Volume 24, Issue 2 (summer 2022)                   Advances in Cognitive Sciences 2022, 24(2): 127-140 | Back to browse issues page

Research code: 2659141
Ethics code: IR.UI.REC.1399.096

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Hadi F, Tavakkoli M, Nilforooshan P. Development and validation of elderly cognitive reserve scale. Advances in Cognitive Sciences 2022; 24 (2) :127-140
URL: http://icssjournal.ir/article-1-1369-en.html
1- MA in Cognitive Science, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
2- Assistant Professor of Psychology, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
3- Associate Professor of Counseling, Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
Abstract:   (711 Views)
Cognitive impairment is one of the significant challenges of the aging population, along with physical problems. There is a significant difference between individuals in terms of age-related cognitive decline. In addition to differences in cognitive decline, a difference between the extent of brain damage and the severity of clinical symptoms in different individuals was observed. "Reserve" is a concept proposed to explain the repeated observations of this significant difference between brain damage and its clinical manifestation in the form of cognitive deficit. Reserve theory has been presented in passive (brain reserve) and active (cognitive reserve) models. Brain reserve refers to the amount of brain damage that a person can suffer before the onset of clinical symptoms. On the other hand, cognitive reserve is related to changes in how a task is processed to compensate for the experienced cognitive decline. One of the methods of measuring cognitive reserve is the proxy indicators approach. Variables reflect innate differences in processing or rich intellectual experiences throughout life. Since using one variable as a proxy of this concept does not well assess the impact of different experiences during life, the development of a tool consisting of several proxy variables has been suggested. The present research aimed first to develop a scale to measure this concept according to the limitations of existing tools and its relevance to Iranian culture and then to examine cognitive reserve status in two healthy and mild cognitive impairment groups.
According to its objectives, this research method was first the descriptive survey and then the causal-comparative. For this purpose, by studying the theoretical foundations of the reserve hypothesis and related research, as well as examining the items of existing foreign tools and their strengths and limitations, the desired scale was created. The initial version of the scale, along with its implementation and scoring instruction, was provided to check the face and content validity of the scale by four experts in the field of aging, and based on their opinion, further changes and corrections were made. After the preliminary implementation, this scale was performed as a semi-structured interview on 100 elderly volunteers (female=53, male=47) with a mean age of (68.23±6.30), who were selected by the available sampling method in 2019. In addition to the researcher-made Elderly Cognitive Reserve Scale, Cognitive Reserve Index Questionnaire (CRIQ) was prepared as a criterion tool and used in this study. The Neuropsychiatric Unit Cognitive Assessment Tool (NUCOG) was also used to determine the cognitive status of the elderly. This study used the internal consistency method (Cronbach's alpha and McDonald´s omega coefficient) and retest reliability (correlation between two test implementations) to evaluate the scale’s reliability. In addition to evaluating the face and content validity by experts, concurrent validity (correlation with criterion tool) and diagnostic validity (discriminant analysis) were examined. The correlations of subscales with each other and the total score were also calculated. An independent t-test was used to determine the difference in cognitive reserve between the two groups (healthy and mild cognitive impairment). Finally, multiple regression analysis was used to predict cognitive status by demographic and cognitive reserve variables. The statistical calculations and data analysis were performed with SPSS-26 software.
The results for psychometric properties of the scale showed the value of 0.623 for Cronbach's alpha coefficient and 0.7 for McDonald´s omega coefficient. These findings are consistent with data that have been observed in other studies. The intra-class correlation coefficient in the retest reliability method was obtained at 0.839 (P<0.001). In the concurrent validity, the Pearson correlation coefficient between Elderly Cognitive Reserve Scale and Cognitive Reserve Index Questionnaire (CRIQ) was calculated at 0.616. In the diagnostic validity using the discriminant analysis method, the canonical correlation coefficient between the total score of the scale and the group membership of the elderly in two healthy and mild cognitive impairment groups was 0.432 (P<0.01). The cut-off point of the scale determining the two groups with high and low cognitive reserve was 44, and the sensitivity and specificity of the scale were 61.2 and 62.7, respectively. The correlation coefficients of the subscales with the total score of the scale ​​were high and significant (r=0.654 for educational achievement, r=0.548 for job complexity, and r=0.947 for leisure activities (P<0.01)). The independent t-test showed that the mean of cognitive reserve in the two groups was significantly different (P<0.001). Moreover, the mean of cognitive reserve in healthy elderly was significantly higher than in the elderly with mild cognitive impairment. Finally, the two-stage regression analysis results showed that among the various demographic variables, the variable of age - the most potent known risk factor for cognitive decline- explains 18% of the variance of cognitive status. The ability to explain variance after the addition of the cognitive reserve variable increases by 22.6%, and finally, these two variables together explain 40.6% of the variance of the cognitive status.
Psychometric data in the present research to examine the elderly cognitive reserve scale revealed that this scale has satisfactory validity and reliability. The findings also showed a significant difference between the two groups of healthy and mild cognitive impairment in terms of cognitive reserve, and finally, the variables of age and cognitive reserve can predict the cognitive status of the elderly.
Given the growing trend of the elderly population, the need to pay attention to cognitive problems along with physical problems is undeniable. The concept of cognitive reserve has been expressed to explain individual differences in the occurrence of cognitive symptoms despite the same brain damage among different people. Awareness of this concept and providing appropriate tools for measuring it can help to understand the factors affecting the prevention of age-related cognitive decline and subsequently improve lifestyle at the different stages of life. Comparing cognitive reserve and cognitive function in the clinical situation helps accurately determine a person's current condition. In people with a high reserve level, which may have compensated for minor brain injuries and have covered the clinical signs of cognitive decline, it is necessary to use more challenging cognitive tests or specific tests to diagnose brain damage. Poor cognitive performance is expected in individuals with low cognitive reserve. Using the Cognitive Reserve Scale provides an overview of various aspects of life that can be helpful in the assessment, treatment, and prediction of interventions.
Ethical Consideration
Compliance with ethical guidelines
The Research Ethics Committee of the University of Isfahan approved this study. All ethical principles are considered in this study (Ethics Code: IR.UI.REC.1399.096). The participants are informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.
Authors' contribution
This article is the result of the senior thesis of the first author with tracking code 2659141. Fatemeh Hadi participated in the presentation of the topic and the initial design, the implementation of the research, the collection, and analysis of information. Mahgol Tavakkoli was in charge of correcting the article and supervising the implementation and content of the research. Parisa Nilforooshan contributed to reviewing and modifying the content.
The Cognitive Sciences and Technologies Council funded part of the costs of this research.
Thanks, and appreciation to the daily training and rehabilitation centers for the middle-aged and elderly- "Ranginkamane Sepid" and "Baghe Tajrobe Salmandan"- and "Isfahan Education Officers and Retirees Association", as well as to the honorable elderly who participated in this research. The authors would also like to thank the Cognitive Sciences and Technologies Council for providing financial support for this research.
Conflict of interest
The authors have expressed no conflict of interest.
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Type of Study: Research |
Received: 2021/11/27 | Accepted: 2022/05/26 | Published: 2022/08/11

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