition of developing a disease such as Parkinson’s disease, it might not develop

as they age, but if they have suffered a traumatic brain injury then their chance of

developing Parkinson’s disease increases.

Another cognitive decline or a symptom that might be due to a brain injury is

dementia. Although dementia has been mentioned in many research articles as being

partly caused by a traumatic head injury, Helmes, Ostbye, and Steenhuis (2011) found

disagreeing results. In their study, they included 585 individuals with an average age of

80 years old where they made them conduct several amounts of cognitive tests to see if

brain injuries played a factor in developing dementia as individuals get older. After

evaluating the results they concluded that there was no association between brain injury

and dementia, and their study in general had no other contributions to this issue, which is

why they also mentioned that one of the limitations of their study was the fact that they

did not have access to medical records of the participants’ head injuries which might have

changed the results in a way or just how accurate they were.

PSYC 3P19 Research Proposal 6

Moving on from cognitive declines, a study conducted by Kolakowsky-Hayner,

Hammond, Wright, Novack, Englander, Diaz-arrastia, Dennison, and Sueno (2012),

focused more on the physical needs of older adults that have suffered a brain injury. They

conducted a longitudinal study with 478 participants that agreed to a 10-year-follow-up.

The researchers found that younger individuals tended to recover quicker from a head

injury and relied less on others for physical assistance, whereas individuals who were 45

and older required more assistance and/or supervision than usual. Although one major

limitation of the study was the fact that they did not differentiate between regular age

declines that affected physical ability and brain injury that played a factor in age declines

that further affected physical ability.

With general knowledge, it is assumed that older individuals with declined physical

abilities need all of the social support that they could get to be able to adapt in a positive

way with the new changes that they are experiencing. Which is why Lefebvre, Cloutier,

and Levert (2008) thought it would be a good idea to study 22 individuals along with

their family members or whoever was providing them with the most support after their

brain injury. The participants studied were between the ages 40-49, which are not

technically considered older adults but the results can still apply to an older generation

due to the fact that social support at any age always has a positive impact on the

individual. Looking at it from the individual who suffered the brain injury, they first

experience many negative outcomes that obviously include cognitive declines, but due to

these cognitive declines they begin to experience social problems such as shortened

attention pan, or paying attention to unnecessary information while disregarding

important information, they are unable to hold conversations with others, and just general
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communication with others becomes difficult. On the other hand, looking at this issue

from the caregivers’ perspective, the fact that they have to take care of this individual

who is an adult and sometimes resistant of being helped because they want to be

independent. Most of the participants in the study, who were the caregivers, said that

although they know their support is positively impacting the life of the injured, it is

negatively impacting their own life because they cannot go back to work or attend to their

own families. They also mentioned the lack of available resources that they could rely on

for a positive impact on the injured relative or friend for when they are unavailable to

give them the support they need. The researchers further explained how important it was

for the family to show as much support as they could to the injured because it decreases

their chances of becoming depressed as well as it increases their chances of becoming

better cognitively socially, and physically.

The current study, being cross-sectional, aims to analyze how a brain injury affects the

process of aging by looking at all aspects of a brain injury’s outcomes, including

cognitive, social, physical and psychological abilities. In the 8 studies discussed above

there were some important findings but not accurate enough or informative enough to

stop the research in regards to this issue. This study further expands on the studies

mentioned above while removing any possible limitations that the researchers came

across such as including the participants’ medical scans of their brain injuries and later

comparing these participants to control groups for more accurate and reliable results.

Method

Participants
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In total, there will be 10 groups five of which will have suffered a brain injury and

five of which have not. The first groups will include participants between the ages of 40-

49, second groups will include 50-59, third group 60-69, fourth group 70-79, and the fifth

group will include participants who are 80 years or older. By having roughly 20

participants per group, the generalization of the results should be reliable.

Measures

Demographic differences. A 12-item survey regarding the age, gender, and sex of the

participants. As well as when their brain injury occurred, their years of education, their

socioeconomic status, if they have a caregiver, their main resource of social support, and

their overall physical health.

Neuropsychological tests. Including memory tests, block designs, digit symbol tests,

verbal fluency tests, word memory tests, and digit vigilance test.

Brain injury report. For participants who suffered a brain injury they must bring in a

brain injury medical report.

Procedure

Participants have the option to complete the surveys either at home or in the lab. This

is because older adults tend to perform better in environments they are more comfortable

in which in turn gives more accurate results. Participants will be asked to complete the

survey first so that we have all of their personal information and can start categorizing

them while they complete the neuropsychological tests. After completing all the tests at

hand, they will be asked to give a copy of their brain injury medical report so that they

can be examined and further categorized of how sever their injury was as well as when it

occurred.
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Predicted results and discussion

After evaluating all tests and comparing them with the control group as well as to each

other to see the differences between the ages, the results are expected to be clear and

accurate. For the neuropsychological tests it is expected to conclude that younger groups

with a brain injury would perform better than older groups since they are able to adapt

and recover better and faster, but when it comes to the control group, overall they are

expected to perform better on all tasks than the groups with brain injuries. Also,

depending on the severity and timing of the brain injury, the more severe it is the worst

they are expected to do on all of the tasks.

Education and economic status also play a huge role in the results of the study,

because it is expected that individuals with higher education and socioeconomic status

would be able to recover faster than individuals who have lower education and are doing

worse economically. As for the brain injury reports, examining those and categorizing

them based on severity and age and comparing them with others and how much these

individuals need social or physical support, it is better to figure out how a brain injury

can fully affect the individuals daily struggles as well as the affects it has on their aging

process.

In conclusion, many factors can play a role in the aging process, especially if an

individual has previously suffered from a brain injury. This could cause premature aging,

which is associated with cognitive, physical, and social declines at a younger age than

usual, which will further negatively impact the regular aging process. As it was shown

throughout this paper, a lot more research needs to be done in regards to this issue to be

able to better help older adults cope with the mentioned declines.
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References

Helmes, E., Ostbye, T., and Steenhuis, R. E. (2011). Incremental contribution of reported

previous head injury to the prediction of diagnosis and cognitive functioning in

older adults. Informa healthcare, 25(4), 338-347.

doi:10.3109/02699052.2011.556104.

Hershaw, J. N., Barry, D. M., and Ettenhofer, M. L. (2017). Increased risk for age-related

impairment in visual attention associated with mild traumatic brain injury:

Evidence from saccadic response times. PLOS ONE, 12(2): e0171752.

doi:10.1371/journal.pone.0171752.

Julien, J., Joubert, S., Ferland, M.C., Frenette, L.C., Boudreau-Duhaime, M.M., Malo-

Veronneau, L., and de Guise E. (2017). Association of traumatic brain injury and

Alzheimer disease onset: A systematic review. Annals of physical and

rehabilitation medicine, 60, 347-356.

http://dx.doi.org/10.1016/j.rehab.2017.03.009.

Kolakowsky-Hayner, S. A., Hammond, F. M., Wright, J., Novack, T. A., Englander, J.,

Diaz-arrastia, R., Dennison, A., and Sueno, P. (2012). Ageing and traumatic brain

injury: Age, decline in function and level of assistance over the first 10 years

post-injury. Informa healthcare, 26(11), 1328-1337. doi:

10.3109/02699052.2012.706353.
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Lefebvre, H., Cloutier, G., and Levert, M. J. (2008). Perspectives of survivors of

traumatic brain injury and their caregivers on long-term social integration.

Informa healthcare, 22(7-8), 535-543. doi: 10.1080/02699050802158243.

Peters, M. E. (2016). Traumatic brain injury (TBI) in older adults: aging with a TBI

versus incident TBI in the aged. International Psychogeriatrics, 28:12, 1931-

1934. doi:10.1017/S1041610216001666.

Wammes, J. D., Good, T. J., and Fernandes, M. A. (2017). Autobiographical and episodic

memory deficits in mild traumatic brain injury. Brain and cognition, 111, 112-

126. http://dx.doi.org/10.1016/j.bandc.2016.11.004.

Wood, R. L. (2017). Accelerated cognitive aging following severe traumatic brain injury:

A review. Taylor & Francis group, 31(10), 1270-1278.

https://doi.org/10.1080/02699052.2017.1332387.