Current and Retrospective Cognitive Reserve Survey (2CR)

Abstract

The Current and Retrospective Cognitive Reserve Survey (2CR; Borella et al., 2023) is a 25-item instrument designed to provide a comprehensive, multidimensional quantification of Cognitive Reserve (CR) proxies. This measure uniquely adopts a “life stage-dependent” framework, distinguishing between current CR (CRc) and retrospective CR (CRr) status, based on recall from younger adulthood. The scale’s development involved synthesizing content from established CR questionnaires and conducting a thorough review of the literature concerning healthy aging and cognition. Initial validation and factor analysis were performed on an Italian sample of individuals aged 55 years and older, demonstrating its utility in assessing CR across the lifespan.

Keywords

Retrospective Cognitive Reserve, Current Cognitive Reserve, Aging, Family Engagement, Social Engagement, Leisure Activity, Socio-Economic Status (SES), Religious/Spiritual Activity, Developmental Measures.

Authors

Borella, Erika, Ghisletta, Paolo, Carbone, Elena, Aichele, Stephen

Purpose

The primary objective of the 2CR survey is to measure essential proxies of Cognitive Reserve across two distinct temporal domains: currently (CRc, reflecting engagement in later adulthood) and retrospectively (CRr, recalling engagement from younger adulthood). This multidimensional assessment encompasses classical CR proxies such as Socio-Economic Status (SES), engagement in leisure activities, and social engagement. Furthermore, it incorporates dimensions of potential importance that are often overlooked in other scales, specifically family engagement and religious/spiritual activity.

Construct

The 2CR is designed to quantify Cognitive Reserve (CR), a psychological construct describing the brain’s capacity to maintain cognitive function despite aging or pathological insults. Instead of measuring neural structure directly, the survey assesses environmental and lifestyle proxies accumulated across the lifespan that are thought to contribute to this resilience.

The scale operationalizes CR as a multi-level structure, incorporating five key domains: Socio-Economic Status (including education and occupation), Family Engagement, Leisure Activity, Social Engagement, and Religious/Spiritual Activity. Crucially, it captures both the current status of these activities (CRc) and the reported status from earlier life stages (CRr), providing a temporal depth often missing in single-point CR assessments.

Validity

The validation process focused on establishing both convergent and discriminant validity, particularly through analyzing correlations with demographic variables such as chronological age and sex.

Results showed that chronological age was weakly and negatively correlated with several CR components, including current leisure activity and social engagement, as well as retrospective leisure activity, Socio-Economic Status (SES: education), and global CR. Age demonstrated a moderately negative association with current family engagement. Furthermore, sex differences were observed: men reported weakly to moderately lower religious activity (both current and retrospective) compared to women, while conversely exhibiting weakly to moderately higher current SES (occupation) and family engagement, along with higher retrospective social engagement and overall CR, relative to women.

Reliability

No data is Available.

Factor Analysis

A Confirmatory Factor Analysis (CFA) was conducted to confirm the proposed structure of the 2CR. The overall model fit was deemed acceptable according to established cutoff criteria (Hu & Bentler 1999). However, models featuring a single global CR factor resulted in a non-positive definite residual covariance matrix, indicating structural inadequacy.

A formal test of change in model fit confirmed the selection of a model incorporating two global CR factors (CRc and CRr). The final analysis confirmed a robust three-level hierarchical factor structure:

• Level 3 (Top Level): Two global Cognitive Reserve factors (Current CR, CRc, and Retrospective CR, CRr).

• Level 2 (Mid-Level): Dimensional CR factors, including Socio-Economic Status, Family Engagement, Leisure Activity, Social Engagement, and Religious/Spiritual Activity.

• Level 1 (Lowest Level): The observed items, many of which are calculated as composite scores.

Instrument

Test Type: Original Inventory/Questionnaire

Format: All standard response-level items are scaled 0–4. An exception is the educational level item, which spans seven categories based on the Italian education system (scaled 1–7) and is subsequently post-multiplied by 2/3 to align with the consistent 0–4 scoring range. Items assessing engagement frequency (leisure, social, spiritual/religious activities) utilize options ranging from “never” to “always (daily)”. The 2CR employs a validated three-level factor model where Level-1 items are often combined into composite scores that feed into Level-2 dimensional factors (latent constructs), which in turn define the Level-3 global CR factors (CRc and CRr).

Language Available: Italian

Population Group: Human; Male; Female

Age Group: Adulthood (18 yrs & older); Middle Age (40-64 yrs); Aged (65 yrs & older); Very Old (85 yrs & older)

Population Details: Respondents: Community-Dwelling Italian Adults (Ages 55–90 Years), Location: Italy

Test Methodology: Test Validity; Convergent Validity; Discriminant Validity; Factor Analysis; Confirmatory Factor Analysis

Keywords

Cognitive Reserve, Aging, Psychometrics, Lifestyle Factors, Multi-dimensional Assessment, Epidemiology.

Authors

Author ORCID Identifier:

• Ghisletta, Paolo: http://orcid.org/0000-0001-7731-2406

• Carbone, Elena: http://orcid.org/0000-0003-4141-3824

• Aichele, Stephen: http://orcid.org/0000-0002-3397-7921

Affiliation Email addresses:

• Borella, Erika: University of Padova, Department of General Psychology ([email protected])

• Ghisletta, Paolo: UniDistance Suisse

• Carbone, Elena: University of Padova, Department of General Psychology

• Aichele, Stephen: Colorado School of Public Health, Department of Epidemiology ([email protected])

Correspondence Address: Borella, Erika: [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching

Commercial: No

Fee: No

Test Year: 2023

Web Site: creativecommons.org/licenses/by/4.0/ (Creative Commons Attribution 4.0 International License)

References

Borella, E., Ghisletta, P., Carbone, E., & Aichele, S. (2023). The Current and Retrospective Cognitive Reserve (2CR) survey and its relationship with cognitive and mood measures. European Journal of Ageing, 20(1), Article 23. DOI: 10.1007/s10433-023-00766-x

Items of the Current and Retrospective Cognitive Reserve Survey (2CR)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This measure consists of 25 items, with multiple items being comprised of multiple parts.

Subscales: Socio-economic status; Family engagement; Leisure activity; Social engagement; Religious/spiritual activity..

Instructions

The following questions refer to different aspects of your life. After each question you will find a series of alternative answers. Please fill in the option that best represents your choice, by marking the corresponding box with an “X”.

Demographics

• Date:

• Code/ID:

• Sex (M/F):

• Date of birth:

• Age:

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EDUCATION

1. What is the highest level of education you achieved?

   • [ ] Pre-school

   • [ ] Elementary school

   • [ ] Middle school

   • [ ] High school

   • [ ] Bachelor’s Degree

   • [ ] Master’s degree

   • [ ] Doctorate (PhD, MD)

2. How many years of schooling (including pre-school) have you completed? __________

OCCUPATION

1. What type of work have you mostly done in life? (Think about the occupation you had for the longest period of time).

   • [ ] Manual, non-qualified occupation

   • [ ] Manually skilled, qualification required

   • [ ] Non-manual, technical qualification required

   • [ ] Professional or freelance (with university degree)

   • [ ] Director or manager

FINANCIAL WELLBEING

1. How difficult is it for you to get through the month financially?

   • [ ] Not difficult at all

   • [ ] Not very difficult

   • [ ] Difficult

   • [ ] Very difficult

   • [ ] Extremely difficult

FAMILY ENGAGEMENT

1. Are you married/ Do you have a partner? YES – NO

2. Do you have any children? YES – NO
   a) If yes, how many children do you have? __________

3. Do you have any grandchildren? YES – NO
   a) If yes, how many grandchildren do you have? __________

Partnership quality

1. Partner’s status: The following statements concern your current partner (if you have a partner). For each statement, indicate your degree of agreement.

   Response Options: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree

   a) My partner has many interests that keep him/her engaged (busy):
   b) My partner, overall, is in good health:
   c) My partner is often in a good mood:
   d) My partner still has a good “mind” (he/she has no memory or attention difficulties):

Connectivity logistics

1. At present, how often do you do the following activities to spend time or keep in touch with family and close friends?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Drive a car or take public transportation
   b) Use a computer, telephone, smart phone, or tablet to communicate

LEISURE ACTIVITY

Recreational exercise

1. At present, how often do you practice the following recreational exercise activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Exercise at the gym
   b) Dancing
   c) Swimming or water aerobics
   Other aerobic exercise (e.g., walking, cycling): __________

Creative expression

1. At present, how often do you practice the following creative activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Playing a musical instrument
   b) Writing
   c) Painting or drawing
   Other creative expression activity: __________

Intellectual stimulation

1. At present, how often do you practice the following leisure activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Reading
   b) Playing chess
   c) Crosswords or other puzzles
   Other games requiring strategy/reasoning: __________

SOCIAL ENGAGEMENT

Volunteering

1. At present, how often do you perform volunteer work in the following settings?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Hospitals or personal care facilities
   b) Schools or other facilities dedicated to young people or children
   c) Any other association with voluntary or charity aims*

Participation in Associations/Clubs

1. At present, how often do you participate socially in the following settings?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Senior clubs, reading groups, associations for the elderly
   b) Political associations or groups
   c) Clubs, groups or associations of professionals (specify*)__________

Public events

1. At present, how often do you practice the following activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Go to the cinema and / or theater and / or concerts
   b) Go to exhibitions and / or museums
   c) Go to conferences, social events, public events

RELIGIOUS / SPIRITUAL ACTIVITY

Individual activities

1. At present, how often do you perform the following religious / spiritual activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Prayer
   b) Meditation

Group activities

1. At present, how often do you participate in the following religious / spiritual activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Rites/ceremonies
   b) Other church or temple community events (dinners, travel, etc.)

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Retrospective Items

The following questions refer to different aspects of your lifestyle when you were younger (specify age range – i.e. 20-35/40 years of age-). After each question you will find a series of alternative answers. Fill in the option that best represent your choice by marking the corresponding box with an “x”.

LEISURE ACTIVITY

Recreational exercise

1. When you were young, how often did you practice the following recreational exercise activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Exercise at the gym
   b) Dancing
   c) Swimming or water aerobics
   Other aerobic exercise (e.g., walking, cycling): __________

Creative expression

1. When you were young, how often did you practice the following creative activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Playing a musical instrument
   b) Writing
   c) Painting or drawing
   Other creative expression activity: __________

Public events

1. When you were young, how often did you practice the following activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Go to the cinema and / or theater and / or concerts
   b) Go to exhibitions and / or museums
   c) Go to conferences, social events, public events

SOCIAL ENGAGEMENT

Volunteering

1. When you were young, how often did you do volunteer work in the following settings?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Hospitals or personal care facilities
   b) Schools or other facilities dedicated to young people or children
   c) Any other association with voluntary or charity aims*

Participation in Associations/Clubs

1. When you were young, how often did you participate socially in the following settings?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Special interest or hobbyist clubs, reading groups
   b) Political associations or groups
   c) Clubs, groups or associations of professionals (specify*)__________

Connectivity logistics

1. When you were young, how often did you do the following to carry out volunteer and association-related activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Drive a car or take public transportation
   b) Use a computer, telephone, smart phone, or tablet to communicate

RELIGIOUS / SPIRITUAL ACTIVITY

Individual activities

1. When you were young, how often did you perform the following religious / spiritual activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Prayer
   b) Meditation

Group activities

1. When you were young, how often did you participate in the following religious / spiritual activities?

   Response Options: Never, Seldom (Yearly), Sometimes (Monthly), Often (Weekly), Always (Daily)

   a) Rites/ceremonies
   b) Other church or temple community events (dinners, travel, etc.)

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Istruzioni

Gentile partecipante, qui di seguito troverà una serie di domande relative a diversi aspetti della sua vita. Dopo ogni domanda troverà una serie di alternative di risposta. Le chiediamo di selezionare l’alternativa che meglio rispecchia la sua scelta, mettendo una crocetta sulla casella corrispondente.

Dati Anagrafici

• Codice partecipante:

• data somministrazione: __ / __ / __

• Data di nascita: __ / __ / __

• Età: ______

• Genere: M F

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SCOLARITÀ

1. Qual è il più alto grado di istruzione che ha raggiunto?

   • [ ] Scuola dell’infanzia

   • [ ] Elementare

   • [ ] Media

   • [ ] Superiore

   • [ ] Laurea triennale

   • [ ] Laurea magistrale

   • [ ] Dottorato di ricerca

2. Quanti anni di scuola (incluso l’asilo) hai completato? __________

OCCUPAZIONE

1. Che tipo di lavoro ha svolto nella sua vita? (Pensi al lavoro che ha svolto per più tempo)

   • [ ] Manuale non qualificato

   • [ ] Manuale qualificato

   • [ ] Qualificato tecnico, non manuale (es. impiegato)

   • [ ] Professionale o libero professionista (con laurea)

   • [ ] Direttore o manager

SITUAZIONE FINANZIARIA

1. Quanto è difficoltoso per lei arrivare a fine mese economicamente?

   • [ ] Per niente

   • [ ] Poco

   • [ ] Abbastanza

   • [ ] Molto

   • [ ] Moltissimo

FAMIGLIA E COINVOLGIMENTO FAMILIARE

1. È sposato/a o ha un/a compagno/a? SÌ – NO

2. Ha figli? SÌ – NO
   a) Se sì, quanti? __________

3. Ha nipoti? SÌ – NO
   a) Se sì, quanti? __________

Qualità delle relazioni

1. Di seguito trova una serie di affermazioni che riguardano il suo partner/compagno-a. Per ognuna di queste indichi il suo grado d’accordo.

   Opzioni di risposta: In completo disaccordo, In disaccordo, Né d’accordo né in disaccordo, D’accordo, Completamente d’accordo

   a) Il mio partner/compagno-a ha vari interessi che lo impegnano:
   b) Il mio partner/compagno-a gode, in generale, di buona salute:
   c) Il mio partner/compagno-a è spesso di buon umore:
   d) Il mio partner/compagno-a ha ancora una buona “mente” (non ha difficoltà di memoria, o di attenzione etc.):

Mezzi per la connessione con la famiglia

1. Attualmente, quanto spesso svolge le seguenti attività per poter passare del tempo e rimanere in contatto con familiari/amici cari?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Guidare la macchina o prendere mezzi pubblici
   b) Usare il computer, il telefono, il cellulare o il tablet per comunicare

TEMPO LIBERO

Attività fisica/ricreativa

1. Attualmente, quanto spesso pratica le seguenti attività fisiche (ricreative)?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Ginnastica
   b) Ballo
   c) Nuoto (nuoto libero, acqua gym)
   Altre attività fisiche/ricreative (es., camminare, andare in bicicletta): __________

Espressione creativa

1. Attualmente, quanto spesso pratica le seguenti attività creative?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Suonare uno strumento musicale
   b) Scrivere
   c) Dipingere o disegnare
   Altre attività creative: __________

Attività mentali

1. Attualmente, quanto spesso pratica le seguenti attività ricreative?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Leggere
   b) Giocare a scacchi
   c) Cruciverba, giochi enigmistici
   Altre attività/giochi che richiedono strategia/ragionamento: __________

COINVOLGIMENTO SOCIALE

Volontariato

1. Attualmente, quanto spesso pratica attività di volontariato, nelle strutture di seguito riportate?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Ospedali o strutture dedicate alla cura della persona
   b) Scuole o altre strutture dedicate a giovani o bambini
   c) Qualsiasi altra associazione ai fini di volontariato o carità*

Partecipazione ad associazioni / club

1. Attualmente, quanto spesso pratica attività sociali, nelle strutture di seguito riportate?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Club senior, gruppi di lettura, associazioni per anziani
   b) Associazioni o gruppi politici
   c) Circoli, gruppi o associazioni di professionisti (specificare il grado di coinvolgimento/mansione svolta*)__________

Eventi pubblici

1. Attualmente, quanto spesso pratica le seguenti attività?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Andare al cinema e/o teatro e/o concerti
   b) Andare a mostre e/o musei
   c) Andare a conferenze, manifestazioni sociali, eventi pubblici

SPIRITUALITÀ

Attività individuali

1. Attualmente, quanto spesso pratica le seguenti attività religiose/spirituali?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Pregare in privato
   b) Meditare

Attività collettive / di comunità

1. Attualmente, quanto spesso partecipa alle seguenti attività religiose/spirituali?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Riti / cerimonie
   b) Altri eventi della propria comunità religiosa (cene, viaggi etc)

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Items Retrospettivi

Di seguito troverà una serie di domande relative al suo stile di vita quando era più giovane (specificare l’età, ad es. 20-35/40 anni). Dopo ogni domanda troverà una serie di alternative di risposta. Le chiediamo di selezionare l’alternativa che meglio rispecchia la sua scelta, mettendo una crocetta sulla casella corrispondente.

TEMPO LIBERO

Attività fisica/ricreativa

1. Da giovane, quanto spesso praticava le seguenti attività fisiche (ricreative)?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Ginnastica
   b) Ballo
   c) Nuoto (nuoto libero, acqua gym)
   Altre attività fisiche/ricreative (es., camminare, andare in bicicletta): __________

Espressione creativa

1. Da giovane, quanto spesso praticava le seguenti attività creative?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Suonare uno strumento musicale
   b) Scrivere
   c) Dipingere o disegnare
   Altre attività creative: __________

Eventi pubblici

1. Da giovane, quanto spesso praticava le seguenti attività?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Andare al cinema e/o teatro e/o concerti
   b) Andare a mostre e/o musei
   c) Andare a conferenze, manifestazioni sociali, eventi pubblici

COINVOLGIMENTO SOCIALE

Volontariato

1. Da giovane, quanto spesso praticava attività di volontariato, nelle strutture di seguito riportate?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Ospedali o strutture dedicate alla cura della persona
   b) Scuole o altre strutture dedicate a giovani o bambini
   c) Qualsiasi altra associazione ai fini di volontariato o carità*

Partecipazione ad associazioni / club

1. Da giovane, quanto spesso praticava attività sociali, nelle strutture di seguito riportate?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Club senior, gruppi di lettura, associazioni per anziani
   b) Associazioni o gruppi politici
   c) Circoli, gruppi o associazioni di professionisti (specificare il grado di coinvolgimento/mansione svolta*)__________

Mezzi per svolgere attività

1. Da giovane, quanto spesso svolgeva le seguenti attività per praticare attività di volontariato e associazionismo?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Guidare la macchina o prendere i mezzi pubblici
   b) Usare il computer, il telefono, il cellulare o il tablet per comunicare

SPIRITUALITÀ

Attività individuali

1. Da giovane, quanto spesso praticava le seguenti attività religiose/spirituali?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Pregare in privato
   b) Meditare

Attività collettive / di comunità

1. Da giovane, quanto spesso partecipava alle seguenti attività religiose/spirituali?

   Opzioni di risposta: Mai, Raramente (una volta all’anno), Qualche volta (una volta al mese), Spesso (una volta a settimana), Sempre (tutti i giorni)

   a) Riti / cerimonie
   b) Altri eventi della propria comunità religiosa (cene, viaggi etc)

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Scoring Instructions

Scoring is performed sequentially across the three levels of the CR framework. First, level-1 variables’ scores are calculated as a single number scaled 0-4. This is the most complicated step and is described further below. Next, level-2 scores (domain-specific CR scores) are calculated as averages of the corresponding level-1 scores. Finally, level-3 scores (global CR scores) are calculated as averages of the corresponding level-2 scores. The following instructions pertain to the specific calculations required at each level.

1. Level-1 variables’ scores correspond to one or more survey questions, as follows:

Responses to level-1 items are scaled 0-4, from left-to-right across response categories: e.g.,

Education level (item 1) spans seven (rather than five) response categories. Thus, education level is first scored 0-6, and these scores are then post-multiplied by 2/3 to arrive at a consistent scaling.

Years of schooling is assessed as a categorical variable. For manual scoring, this should be stratified into five ordinal responses (0-4) for consistent weighting with other level 1 variables. E.g., 0-5 years, 6-10 years, 11-15 years, 16-20 years, > 20 years.

Financial wellbeing (item 4) should be reverse scored (e.g., 0=4, 1=3, 2=3, 3=1, 4=0) prior to its inclusion in subsequent calculations.

For unmarried/unpartnered persons, scores for partnership quality items (8a, 8b, 8c, 8d) should be assigned values of 2 (“neither agree nor disagree”).

Scores for level-1 variables based on multiple items (parcels) are calculated as the average of the corresponding items. For example, the level-1 score for current intellectual simulation (is_c) is calculated as the mean of items 12a, 12b, and 12c.

2. Level-2 variables’ scores are calculated as averages of the corresponding level-1 variables’ scores:

3. Level-3 variables’ scores are calculated as averages of the corresponding level-2 variables’ scores:

Important Note: Researchers may optionally exclude religious/spiritual activity items in calculations of global cognitive reserve scores (CR_c, CR_r). Religious practice was used in the initial test sample (during survey development) to be inversely related to cognitive performance but was also related to social class; these two dynamics of religious practice may also function differently across new populations. Hence, the decision of whether to include religious/spiritual activity in total CR scores should be made contingent on the specific research goals, and noted accordingly.