774620

research-article2018
ASMXXX10.1177/1073191118774620AssessmentMorales and Fernández

Article
Assessment

Assessment of Cognitively Stimulating

1­–10
© The Author(s) 2018
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DOI: 10.1177/1073191118774620
https://doi.org/10.1177/1073191118774620
journals.sagepub.com/home/asm

Manuel Morales Ortiz1 and Aaron Fernández1

Abstract
Theoretical models of active ageing and cognitive reserve emphasize the importance of leading an active life to delay age-
related cognitive deterioration and maintain good levels of well-being and personal satisfaction in the elderly. The objective
of this research was to construct a scale to measure cognitively stimulating activities (CSA) in the Spanish language. The
sample consisted of a total of 453 older persons. The scale was constructed from a list of 28 items and validated using
structural equation models. The scale obtained showed a negative correlation with age and a positive correlation with
education and physical activity. Using hierarchical regression models, CSAs were found to have a significant effect on
attention when controlling for the effect of age and education. Likewise, a significant interaction between age and CSA
was found on the measure of episodic memory. The validated CSA scale will enable the relationships between changes in
cognitive functions and stimulating activities to be studied.

Keywords
ageing, leisure activities, lifestyle, neuropsychology, measurement

Life expectancy in Western countries has increased in recent
years. This has meant that governments have become
increasingly concerned about the social and health conse-
quences involved in having an ageing population. In 2015,
there were 901 million people older than 60 years, and this
figure is expected to rise to 2.1 billion in 2050 (United
Nations, 2015). Ensuring that these older adults maintain
their physical and cognitive skills and capabilities in the
best condition possible has both individual and societal
benefits. From the point of view of the individual, improv-
ing the quality of life of people in this age-group will pre-
vent (or delay) the possible appearance of problems of
dependency and achieve better quality of life during those
years. From a societal point of view, keeping older adults
healthy and active will help reduce the budgets allocated to
dealing with their health problems.
Various studies have shown that age-related decline
(physical and mental) can be delayed or moderated depend-
ing on a series of factors. One of these is active participation
in leisure activities (LA). Older adults who engage in LA
show a better quality of life and better cognitive functioning
than those with lower levels of activity (Fratiglioni, Paillard-
Borg, & Winblad, 2004; Hertzog, Kramer, Wilson, &
Lindenberger, 2008). It has been found that the risk of
developing Alzheimer’s disease is less in older adults who
regularly carry out physical activities (PA) than those who
lead a sedentary lifestyle (Hertzog et al., 2008; Raji et al.,
2016; Schooler & Mulatu, 2001).
Several theories have sought to explain these results.
Active ageing theories have related the well-being and per-
sonal satisfaction of older people with greater participation in
LA (Hertzog et al., 2008; Jopp & Hertzog, 2010; Lee, Lan, &
Yen, 2011). More active people will seek out more complex
situations that will yield greater satisfaction and allow them
to stimulate their cognitive functions (Schooler & Mulatu,
2001). In the same way, the theory of “use it or lose it”
(Bielak, Anstey, Christensen, & Windsor, 2012; Hertzog,
2009) considers that older people who lead an active life will
always present higher levels of cognitive functioning over
time (preserved differentiation). Likewise, people with more
active lifestyles will have lower levels of change (decline)
than the less active ones (differential preservation).
The cognitive reserve (CR) theory also considers that the
experiences or events that individuals are subjected to may
compensate for the effect of age-related brain damage
(Reed et al., 2011; Stern, 2009). Studies based on this the-
ory have found a relationship between lifestyle and the
onset of dementia (Fernández-Mayoralas et al., 2015;
1
Universidad de Sevilla, Sevilla, Spain
Corresponding Author:
Manuel Morales Ortiz, Departamento de Psicología Experimental,
Facultad de Psicología, Universidad de Sevilla, C/ Camilo José Cela s/n,
Sevilla 41018, Spain.
Email: morales@us.es
2 Assessment 00(0)
Fratiglioni et al., 2004; Sobral, Pestana, & Paúl, 2015;
Valenzuela & Sachdev, 2006; Verghese et al., 2003; Wilson,
Barnes, & Bennett, 2003).
Assessments of cognitively stimulating activities (CSA)
have been carried out using self-reports (Salthouse, Berish, &
Miles, 2002; Schinka et al., 2005; Wilson et al., 2003).
Reliability measures were based on the alpha coefficient
(varying between .60 and .88) and/or the test–retest alpha
(varying between .73 and .79). The three studies mentioned
were validated by associating the CSA measure with mea-
sures of neuropsychological functioning (Schinka et al.,
2005), or by associating the CSA measures with measures of
cognitive functioning using linear regression and after con-
trolling for factors such as education (Wilson et al., 2003), or
gender and age (Salthouse et al., 2002). The results obtained
correlated positively with education, level of occupation, and
measures of cognitive functioning, and negatively with age.
There is at present no measurement in Spanish that
enables us to reliably measure and isolate CSA; there are
only measures of CR (León, García-García, & Roldán-
Tapia, 2014; Rami et al., 2011), which include various fac-
tors (e.g., level of occupation, education, hobbies, social
life, daily activities, etc.) but do not allow us to identify the
effects of CSA in isolation. Moreover, these tests were car-
ried out with very small samples. A scale was recently
developed to measure LA (Martínez-Rodríguez, Iraurgi, &
Gómez-Marroquin, 2016) but was not designed specifically
to measure CSA. Their items are associated more with per-
sonal satisfaction than with cognitive stimulation.
Since there is at present no scale for measuring this con-
struct, the objective of this study was to develop a scale to
measure CSAs in the Spanish context. Having an indepen-
dent measure of CSA available in Spanish will make it pos-
sible to follow up with longitudinal studies of activities of
this kind, as well as to discover their effects, either indepen-
dently or in their interactions with other variables, such as
age, education, or PA. This interaction has been regarded as
a basic condition for determining the effectiveness of CSA
in cognitive functioning (Salthouse et al., 2002). Our initial
hypothesis, therefore, was that CSAs would be associated
with different cognitive functions. It was expected that, as
the number of these activities increased, so there would be
a corresponding increase in cognitive functions, which
would be considered as evidence of the validity of the scale,
particularly if the cognitive changes were observed to inter-
act with variables such as age.
Method
Participants
The sample was made up of 453 people mostly of older age
living in the province of Seville, Spain (320 females), with
a mean age of 66.34 years (SD = 6.95, range = 48-90 years),
and an average number of 10.35 years in formal education
(SD = 4.97, range = 0-25 years). In all, 91.8% (416) of the
sample had occupations at skill levels 1 and 2 (unskilled,
manual workers, agricultural workers, etc.) using the CNIO-
11 classification (Instituto Nacional de Estadística, 2012).
These people were enrolled in the Experience Classroom at
the University of Seville, which is an activity that lasts 4
years and allows older people to gain access to education
and cultural activities (seminars and lectures). Subjects
were excluded if they fulfilled any of the following criteria:
(1) previous history of neuropathology; (2) previous hospi-
talization due to psychopathological disorders (e.g., schizo-
phrenia, depression, etc.); (3) previous history of abnormal
psychomotor development; (4) a history of drug or alcohol
abuse; (5) taking psychotropic medication that affects atten-
tion and concentration or causes sleepiness; (6) mother
tongue was not Spanish. The mean score of subjects taking
the Mini-Examen Cognoscitivo, the Spanish version of the
Mini-Mental State Examination (MMSE; Lobo, Ezquerra,
Burgada, Sala, & Seva, 1979) was 28.02 (SD = 2.07) and
the mean score on the Spanish short version of the Geriatric
Depression Scale developed by Martínez de la Iglesia et al.
(2002) was 3.19 (SD = 2.78, range = 0-15). An attempt was
made to include subjects from both urban and rural environ-
ments. Subjects participating in the study provided informed
consent. Authorization to perform the study was given by
the management of the Experience Classroom and the
Ethics Committee of the University of Seville.
Instruments
Questionnaire about Sociodemographic and Health Vari-
ables. Individuals were asked about their age, what jobs
they had had during their lives, level of education (the num-
ber of years of formal education received was recorded),
what medical conditions or illnesses they had, at the time or
previously, PA that they carried out and how often, what
medication they were taking, and so on. PA was measured
using a self-report Likert-type scale that asked them to indi-
cate how often (1 = less than a couple of times a year, 2 = a
couple of times a year, 3 = a couple of times a month, 4 = a
couple of times a week, and 5 = every day) they performed
9 PA (walking, cycling, swimming, keep-fit exercises, jog-
ging, yoga and/or Pilates, dance classes, meditation, and
looking after plants/lawn mowing).
Cognitively Stimulating Activities Scale. A Likert-type scale
was constructed, initially made up of 28 items, which asked
how often CSAs of varying degrees of difficulty were car-
ried out (see Table 1). The items were selected after consid-
ering the three scales that had previously been validated in
an English-speaking environment (Salthouse et al., 2002;
Schinka et al., 2005; Wilson et al., 2003). The scale was
graded from 1 to 5 depending on how often the activity in
Morales and Fernández 3
Table 1.  List of Cognitive Stimulation Activities.
Item Activity
 1 I watch television and/or listen to the radio.
 2 I watch talk shows on TV or listen to them on radio.
 3 I use computers.
 4 I read books, newspapers, poetry, etc.
 5 I write letters, diaries, etc.
 6 I write poems, novels, etc.
 7 I have a hobby (crossword puzzles, Sudoku, etc.)
 8 I play games with other people (chess, cards,
dominoes, etc.)
 9 I listen to music.
10 I belong to a club/society or take part in some social
activity.
11 I go to the movies, theater, exhibitions.
12 I take the occasional pleasure trip (tourism, hiking, . . .)
13 I spend part of my time on my hobbies.
14 I go out for a drink with my friends.
15 I visit friends or relatives.
16 I look after a (dependent) relative.
17 I try to learn new things.
18 I paint pictures.
19 I try to repair things when they stop working.
20 I take classes (not including sports).
21 I give classes (include any classes).
22 I take part in discussions on any topic that crops up
(with my family or my friends, etc.)
23 I can handle my financial affairs unaided.
24 I cook at home.
25 I look for and try out new recipes.
26 I drive my car or ride my motorbike.
27 I clean my house.
28 I am learning to play a musical instrument or I already
have one and play it.
question was performed (1 = less than a couple of times a
year, 2 = a couple of times a year, 3 = a couple of times a
month, 4 = a couple of times a week, 5 = every day). Table 1
shows items selected. A Spanish translation of the items is
provided in the supplementary material (available in the
online version of the article).
Verbal Selective Reminding Test.  Form 1 of the Spanish ver-
sion of the verbal selective reminding test was applied
(Campo & Morales, 2004; Morales et al., 2010). Following
Buschke’s procedure (1973), subjects were presented with a
list of 12 unrelated words in 6 selective reminding trials.
Their total recall (RECALL), long-term recall (LTR), con-
sistent recall (CLTR), and delayed recall (DELAY) scores
were recorded. LTR is the number of words that had already
been recalled in two consecutive trials. CLTR is the number
of words that had already been recalled in two consecutive
trials and could still be recalled. DELAY is the number of
words recalled 30 minutes after completing the six trials.
The characteristics and psychometric properties of this test
can be found in Campo and Morales (2004).
Stroop Effect Test. This test consists of performing three
tasks on three different cards: reading words, naming col-
ors, and a final interference task (Golden, 1978). The first
of the cards involved reading the words of the colors
“red,” “blue,” and “green” printed in black and randomly
displayed in five columns of 20 words each; the subject
was instructed to “read each column aloud as quickly as
possible.” The total number of words read in 45 seconds
was recorded and any subject who read the 100 words
within the time limit returned to the beginning of the card.
On the second card, naming colors, there were, once again,
five columns with 20 “XXXX” in red, green, and blue ink,
and the task involved naming the color of each element in
the columns as quickly as possible in 45 seconds, as
before; the number of correctly named colors was recorded
as the STROOP2 score. Last, the third card, the so-called
interference task, presented the same words as on the first
card, but this time printed in a different color from the
color named (e.g., the word “red” was printed in blue ink)
and the subject was asked to name the color of the words
in the columns rather than what the word said. Correct
responses were recorded as the STROOP3 score. Because
of the nature of the task, this card was useful for observing
some components of executive function, such as
inhibitory control, since the subject had to suppress the
prepotent response of reading the word and change it to
the name of the color of the ink in which the words were
written.
Digit Symbol-Coding Test.  The digit symbol-coding test is a
subtest of the Wechsler Adult Intelligence Scale, WAIS-III
(Wechsler, 1981), and comprises two tasks designed to
measure working memory capacity and its manipulation. In
the first test, the subject was asked to repeat—immediately
and in the same order—a set of numbers read aloud by the
researcher at the rate of one per second, in blocks of two
trials. The first block started with two numbers and then
increased by one each time one of the trials in a block was
successfully completed; the number of correct trials was
recorded in the variable (FSPAN). In the second task,
designed to test the capacity to manipulate information, the
same process was performed, but the subject was asked to
repeat the numbers in the reverse order to the one in which
they were presented, recording the correct trials in the vari-
able (BSPAN).
Mini-Examen Cognoscitivo.  This is the Spanish version of the
MMSE (Lobo et al., 1979). The total score on the scale was
used and a score of 24 was considered the cutoff point (Lla-
mas-Velasco, Llorente-Ayuso, Contador, & Bermejo-
Pareja, 2015).
4 Assessment 00(0)
Escala Abreviada de Depresión.  This is the Spanish version of
the Geriatric Depression Scale (Yesavage et al., 1982). The
total score on the scale was recorded (Martínez de la Iglesia
et al., 2002). A score of more than 5 was proposed as the
cutoff for considering the possible existence of depression.
Table 2 shows the descriptive statistics of the variables
measured.
Procedure
The subjects were evaluated on an individual basis in one of
the laboratories at the Department of Experimental
Psychology. Trained psychologists explained that the objec-
tive of the research was to perform a study on memory and
the subjects were invited to take part. Once the acceptance
form had been signed, the six trials associated with the
Verbal Selective Reminding Test were administered. The
subjects then completed the sociodemographic question-
naire and the remaining tests. After 30 minutes, they were
asked again to repeat as many words as they could remem-
ber from the initial list read to them half an hour earlier
(delayed memory task, DELAY measure).
Data Analysis
The R program (v. 3.2.3) was used for statistical analysis (R
Development Core Team, 2008). The Kaiser–Meyer–Olkin
(KMO) test and Bartlett’s sphericity test were used to deter-
mine the adequacy of the correlation matrix for performing
factor analysis. Mardia’s test was applied to check the
assumptions of multivariate normality. The description of
the measures, calculation of the alpha coefficient, Horn’s
parallel analysis and Velicer’s minimum average partial
(MAP) to determine the number of factors, and exploratory
factor analysis (EFA) were performed using the principal
function of the psych library (v. 1.6.3; Revelle, 2008).
Confirmatory factor analysis (CFA) was carried out using
the cfa function of the lavaan library (v. 0.5-20; Rosseel,
2012). The diagonally weighted least squares (WLSMV)
estimator proposed for ordinal variables was employed. The
criteria for considering the goodness of fit of the model
were as follows: a χ2/gl ratio < 2 (excellent), χ2/gl < 3
(good), good fit for the Tucker–Lewis index (TLI) > 0.9,
comparative fit index (CFI) > 0.9, incremental fit index
(IFI) > 0.9, and root mean square error of approximation
(RMSEA) ≤ 0.05.
Results
Partition of the Sample and Items Selected
For the cross-validation study, the sample was divided into
two sets using the sample function of the R program, with
the objective of using the first as the training set for calibrat-
ing the test (N = 231) and the second as the test set (N =
222). The training set was used to identify the most dis-
criminating items and to carry out EFA. The test set was
used to validate the scale by means of CFA.
Of the 28 initial items, those that had low correlations
with the total test score (r < .35) and a lower discrimination
index (<1.23) were eliminated, leaving items 3, 5, 9, 11, 13,
14, 17, 19, 20, 22, 23, and 25. Alpha coefficient was .79,
95% confidence interval (CI) = [0.75, 0.83]. Both parallel
analysis and the MAP criterion indicated that a single factor
should be extracted.
Principal component analysis was carried out using the
training sample. The KMO test of sampling adequacy and
Bartlett’s test of sphericity indicated that EFA was appro-
priate: KMO index = .84, χ2(45, N = 231) = 541.863, p <
.001. Mardia’s test rejected the hypothesis of multivariate
normality of the data by finding a highly skewed distribu-
tion (skew = 678.52, p < .001). Velicer’s MAP criterion and
parallel analysis indicated that a single component should
be extracted for both scales. Principal component analysis
explained 31% of variance. Item 25 correlated less than
0.35 with the general factor. This item was removed from
the scale.
Confirmatory Factor Analysis
CFA of the 11 remaining items in each of the samples was
carried out using the diagonally weighted least squares
estimator, with mean and variance adjustment (WLSMV)
suggested for ordinal data (Flora & Curran, 2004). In the
test sample results, all the statistics showed a good fit:
χ2(44, N = 222) = 55.966, p = .061, χ2/gl = 55.966/44 =
1.34, CFI = 0.99, TLI = 0.99, IFI = 0.99, RMSEA = 0.04,
90%CI [0.00, 0.06], p = .73. All items showed correlations
greater than .40. Table 3 shows the descriptive measures of
each of the items and shows the standardized parameters of
the EFA and CFA models. Table 4 shows the polychoric
correlations of the items.
Correlational Measures
There was a positive correlation between the total score for
the CSA scale and education (r = .38, p < .001), age (r =
−.48, p < .001), and PA (r = .35, p < .001). No significant
differences between men and women were found on the
CSA scale: t(451) = 0.72, p = .47. On the other hand, sig-
nificant differences were found between those with low
occupational status (M = 35.64) and those with high occu-
pational status (M = 40.38): t(451) = −3.13, p = .002.
Neuropsychological Measures
An EFA of neuropsychological measures was carried out.
Both parallel analysis and Velicer’s MAP test indicated that
two factors should be extracted. The first factor (Cog1) was
related to measures of episodic memory (RECALL, LTR,
Morales and Fernández 5

Table 2.  Descriptive Statistics for Neuropsychological and Other Variables.

Variable M SD Min Max

RECALL: Total recall 41.01 10.21 9 65
LTR: Long-term recall 26.47 13.82 0 62
CLTR: Consistent long-term recall 19.32 12.69 0 62
DELAY: Delay recall 5.76 2.81 0 12
GDS: Geriatric Depression Scale 3.19 2.78 0 15
MEC: Mini-Examen Cognoscitivo (Spanish version of MMSE) 28.02 2.07 18 30
FSPAN: Digit forward correct answers 7.62 1.77 4 15
BSPAN: Digit backward correct answers 4.97 1.84 1 12
STROOP2: Number of colors named correct 96.34 21.30 10 200
STROOP3: Number of correct answers in the interference task 61.23 13.85 16 108
PA: Physical activity 18.73 4.55 1 33
Education 10.35 4.97 0 25
Age 66.34 6.95 48 90

Note: SD = standard deviation; Min = minimum; Max = maximum; MMSE = Mini-Mental State Examination.

Table 3.  Descriptive Statistics of Selected Items and Parameter Estimates (EFA and CFA).

Item Activity Mean SD R alphaW EFA CFA

3 I use computers 2.79 1.82 0.65 0.77 0.62 0.67
5 I write letters, diaries, etc. 1.84 1.41 0.47 0.78 0.44 0.49
9 I listen to music 4.00 1.28 0.55 0.78 0.55 0.53
11 I go to the movies, theater, exhibitions 2.58 0.99 0.60 0.77 0.65 0.62
13 I spend part of my time on my hobbies 4.18 1.28 0.53 0.78 0.51 0.50
14 I go out for a drink with my friends 2.95 1.19 0.54 0.78 0.56 0.49
17 I try to learn new things 4.28 1.26 0.70 0.76 0.73 0.84
19 I try to repair things when they stop working 3.40 1.46 0.49 0.78 0.47 0.47
20 I take classes (not including sports) 3.38 1.6 0.64 0.76 0.65 0.69
22 I take part in discussions on any topic that crops up . . . 3.83 1.30 0.55 0.77 0.57 0.55
23 I can handle my financial affairs unaided 3.60 1.37 0.55 0.77 0.54 0.55

Note: SD = standard deviation; alphaW = index of reliability resulting from deletion of the item; EFA = exploratory factor analysis; CFA = confirmatory
factor analysis.

Table 4.  Polychoric Correlation Matrix: Lower Triangular Matrix Training Sample and Upper Triangular Matrix Testing Sample.

ACE03 ACE05 ACE09 ACE11 ACE13 ACE14 ACE17 ACE19 ACE20 ACE22 ACE23
ACE03 1.00 0.38 0.34 0.45 0.26 0.23 0.61 0.35 0.63 0.37 0.41
ACE05 0.41 1.00 0.17 0.26 0.31 0.19 0.37 0.24 0.38 0.26 0.25
ACE09 0.35 0.28 1.00 0.37 0.31 0.18 0.50 0.29 0.42 0.48 0.32
ACE11 0.31 0.28 0.35 1.00 0.18 0.44 0.39 0.11 0.50 0.31 0.45
ACE13 0.36 0.37 0.41 0.14 1.00 0.21 0.42 0.25 0.28 0.24 0.16
ACE14 0.22 0.13 0.36 0.48 0.26 1.00 0.30 0.11 0.36 0.29 0.23
ACE17 0.61 0.42 0.40 0.46 0.49 0.30 1.00 0.51 0.70 0.51 0.50
ACE19 0.22 0.14 0.17 0.30 0.18 0.19 0.36 1.00 0.29 0.34 0.43
ACE20 0.52 0.37 0.28 0.40 0.28 0.29 0.65 0.37 1.00 0.48 0.43
ACE22 0.34 0.21 0.32 0.44 0.32 0.28 0.45 0.28 0.25 1.00 0.25
ACE23 0.46 0.21 0.16 0.31 0.14 0.21 0.46 0.41 0.41 0.29 1.00

CLTR, and DELAY) and the second factor (Cog2) to mea- The measures of attention and executive function showed cor-
sures of attention and executive function (FSPAN, BSPAN, relations higher than .70 with the factor. The percentage of
STROOP2, and STROOP3). All the measures associated with variance for the two factors was 78%. Hierarchical regres-
the episodic memory factor correlated more than .85 with it. sions were run with both factors, entering CSA (Model 1), as
6 Assessment 00(0)
well as age (Model 2) and education (Model 3). Model 4
included the interaction between CSA and age. The results are
shown in Table 5 and Figure 1.
It can be observed that the effect of CSA on episodic
memory disappeared when the education and age variables
were introduced. However, when the term interaction
between CSA and age was entered, the model changed sig-
nificantly. In the case of attention, the effects of CSA were
not modified when the age and education variables were
added. Entering the effect of the interaction between age
and CSA did not improve the model.
Discussion
This study achieved the initial objective of constructing a
scale to measure CSA in Spanish-speaking older adults.
The test obtained presents adequate psychometric proper-
ties. The proposed factor structure is valid. This is the
first time a CSA scale has been validated with structural
equation modeling in Spain. As was found in previous
studies (Salthouse et al., 2002; Wilson et al., 2003), CSA
correlated negatively with age and positively with educa-
tion and occupation (Valenzuela & Sachdev, 2006).
Although the constructed scale does not include a large
number of items, the correlations were similar to those
obtained by Wilson et al. (2003) and Salthouse et al.
(2002). Furthermore, the scale was composed of items
belonging to different dimensions, such as the social
dimension, or of high-level cognitive activities that have
been included in other scales.
The results obtained by correlating the CSA scale with
the neuropsychological variables do not completely coincide
with those obtained in the three validation studies. The neu-
ropsychological measures used in this study are comparable
to those used in Wilson et al. (2003) and Schinka et al.
(2005). Less comparable are the measures used by Salthouse
et al. (2002) because they did not report any attention mea-
sure, and the episodic memory measures were the average of
the variables instead of the score in the factor. Wilson et al.
(2003) found no relationship between CSA and episodic
memory, which is similar to the result found in our case (see
Model 3 in Table 5 for this variable). These authors, how-
ever, did not include a term for the interaction between CSA
and age. Introducing interaction meant a change in the effect
of CSA on episodic memory, in the sense that it had a mod-
erating effect. The study by Schinka et al. (2005) used mea-
sures of episodic memory that correlated with CSA, but did
not perform hierarchical regression. The interaction between
stimulating activities and age implies that engaging in stimu-
lating activities can compensate for the effect of age on
decline in episodic memory. Although age-related memory
decline does not disappear completely, the effect is reduced
by carrying out stimulating activities in old-old people. In
our study, we found that while young-old people (between
50 and 65 years) did not benefit from CSA in old-old people
(older than 70 years) the advantages were significant. The
performance in episodic memory was higher in those with
high values in CSA. A possible explanation is the positive
effect that CSAs have on CR. Reed et al. (2011) found that
activities of this type were strongly associated with CR, to a
greater extent even than education. More follow-up longitu-
dinal studies showing the relationship between degree of
participation in such activities and cognitive decline are
needed to confirm this hypothesis.
With regard to attention, Wilson et al. (2003) did not
find that CSA had any effect on this either. While Schinka
et al. (2005) found that CSA correlated negatively with
time taken to perform the Trail Making Test B, they did
not, as was the case with episodic memory, control for
variables such as age and education. Our study found a
difference between the effect of CSA on episodic memory
and the effect on attention. If we compare two people of
different ages, differences in memory are greater in those
who are less active. However, these differences do not
exist when we compare attention, implying that attention
levels are higher as more CSAs are performed, controlling
for age and level of education. A possible explanation for
these results would involve considering different types of
CR, as suggested by Reed et al. (2011). While CSA does
succeed in slowing down the effect of age on episodic
memory, the same cannot be said with respect to the
decline of attentional factors. To put it simply, only those
people with high levels of CSA will display higher atten-
tional levels.
In our opinion, the CSA scale constructed offers sev-
eral advantages. First, it has only 11 items, which makes
it easier to collect data. Since this is a short version, it
means that little time needs to be devoted to this test.
Furthermore, the items finally included have been shown
to be related to the preservation of cognitive functions. It
has been found, for example, that the decrease in the fre-
quency of day-to-day computer use can be an indicator
associated with mild cognitive impairment (Kaye et al.,
2014).
A second advantage of the scale is that it includes items
that involve a social dimension, which has been considered
an important element in the evaluation of LA (Adams,
Leibbrandt, & Moon, 2011). Vance and Wright (2009)
regard social interaction as a source of neurogenesis with a
protective effect against the cognitive decline that can be
expected with age. Even so, it is difficult to separate the
social dimension from cognitive activity, as Schinka et al.
(2005) point out. Likewise, the scale includes CSA-related
items linked to the individual’s motivation for seeking
novel stimulation (“I try to repair things when they stop
working”). This degree of “curiosity” has also been studied
as a protective factor against age-related cognitive decline
(Düzel, van Praag, & Sendtner, 2016).
 Morales and Fernández

Table 5.  Hierarchical Regression Results for Measures of Cog1 (Episodic Memory) and Cog2 (Attention).

Dependent variable

  Cog1 Cog2

  (1) (2) (3) (4) (1) (2) (3) (4)

CSA 0.024*** (0.006) 0.006 (0.006) −0.001 (0.006) −0.003 (0.006) 0.053*** (0.005) 0.040*** (0.006) 0.029*** (0.006) 0.029*** (0.006)
Age −0.047*** (0.007) −0.043*** (0.007) 0.037*** (0.009) −0.034*** (0.007) −0.029*** (0.006) 0.055*** (0.009)
Education 0.036*** (0.010) −0.040*** (0.007) 0.054*** (0.009) −0.029*** (0.007)
CSA × Age 0.002*** (0.001) 0.0003 (0.001)
Constant −0.798*** (0.196) 2.894*** (0.591) 2.524*** (0.591) 0.055 (0.047) −1.737*** (0.181) 0.988* (0.556) 0.422 (0.541) 0.008 (0.044)
Observations 453 453 453 453 453 453 453 453
R2 0.037 0.122 0.149 0.163 0.178 0.224 0.286 0.286
Adjusted R2 0.035 0.118 0.143 0.156 0.176 0.220 0.281 0.280

Note: Variables were centered in Model 4. CSA = cognitively stimulating activities.

*p < .05. **p < .01. ***p < .001.
7
8 Assessment 00(0)
Figure 1.  Relationships between age and episodic memory factor by three different levels of cognitively stimulating activities (CSA).
Another advantage of this scale is that it shows correlations
with measures such as PA and education that have been linked
to CR (León et al., 2014; Rami et al., 2011) and so can be used
in future research as indicators of this construct. Wilson et al.
(2003) pointed out that education was an indicator that was
associated with CR, but it was heavily influenced by the
socioeconomic level of the individual. For them, CSA is an
indicator of CR independent of socioeconomic status.
Nonetheless, there is a need for future validation studies in
other populations to confirm the results obtained here.
However, it is also worth pointing out some limitations of
this study. First, known stimulating activities such as playing
a musical instrument were discarded because they had very
low frequency in the study population and did not meet the
statistical criteria. Second, the individual differences in a par-
ticular activity have not been taken into account. An activity
like writing poetry can be relatively easy for a person accus-
tomed to it and very difficult for someone who is not used to
it. That is to say, the same activity can imply a different level
of effort for each person. Finally, it is possible that the list of
stimulant activities was not exhaustive and the older people
performed activities not included in the test.
In conclusion, the main contribution of this work is the
elaboration and validation of a scale to measure the stimu-
lating activities of cognition in Spanish. The main differ-
ence between this scale and others is that the various
activities are not just included. Items should have good
psychometric properties. Likewise, it may be considered
that our study provides some evidence for the “use it or
lose it” hypothesis with regard to the effect of ageing on
cognitive function. However, this assertion must be taken
with a degree of caution, since this is a cross-sectional
study and needs to be completed with results obtained from
future studies of a longitudinal nature. As has been demon-
strated in the literature (Salthouse et al., 2002), only by
monitoring individuals over long periods of time can con-
clusive evidence be provided about the effect of CSA on
cognitive function. It is therefore necessary to have valid
measures available, such as the one developed in this study.
Acknowledgment
We would like to thank two anonymous reviewers for suggestions
to improve the article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, author-
ship, and/or publication of this article.
Supplemental Material
The online supplementary material is available at http://journals.
sagepub.com/doi/suppl/10.1177/1073191118774620.
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