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Considine CM, Rossetti MA, Anderson K, Del Bene VA, Anderson SA, Celka AS, Edmondson MC, Sheese ALN, Piccolino A, Teixeira AL, Stout JC. Huntington study group's neuropsychology working group position on best practice recommendations for the clinical neuropsychological evaluation of patients with Huntington disease. Clin Neuropsychol 2024; 38:984-1006. [PMID: 37849335 DOI: 10.1080/13854046.2023.2267789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.
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Affiliation(s)
- Ciaran M Considine
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Agustina Rossetti
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kendra Anderson
- Department of Neurology, McGovern Medical School UT Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Sharlet A Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea S Celka
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - Adam Piccolino
- Psychology, Piccolino Psychological Services, Burnsville, MN, USA
| | - Antonio L Teixeira
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, and School of Psychological Science, Monash University, Melbourne, Australia
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Kanser RJ, Rapport LJ, Hanks RA, Patrick SD. Time and money: Exploring enhancements to performance validity research designs. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:256-263. [PMID: 34932422 DOI: 10.1080/23279095.2021.2019740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The study examined the effect of preparation time and financial incentives on healthy adults' ability to simulate traumatic brain injury (TBI) during neuropsychological evaluation. METHOD A retrospective comparison of two TBI simulator group designs: a traditional design employing a single-session of standard coaching immediately before participation (SIM-SC; n = 46) and a novel design that provided financial incentive and preparation time (SIM-IP; n = 49). Both groups completed an ecologically valid neuropsychological test battery that included widely-used cognitive tests and five common performance validity tests (PVTs). RESULTS Compared to SIM-SC, SIM-IP performed significantly worse and had higher rates of impairment on tests of processing speed and executive functioning (Trails A and B). SIM-IP were more likely than SIM-SC to avoid detection on one of the PVTs and performed somewhat better on three of the PVTs, but the effects were small and non-significant. SIM-IP did not demonstrate significantly higher rates of successful simulation (i.e., performing impaired on cognitive tests with <2 PVT failures). Overall, the rate of the successful simulation was ∼40% with a liberal criterion, requiring cognitive impairment defined as performance >1 SD below the normative mean. At a more rigorous criterion defining impairment (>1.5 SD below the normative mean), successful simulation approached 35%. CONCLUSIONS Incentive and preparation time appear to add limited incremental effect over traditional, single-session coaching analog studies of TBI simulation. Moreover, these design modifications did not translate to meaningfully higher rates of successful simulation and avoidance of detection by PVTs.
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Affiliation(s)
- Robert J Kanser
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI, USA
| | - Sarah D Patrick
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Lace JW, Sanborn V, Galioto R. Standalone Performance Validity Tests May Be Differentially Related to Measures of Working Memory, Processing Speed, and Verbal Memory in Patients With Multiple Sclerosis. Assessment 2024; 31:732-744. [PMID: 37303186 DOI: 10.1177/10731911231178289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cognitive functioning may account for minimal levels (i.e., 5%-14%) of variance of performance validity test (PVT) scores in clinical examinees. The present study extended this research twofold: (a) by determining the variance cognitive functioning explains within three distinct PVTs (b) in a sample of patients with multiple sclerosis (pwMS). Seventy-five pwMS (Mage = 48.50, 70.6% female, 80.9% White) completed the Victoria Symptom Validity Test (VSVT), Word Choice Test (WCT), Dot Counting Test (DCT), and three objective measures of working memory, processing speed, and verbal memory as part of clinical neuropsychological assessment. Regression analyses in credible groups (ns ranged from 54 to 63) indicated that cognitive functioning explained 24% to 38% of the variance in logarithmically transformed PVT variables. Variance from cognitive testing differed across PVTs: verbal memory significantly influenced both VSVT and WCT scores; working memory influenced VSVT and DCT scores; and processing speed influenced DCT scores. The WCT appeared least related to cognitive functioning of the included PVTs. Alternative plausible explanations, including the apparent domain/modality specificity hypothesis of PVTs versus the potential sensitivity of these PVTs to neurocognitive dysfunction in pwMS were discussed. Continued psychometric investigations into factors affecting performance validity, especially in multiple sclerosis, are warranted.
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Affiliation(s)
- John W Lace
- Cleveland Clinic Foundation, OH, USA
- Prevea Health, Green Bay, WI, USA
| | - Victoria Sanborn
- Kent State University, OH, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Rachel Galioto
- Cleveland Clinic Foundation, Mellen Center for Multiple Sclerosis, OH, USA
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Roor JJ, Peters MJV, Dandachi-FitzGerald B, Ponds RWHM. Performance Validity Test Failure in the Clinical Population: A Systematic Review and Meta-Analysis of Prevalence Rates. Neuropsychol Rev 2024; 34:299-319. [PMID: 36872398 PMCID: PMC10920461 DOI: 10.1007/s11065-023-09582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/16/2022] [Indexed: 03/07/2023]
Abstract
Performance validity tests (PVTs) are used to measure the validity of the obtained neuropsychological test data. However, when an individual fails a PVT, the likelihood that failure truly reflects invalid performance (i.e., the positive predictive value) depends on the base rate in the context in which the assessment takes place. Therefore, accurate base rate information is needed to guide interpretation of PVT performance. This systematic review and meta-analysis examined the base rate of PVT failure in the clinical population (PROSPERO number: CRD42020164128). PubMed/MEDLINE, Web of Science, and PsychINFO were searched to identify articles published up to November 5, 2021. Main eligibility criteria were a clinical evaluation context and utilization of stand-alone and well-validated PVTs. Of the 457 articles scrutinized for eligibility, 47 were selected for systematic review and meta-analyses. Pooled base rate of PVT failure for all included studies was 16%, 95% CI [14, 19]. High heterogeneity existed among these studies (Cochran's Q = 697.97, p < .001; I2 = 91%; τ2 = 0.08). Subgroup analysis indicated that pooled PVT failure rates varied across clinical context, presence of external incentives, clinical diagnosis, and utilized PVT. Our findings can be used for calculating clinically applied statistics (i.e., positive and negative predictive values, and likelihood ratios) to increase the diagnostic accuracy of performance validity determination in clinical evaluation. Future research is necessary with more detailed recruitment procedures and sample descriptions to further improve the accuracy of the base rate of PVT failure in clinical practice.
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Affiliation(s)
- Jeroen J Roor
- Department of Medical Psychology, VieCuri Medical Center, Venlo, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Maarten J V Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Brechje Dandachi-FitzGerald
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Rudolf W H M Ponds
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centres, location VU, Amsterdam, The Netherlands
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Tyson BT, Shahein A, Abeare CA, Baker SD, Kent K, Roth RM, Erdodi LA. Replicating a Meta-Analysis: The Search for the Optimal Word Choice Test Cutoff Continues. Assessment 2023; 30:2476-2490. [PMID: 36752050 DOI: 10.1177/10731911221147043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This study was designed to expand on a recent meta-analysis that identified ≤42 as the optimal cutoff on the Word Choice Test (WCT). We examined the base rate of failure and the classification accuracy of various WCT cutoffs in four independent clinical samples (N = 252) against various psychometrically defined criterion groups. WCT ≤ 47 achieved acceptable combinations of specificity (.86-.89) at .49 to .54 sensitivity. Lowering the cutoff to ≤45 improved specificity (.91-.98) at a reasonable cost to sensitivity (.39-.50). Making the cutoff even more conservative (≤42) disproportionately sacrificed sensitivity (.30-.38) for specificity (.98-1.00), while still classifying 26.7% of patients with genuine and severe deficits as non-credible. Critical item (.23-.45 sensitivity at .89-1.00 specificity) and time-to-completion cutoffs (.48-.71 sensitivity at .87-.96 specificity) were effective alternative/complementary detection methods. Although WCT ≤ 45 produced the best overall classification accuracy, scores in the 43 to 47 range provide comparable objective psychometric evidence of non-credible responding. Results question the need for designating a single cutoff as "optimal," given the heterogeneity of signal detection environments in which individual assessors operate. As meta-analyses often fail to replicate, ongoing research is needed on the classification accuracy of various WCT cutoffs.
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Affiliation(s)
| | | | | | | | | | - Robert M Roth
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Deloria R, Kivisto AJ, Swier-Vosnos A, Elwood L. Optimal per test cutoff scores and combinations of failure on multiple embedded performance validity tests in detecting performance invalidity in a mixed clinical sample. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:716-726. [PMID: 34528833 DOI: 10.1080/23279095.2021.1973005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We tested the usefulness of six embedded performance validity tests (EPVTs) in identifying performance invalidity in a mixed clinical sample. Using a retrospective design, 181 adults were classified as valid (n = 146) or invalid (n = 35) performance based upon their performance on one of three standalone PVTs (Test of Memory Malingering, Victoria Symptom Validity Test, Dot Counting Test). Multiple cutoffs were identified corresponding to predetermined false positive rates of 0, 5, 10, and 15% for each of six EPVTs. EPVT cutoffs corresponding to the predetermined false positive benchmarks were generally more conservative than currently established scores. Sensitivity was low (.0%-42.9%) for individual EPVTs across these cutoffs and was moderately improved by the combination of multiple EPVT failures. The optimal number of EPVT failures using the 10% false positive rate was ≥ 2. Although the overall classification accuracy of 80.7% and specificity of 89.0% were comparable to prior research, the sensitivity of 45.7% was more modest than previous estimates. Low sensitivities indicate that this combination of EPVTs failed to detect a majority of invalid performers.
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Affiliation(s)
- Rebecca Deloria
- Graduate Department of Clinical Psychology, University of Indianapolis, Indianapolis, IN, United States
| | - Aaron J Kivisto
- Graduate Department of Clinical Psychology, University of Indianapolis, Indianapolis, IN, United States
| | | | - Lisa Elwood
- Graduate Department of Clinical Psychology, University of Indianapolis, Indianapolis, IN, United States
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Dhaynaut M, Grashow R, Normandin MD, Wu O, Marengi D, Terry DP, Sanchez JS, Weisskopf MG, Speizer FE, Taylor HA, Guehl NJ, Seshadri S, Beiser A, Daneshvar DH, Johnson K, Iverson GL, Zafonte R, El Fakhri G, Baggish AL. Tau Positron Emission Tomography and Neurocognitive Function Among Former Professional American-Style Football Players. J Neurotrauma 2023; 40:1614-1624. [PMID: 37282582 PMCID: PMC10458363 DOI: 10.1089/neu.2022.0454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
American-style football (ASF) players experience repetitive head impacts that may result in chronic traumatic encephalopathy neuropathological change (CTE-NC). At present, a definitive diagnosis of CTE-NC requires the identification of localized hyperphosphorylated Tau (p-Tau) after death via immunohistochemistry. Some studies suggest that positron emission tomography (PET) with the radiotracer [18F]-Flortaucipir (FTP) may be capable of detecting p-Tau and thus establishing a diagnosis of CTE-NC among living former ASF players. To assess associations between FTP, football exposure, and objective neuropsychological measures among former professional ASF players, we conducted a study that compared former professional ASF players with age-matched male control participants without repetitive head impact exposure. Former ASF players and male controls underwent structural magnetic resonance imaging and PET using FTP for p-Tau and [11C]-PiB for amyloid-β. Former players underwent neuropsychological testing. The ASF exposure was quantified as age at first exposure, professional career duration, concussion signs and symptoms burden, and total years of any football play. Neuropsychological testing included measures of memory, executive functioning, and depression symptom severity. P-Tau was quantified as FTP standardized uptake value ratios (SUVR) and [11C]-PiB by distribution volume ratios (DVR) using cerebellar grey matter as the reference region. There were no significant differences in [18F]-FTP uptake among former ASF players (n = 27, age = 50 ± 7 years) compared with control participants (n = 11, age = 55 ± 4 years), nor did any participant have significant amyloid-β burden. Among ASF participants, there were no associations between objective measures of neurocognitive functioning and [18F]-FTP uptake. There was a marginally significant difference, however, between [18F]-FTP uptake isolated to the entorhinal cortex among players in age-, position-, and race-adjusted models (p = 0.05) that may represent an area of future investigation. The absence of increased [18F]-FTP uptake in brain regions previously implicated in CTE among former professional ASF players compared with controls questions the utility of [18F]-FTP PET for clinical evaluation in this population.
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Affiliation(s)
- Maeva Dhaynaut
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc D. Normandin
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ona Wu
- Athinoula A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin S. Sanchez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E. Speizer
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachsetts, USA
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Nicolas J. Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UTHSA, San Antonio, Texas, USA
| | - Alexa Beiser
- NHLBI's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics and Neurology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel H. Daneshvar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
| | - Keith Johnson
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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Oudman E, Wijnia JW, Bidesie J, Al-Hassaan Z, Laenen S, Jong-Tjien-Fa AV. Young Nonalcoholic Wernicke Encephalopathy Patient Achieves Remission Following Prolonged Thiamine Treatment and Cognitive Rehabilitation. J Clin Med 2023; 12:jcm12082901. [PMID: 37109239 PMCID: PMC10143616 DOI: 10.3390/jcm12082901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Wernicke encephalopathy (WE), a neurological emergency commonly associated with alcohol use disorder, results from a severe deficiency of vitamin B1. If left untreated, patients either succumb to the illness or develop chronic Korsakoff's syndrome (KS). Recently, an increasing number of nonalcoholic WE case studies have been published, highlighting a lack of understanding of malnutrition-related disorders among high-functioning patients. We present the case of a 26 year old female who developed life-threatening WE after COVID-19-complicated obesity surgery. She experienced the full triad of WE symptoms, including eye-movement disorders, delirium, and ataxia, and suffered for over 70 days before receiving her initial WE diagnosis. Late treatment resulted in progression of WE symptoms. Despite the severity, the patient achieved remission of some of the symptoms in the post-acute phase due to prolonged parenteral thiamine injections and intensive specialized rehabilitation designed for young traumatic brain injury (TBI) patients. The rehabilitation resulted in gradual remission of amnesia symptomatology, mainly increasing her autonomy. The late recognition of this case highlights the importance of early diagnosis and prompt, targeted intervention in the management of nonalcoholic WE, as well as underscores the potential for positive outcomes after delayed treatment through intensive cognitive rehabilitation in specialized treatment centers.
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Affiliation(s)
- Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, 3584 CS Utrecht, The Netherlands
- Slingedael Korsakoff Expertise Center, Lelie Care Group, 3086 EZ Rotterdam, The Netherlands
| | - Jan W Wijnia
- Experimental Psychology, Helmholtz Institute, Utrecht University, 3584 CS Utrecht, The Netherlands
- Slingedael Korsakoff Expertise Center, Lelie Care Group, 3086 EZ Rotterdam, The Netherlands
| | - Janice Bidesie
- Experimental Psychology, Helmholtz Institute, Utrecht University, 3584 CS Utrecht, The Netherlands
- Slingedael Korsakoff Expertise Center, Lelie Care Group, 3086 EZ Rotterdam, The Netherlands
| | - Zyneb Al-Hassaan
- Daan Theeuwes Center for Intensive Neurorehabilitation, 3447 GN Woerden, The Netherlands
| | - Sascha Laenen
- Daan Theeuwes Center for Intensive Neurorehabilitation, 3447 GN Woerden, The Netherlands
| | - Amy V Jong-Tjien-Fa
- Daan Theeuwes Center for Intensive Neurorehabilitation, 3447 GN Woerden, The Netherlands
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Markowitsch HJ, Staniloiu A, Wahl-Kordon A. Urbach-Wiethe disease in a young patient without apparent amygdala calcification. Neuropsychologia 2023; 183:108505. [PMID: 36775051 DOI: 10.1016/j.neuropsychologia.2023.108505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Urbach-Wiethe disease is an extremely rare genetically-based syndrome which usually leads to dermatological and neurological changes. Neurologically, the amygdaloid region is primarily bilaterally affected. Therefore, several functions modulated by the amygdala are changed in patients with Urbach-Wiethe disease. As the neurological alterations evolve only gradually, it is particularly important to determine the cognitive and brain status of a juvenile. The patient described here was seen briefly at age 9 and tested neuropsychologically at age 19; furthermore, computer tomography and magnetic resonance imaging of his head was done. There were no important abnormalities in the brain, which is unusual in the light of previous data from other patients. On the cognitive level, the patient was generally within normal limits. However, he had mild problems in attention and concentration, and more prominent problems in emotional processing domain, and in personality dimensions. It is concluded that amygdala calcifications in Urbach-Wiethe disease take place progressively-possibly underpinned by genetic and gender variables; this can subsequently allow psychosocial-social factors (such a proper education and socialization) and biological factors (compensatory neuroplasticity) to retard and diminish the development of socio-emotional and cognitive deteriorations, though the outcome of questionnaires indicates that such patients may develop substantial concerns as to their future life and well-being.
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Affiliation(s)
| | - Angelica Staniloiu
- University of Bielefeld, Germany; University of Bucharest, Romania; Oberberg Clinic Hornberg, Germany
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Horner MD, Denning JH, Cool DL. Self-reported disability-seeking predicts PVT failure in veterans undergoing clinical neuropsychological evaluation. Clin Neuropsychol 2023; 37:387-401. [PMID: 35387574 DOI: 10.1080/13854046.2022.2056923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: This study examined disability-related factors as predictors of PVT performance in Veterans who underwent neuropsychological evaluation for clinical purposes, not for determination of disability benefits. Method: Participants were 1,438 Veterans who were seen for clinical evaluation in a VA Medical Center's Neuropsychology Clinic. All were administered the TOMM, MSVT, or both. Predictors of PVT performance included (1) whether Veterans were receiving VA disability benefits ("service connection") for psychiatric or neurological conditions at the time of evaluation, and (2) whether Veterans reported on clinical interview that they were in the process of applying for disability benefits. Data were analyzed using binary logistic regression, with PVT performance as the dependent variable in separate analyses for the TOMM and MSVT. Results: Veterans who were already receiving VA disability benefits for psychiatric or neurological conditions were significantly more likely to fail both the TOMM and the MSVT, compared to Veterans who were not receiving benefits for such conditions. Independently of receiving such benefits, Veterans who reported that they were applying for disability benefits were significantly more likely to fail the TOMM and MSVT than were Veterans who denied applying for benefits at the time of evaluation. Conclusions: These findings demonstrate that simply being in the process of applying for disability benefits increases the likelihood of noncredible performance. The presence of external incentives can predict the validity of neuropsychological performance even in clinical, non-forensic settings.
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Affiliation(s)
- Michael David Horner
- Mental Health Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John H Denning
- Mental Health Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Danielle L Cool
- Mental Health Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
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Comparative Data for the Morel Emotional Numbing Test: High False-Positive Rate in Older Bona-Fide Neurological Patients. PSYCHOLOGICAL INJURY & LAW 2023. [DOI: 10.1007/s12207-023-09470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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12
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Kanser RJ, Logan PM, Steward KA, Vanderbleek EN, Kamper JE. Specificity of Embedded Performance Validity Tests in Elderly Veterans with Mild and Major Neurocognitive Disorder. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2022:6964520. [PMID: 36578198 DOI: 10.1093/arclin/acac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study explored the specificity of four embedded performance validity tests (PVTs) derived from common neuropsychological tasks in a sample of older veterans with verified cognitive decline and whose performance was deemed valid by licensed psychologists. METHOD Participants were 180 veterans who underwent comprehensive neuropsychological evaluation, were determined to have valid performance following profile analysis/conceptualization, and were diagnosed with mild neurocognitive disorder (i.e., MCI; n = 64) or major neurocognitive disorder (i.e., Dementia; n = 116). All participants completed at least one of four embedded PVTs: Reliable Digit Span (RDS), California Verbal Learning Test-2nd ed. Short Form (CVLT-II SF) Forced choice, Trails B:A, and Delis-Kaplan Executive Function System (DKEFS) Letter and Category Fluency. RESULTS Adequate specificity (i.e., ≥90%) was achieved at modified cut-scores for all embedded PVTs across MCI and Dementia groups. Trails B:A demonstrated near perfect specificity at its traditional cut-score (Trails B:A < 1.5). RDS ≤ 5 and CVLT-II SF Forced Choice ≤7 led to <10% false positive classification errors across MCI and dementia groups. DKEFS Letter and Category Fluency achieved 90% specificity at extremely low normative cut-scores. CONCLUSIONS RDS, Trails B:A, and CVLT-II SF Forced Choice reflect promising embedded PVTs in the context of dementia evaluations. DKEFS Letter and Category Fluency appear too sensitive to genuine neurocognitive decline and, therefore, are inappropriate PVTs in adults with MCI or dementia. Additional research into embedded PVT sensitivity (via known-groups or analogue designs) in MCI and dementia is needed.
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Affiliation(s)
- Robert J Kanser
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Patrick M Logan
- Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, FL, USA.,Mental Health and Behavioral Science, Louisville VA Medical Center, Louisville, KY, USA
| | - Kayla A Steward
- Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Emily N Vanderbleek
- Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Joel E Kamper
- Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, FL, USA
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13
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Cohen CD, Rhoads T, Keezer RD, Jennette KJ, Williams CP, Hansen ND, Ovsiew GP, Resch ZJ, Soble JR. All of the accuracy in half of the time: Assessing abbreviated versions of the Test of Memory Malingering in the context of verbal and visual memory impairment. Clin Neuropsychol 2022; 36:1933-1949. [PMID: 33836622 DOI: 10.1080/13854046.2021.1908596] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ObjectiveThe Test of Memory Malingering (TOMM) Trial 1 (T1) and errors on the first 10 items of T1 (T1-e10) were developed as briefer versions of the TOMM to minimize evaluation time and burden, although the effect of genuine memory impairment on these indices is not well established. This study examined whether increasing material-specific verbal and visual memory impairment affected T1 and T1-e10 performance and accuracy for detecting invalidity. Method: Data from 155 neuropsychiatric patients administered the TOMM, Rey Auditory Verbal Learning Test (RAVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R) during outpatient evaluation were examined. Valid (N = 125) and invalid (N = 30) groups were established by four independent criterion performance validity tests. Verbal/visual memory impairment was classified as ≥37 T (normal memory); 30 T-36T (mild impairment); and ≤29 T (severe impairment). Results: Overall, T1 had outstanding accuracy, with 77% sensitivity/90% specificity. T1-e10 was less accurate but had excellent discriminability, with 60% sensitivity/87% specificity. T1 maintained excellent accuracy regardless of memory impairment severity, with 77% sensitivity/≥88% specificity and a relatively invariant cut-score even among those with severe verbal/visual memory impairment. T1-e10 had excellent classification accuracy among those with normal memory and mild impairment, but accuracy and sensitivity dropped with severe impairment and the optimal cut-score had to be increased to maintain adequate specificity. Conclusion: TOMM T1 is an effective performance validity test with strong psychometric properties regardless of material-specificity and severity of memory impairment. By contrast, T1-e10 functions relatively well in the context of mild memory impairment but has reduced discriminability with severe memory impairment.
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Affiliation(s)
- Cari D Cohen
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Tasha Rhoads
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Richard D Keezer
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,School of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, IL, USA
| | - Kyle J Jennette
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Christopher P Williams
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Nicholas D Hansen
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Gabriel P Ovsiew
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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14
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Price AM, Palumbo R, Marin A, Uppal P, Suh C, Budson AE, Turk KW. Distinguishing Between Genuine and Feigned Dementia Using Event-related Potentials. Cogn Behav Neurol 2022; 35:188-197. [PMID: 35830243 PMCID: PMC9444996 DOI: 10.1097/wnn.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals with probable Alzheimer disease (AD) may perform below cutoffs on traditional, memory-based performance validity tests. Previous studies have found success using event-related potentials (ERPs) to detect feigned neurocognitive impairment in younger populations. OBJECTIVE To evaluate the utility of an auditory oddball task in conjunction with the P3b peak amplitude to distinguish probable AD from simulated dementia. METHOD Twenty individuals with probable AD and 20 older healthy controls (HC) underwent an ERP auditory oddball protocol and the Test of Memory Malingering (TOMM). The HC were asked to perform honestly for one condition and to simulate dementia for the other. The individuals with probable AD were asked to perform honestly. The P3b peak amplitude and button press accuracy were collected from each participant and were analyzed to determine their effectiveness in detecting performance validity. RESULTS The P3b peak amplitude remained stable regardless of behavioral condition in the HC group. When combined with the TOMM Trial 2 score, the P3b peak amplitude further improved the ability to correctly differentiate individuals with probable AD from HC simulating dementia with 100% sensitivity and 90% specificity. CONCLUSION The P3b peak amplitude was found to be an effective physiologic measure of cognitive impairment in individuals with probable AD compared with HC simulating dementia. When combined with the TOMM Trial 2 score, the P3b peak amplitude served as a promising performance validity measure for differentiating individuals with probable AD from HC simulating dementia.
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Affiliation(s)
- August M. Price
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Clinical Psychology, William James College, Newton, Massachusetts
| | - Rocco Palumbo
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Anna Marin
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Prayerna Uppal
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Cheongmin Suh
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Andrew E. Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Katherine W. Turk
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
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15
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Holcomb M, Pyne S, Cutler L, Oikle DA, Erdodi LA. Take Their Word for It: The Inventory of Problems Provides Valuable Information on Both Symptom and Performance Validity. J Pers Assess 2022:1-11. [PMID: 36041087 DOI: 10.1080/00223891.2022.2114358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study was designed to compare the validity of the Inventory of Problems (IOP-29) and its newly developed memory module (IOP-M) in 150 patients clinically referred for neuropsychological assessment. Criterion groups were psychometrically derived based on established performance and symptom validity tests (PVTs and SVTs). The criterion-related validity of the IOP-29 was compared to that of the Negative Impression Management scale of the Personality Assessment Inventory (NIMPAI) and the criterion-related validity of the IOP-M was compared to that of Trial-1 on the Test of Memory Malingering (TOMM-1). The IOP-29 correlated significantly more strongly (z = 2.50, p = .01) with criterion PVTs than the NIMPAI (rIOP-29 = .34; rNIM-PAI = .06), generating similar overall correct classification values (OCCIOP-29: 79-81%; OCCNIM-PAI: 71-79%). Similarly, the IOP-M correlated significantly more strongly (z = 2.26, p = .02) with criterion PVTs than the TOMM-1 (rIOP-M = .79; rTOMM-1 = .59), generating similar overall correct classification values (OCCIOP-M: 89-91%; OCCTOMM-1: 84-86%). Findings converge with the cumulative evidence that the IOP-29 and IOP-M are valuable additions to comprehensive neuropsychological batteries. Results also confirm that symptom and performance validity are distinct clinical constructs, and domain specificity should be considered while calibrating instruments.
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Affiliation(s)
| | | | - Laura Cutler
- Department of Psychology, Neuropsychology Track, University of Windsor
| | | | - Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor
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16
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Fernandes S, Ferreira I, Querido L, Daugherty JC. To adjust or not to adjust: Cut-off scores in performance validity testing in Portuguese older adults with dementia. Front Psychol 2022; 13:989432. [PMID: 36033073 PMCID: PMC9406512 DOI: 10.3389/fpsyg.2022.989432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
The rising demographic of older adults worldwide has led to an increase in dementia cases. In order to ensure the proper allocation of care and resources to this clinical group, it is necessary to correctly distinguish between simulated versus bona-fide cognitive deficits typical of dementia. Performance Validity Tests (PVTs) are specifically designed to assess a lack of effort and the possible simulation of cognitive impairment. Previous research demonstrates that PVTs may be sensitive to dementia, thus inaccurately classifying real memory impairment as simulation. Here, we analyzed the sensitivity of PVTs in discriminating between dementia and simulation using receiver operating characteristic (ROC) curve analyses. Further, we examined the potential need for adjusting cut-off scores for three stand-alone (Test of Memory Malingering, Rey-15 Item Memory Test, and Coin in Hand-Extended Version) and one embedded (Reliable Digit Span) PVT for Portuguese older adults with dementia. The results showed that (1) all measures, except for the Coin in Hand— Extended version (CIH-EV), were sensitive to one or more sociodemographic and/or cognitive variables, and (2) it was necessary to adjust cut-off points for all measures. Additionally, the Rey-15 Item Memory Test did not demonstrate sufficient discriminating capacity for dementia. These results present important implications for clinical practice and the daily life of patients, as the use of incorrect cut-off points could impede patients from getting the resources they need.
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Affiliation(s)
- Sandra Fernandes
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Sandra Fernandes,
| | - Inês Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Luís Querido
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - Julia C. Daugherty
- Psychology Department, Campus Duques de Soria, University of Valladolid, Valladolid, Spain
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17
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DiCarlo GM, Ernst WJ, Kneavel ME. An exploratory study of the convergent validity of the Test of Effort (TOE) in adults with acquired brain injury. Brain Inj 2022; 36:424-431. [PMID: 35113759 DOI: 10.1080/02699052.2022.2034953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To examine the convergent validity of the Test of Effort (TOE), a performance validity test (PVT) currently under development that employs a two-subtest (one verbal, one visual), forced-choice recognition memory format. RESEARCH DESIGN A descriptive, correlational design was employed to describe performance on the TOE and examine the convergent validity between the TOE and comparison measures. METHODS AND PROCEDURES A sample of 53 individuals with chronic acquired brain injury (ABI) were administered the TOE and three well-validated PVTs (Reliable Digit Span [RDS], Test of Memory Malingering [TOMM] and Dot Counting Test [DCT]). MAIN OUTCOMES AND RESULTS The TOE appeared more difficult than it actually was, suggesting adequate face validity. Medium-to-large correlations were observed between the TOE and established PVTs, suggesting good convergent validity. Provisional cutoff scores are offered based on performance of a subgroup of participants with "sufficient effort." CONCLUSIONS Overall, the TOE shows promise as a PVT measure for clinical use. Future studies with larger and more diverse samples are needed to more fully determine the psychometric characteristics of the TOE.
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Affiliation(s)
| | - William J Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Meredith E Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
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18
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Ashendorf L, Withrow S, Ward SH, Sullivan SK, Sugarman MA. Decision rules for an abbreviated administration of the Test of Memory Malingering. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-10. [PMID: 35068279 DOI: 10.1080/23279095.2022.2026948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The present study investigated abbreviation methods for the Test of Memory Malingering (TOMM) in relation to traditional manual-based test cutoffs and independently derived more stringent cutoffs suggested by recent research (≤48 on Trial 2 or 3). Consecutively referred outpatient U.S. military veterans (n = 260) were seen for neuropsychological evaluation for mild traumatic brain injury or possible attention-deficit/hyperactivity disorder. Performance on TOMM Trial 1 was evaluated, including the total score and errors on the first 10 items (TOMMe10), to determine correspondence and redundancy with Trials 2 and 3. Using the traditional cutoff, valid performance on Trials 2 and 3 was predicted by zero errors on TOMMe10 and by Trial 1 scores greater than 41. Invalid performance was predicted by commission of more than three errors on TOMMe10 and by Trial 1 scores less than 34. For revised TOMM cutoffs, a Trial 1 score above 46 was predictive of a valid score, and a TOMMe10 score of three or more errors or a Trial 1 score below 36 was associated with invalid TOMM performance. Conditional abbreviation of the TOMM is feasible in a vast majority of cases without sacrificing information regarding performance validity. Decision trees are provided to facilitate administration of the three trials.
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Affiliation(s)
- Lee Ashendorf
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susanne Withrow
- Behavioral Health Service Line, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sarah H Ward
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara K Sullivan
- Psychology Service, VA Bedford Healthcare System, Bedford, MA, USA
| | - Michael A Sugarman
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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19
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Corriveau-Lecavalier N, Alden EC, Stricker NH, Machulda MM, Jones DT. OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1199-1207. [PMID: 35435228 PMCID: PMC9396449 DOI: 10.1093/arclin/acac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Individuals with early-onset dysexecutive Alzheimer's disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom misinterpretation and misdiagnosis. METHOD The aim of this retrospective study is to evaluate rates of failure on a common PVT, the test of memory malingering (TOMM), in a sample of clinical patients with biomarker-confirmed early-onset dAD who completed neuropsychological testing. RESULTS We identified seventeen patients with an average age of symptom onset at 52.25 years old. Nearly fifty percent of patients performed below recommended cut-offs on Trials 1 and 2 of the TOMM. Four of six patients who completed outside neuropsychological testing were misdiagnosed with alternative etiologies to explain their symptomatology, with two of these patients' performances deemed unreliable based on the TOMM. CONCLUSIONS Low scores on the TOMM should be interpreted in light of contextual and optimally biological information and do not necessarily rule out a neurodegenerative etiology.
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Affiliation(s)
- Nick Corriveau-Lecavalier
- Corresponding author at: 200 First Street S.W., Rochester, MN 55905, USA. Tel/Fax: 507-266-4106; E-mail address:
| | - Eva C Alden
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nikki H Stricker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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20
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Sanborn V, Lace J, Gunstad J, Galioto R. Considerations regarding noncredible performance in the neuropsychological assessment of patients with multiple sclerosis: A case series. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 30:458-467. [PMID: 34514920 DOI: 10.1080/23279095.2021.1971229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Determining the validity of data during clinical neuropsychological assessment is crucial for proper interpretation, and extensive literature has emphasized myriad methods of doing so in diverse samples. However, little research has considered noncredible presentation in persons with multiple sclerosis (pwMS). PwMS often experience one or more factors known to impact validity of data, including major neurocognitive impairment, psychological distress/psychogenic interference, and secondary gain. This case series aimed to illustrate the potential relationships between these factors and performance validity testing in pwMS. Six cases from an IRB-approved database containing pwMS referred for neuropsychological assessment at a large, academic medical center involving at least one of the above-stated factors were identified. Backgrounds, neuropsychological test data, and clinical considerations for each were reviewed. Interestingly, no pwMS diagnosed with major neurocognitive impairment was found to have noncredible performance, nor was any patient with noncredible performance in the absence of notable psychological distress. Given the variability of noncredible performance and multiplicity of factors affecting performance validity in pwMS, clinicians are strongly encouraged to consider psychometrically appropriate methods for evaluating validity of cognitive data in pwMS. Additional research aiming to elucidate base rates of, mechanisms begetting, and methods for assessing noncredible performance in pwMS is imperative.
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Affiliation(s)
| | - John Lace
- Cleveland Clinic, Neurological Institute, Section of Neuropsychology, Cleveland, OH, USA
| | - John Gunstad
- Psychological Sciences, Kent State University, Kent, OH, USA.,Brain Health Research Institute, Kent State University, Kent, OH, USA
| | - Rachel Galioto
- Cleveland Clinic, Neurological Institute, Section of Neuropsychology, Cleveland, OH, USA.,Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland, OH, USA
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21
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Vilar-López R, Daugherty JC, Pérez-García M, Piñón-Blanco A. A pilot study on the adequacy of the TOMM in detecting invalid performance in patients with substance use disorders. J Clin Exp Neuropsychol 2021; 43:255-263. [PMID: 33855936 DOI: 10.1080/13803395.2021.1912298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The validity of neuropsychological test performance has scarcely been studied in patients with substance use disorders (SUD), despite the possibility that some SUD individuals may distort their performance for compensation seeking (e.g., work leave, permanent or total disability, or the designation of services such as sheltered housing). Thus, the aim of the present study is to determine: (i) the possible utility of the Test of Memory Malingering (TOMM) in detecting invalid test results among SUD patients, and (ii) the percentage of individuals that underperform the TOMM among SUD patients seeking compensation.Method: Seventy-seven patients (59 men and 18 women) with SUD in outpatient treatment with an age range between 20 and 59 years were divided into two groups: SUD patients without compensation seeking (n = 41), and SUD patients with compensation seeking (n = 36). Participants performed a neuropsychological assessment with measures of processing speed, working memory, inhibition, verbal memory, cognitive flexibility, and decision-making, that also included the TOMM.Results: Our results demonstrate that there were no significant differences on TOMM performance between the two groups. Only one participant underperformed the TOMM (1.3% of the sample). Results showed cognitive impairment in the sample, but no differences between the groups on the different neuropsychological measures.Conclusions: This constitutes the first study to explore the capacity of a forced-choice test to detect invalid test results in an SUD population. There was a high performance on the TOMM among the SUD participants of our study despite their cognitive impairment, indicating adequate effort in their neuropsychological test performance. Further, these findings suggest that the probability of showing invalid neuropsychological performance among SUD compensation seeking patients is much lower than what has been found in other populations, such as in mild brain injury patients.
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Affiliation(s)
- Raquel Vilar-López
- The Mind, Brain and Behavior Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
| | - Julia C Daugherty
- The Mind, Brain and Behavior Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
| | - Miguel Pérez-García
- The Mind, Brain and Behavior Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
| | - Adolfo Piñón-Blanco
- Unidad Asistencial de Drogodependencias del Ayuntamiento de Vigo CEDRO, Pontevedra, Spain.,Galicia Sur Health Research Institute, Translational Neuroscience Group, CIBERSAM, Hospital Álvaro Cunqueiro Bloque Técnico, Vigo, Spain
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22
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Ferreira I, Fernandes S, Querido L, Pires R, Daugherty JC, Hidalgo-Ruzzante N, Pérez-García M. Validation of the Coin in Hand-Extended Version Among Older Adults With and Without Dementia. Arch Clin Neuropsychol 2021; 37:91-103. [PMID: 33856437 DOI: 10.1093/arclin/acab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The current study aimed to validate the Performance Validity Test Coin in Hand-Extended Version (CIH-EV) in groups of healthy older adults and older adults with dementia. METHOD Using an analog simulation paradigm, the healthy control group and the clinical group were instructed to perform to the best of their ability, whereas the feigning older adults were instructed to simulate a memory deficit to obtain allowance, financial aid, or early retirement. RESULTS Results showed that the control and clinical groups performed more optimally than the feigning group, although the clinical group had superior response times. The CIH-EV was insensitive to sociodemographic variables and neurocognitive functioning in all groups, demonstrated good convergent validity with other performance validity measures, and showed a reduced rate of false positives. CONCLUSIONS This study corroborates the CIH-EV's effectiveness in detecting the simulation of cognitive deficits in healthy older adults and older adults with dementia.
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Affiliation(s)
- Inês Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Sandra Fernandes
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Luís Querido
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Julia C Daugherty
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
| | - Natalia Hidalgo-Ruzzante
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Evolutionary and School Psychology, Universidad de Granada, Granada, Spain
| | - Miguel Pérez-García
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
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23
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Grant AF, Werner NJ. Retrospective Analysis of the Test of Memory Malingering in a Low Intellectual Quotient Intractable Epilepsy Sample. Arch Clin Neuropsychol 2020; 35:726-734. [PMID: 32377674 DOI: 10.1093/arclin/acaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Test of Memory Malingering (TOMM) is commonly used by neuropsychologists (Sharland, M. J., & Gfeller, J. D. (2007). A survey of neuropsychologists' beliefs and practices with respect to the assessment of effort. Archives of Clinical Neuropsychology, 22 (2), 213-223); however there is variable research regarding its use in low intelligence and epileptic populations (Hill, S. K., Ryan, L. M., Kennedy, C. H., & Malamut, B. L. (2003). The relationship between measures of declarative memory and the Test of Memory Malingering in patients with and without temporal lobe dysfunction. Journal of Forensic Neuropsychology, 3 (3), 1-18; Hurley, K. E., & Deal, W. P. (2006). Assessment instruments measuring malingering used with individuals who have mental retardation: Potential problems and issues. Mental Retardation, 44 (2), 112-119; Simon, M. J. (2007). Performance of mentally retarded forensic patients on the Test of Memory Malingering. Journal of Clinical Psychology, 63 (4), 339-344). The present study evaluates whether the standard TOMM cutoffs are resistant to low estimated IQ (≤80) in a clinical sample of patients with intractable epilepsy. A second aim is to decipher possible relationships between the TOMM and memory performance. METHODS Retrospective data analysis was conducted between 2010 and 2019 on 42 adults with intractable epilepsy who completed a comprehensive neuropsychological evaluation as part of screening procedures for epilepsy surgery. IQ estimates and TOMM were administered to all participants. Some were also administered memory- and mood-related measures. RESULTS Traditional TOMM cutoffs demonstrated excellent specificity with only one participant scoring below the cutoff score on the Retention Trial, but not on Trial 2. The TOMM significantly correlated with several scores on various memory tests. CONCLUSIONS The TOMM may be appropriate for use in low intellectually functioning populations with intractable epilepsy given the excellent specificity seen in this study. Future studies may seek to better understand the relationship between TOMM and memory performance in other low-functioning populations.
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Affiliation(s)
- Alexandra F Grant
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Nicole J Werner
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Rinaldi A, Stewart-Willis JJ, Scarisbrick D, Proctor-Weber Z. Clinical utility of the TOMMe10 scoring criteria for detecting suboptimal effort in an mTBI veteran sample. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:670-676. [PMID: 32780587 DOI: 10.1080/23279095.2020.1803870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the context of diminishing reimbursement and patient access demands, researchers continually refine performance validity measures (PVMs) to maximize efficiency while maintaining confidence in obtained data. This is particularly true for high PVM failure populations (e.g., mTBI patients). The TOMMe10 (number of errors on first 10 TOMM items) is one method this study utilized for classifying PVM performance as pass/fail (fail defined as failure on 2 of 6 PVM scores, pass defined as 0/1 failures). The present study hypothesized that the TOMMe10 would have equitable sensitivity/specificity for identifying non-credible cognitive performance among veterans with mTBI compared to previous research findings and commonly used performance validity measures (e.g., TOMM or WMT). Data were analyzed from 54 veterans assigned to a pass and fail group based on their performance across six recognized PVMs. Results revealed pass/fail groups were not significantly different regarding age, educational, or racial background. ROC analyses found the TOMMe10 demonstrated excellent discriminability (AUC = .803 ±.128), indicating that the TOMMe10 could have clinical utility within an mTBI veteran sample, particularly in conjunction with a second PVM. Specific population limitations are discussed. Additional research should elucidate this measure's performance with additional populations, including non-veteran mTBI, dementia, moderate-severe TBI, and inpatient populations.
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Affiliation(s)
- Anthony Rinaldi
- Department of Psychology, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | | | - David Scarisbrick
- WVU Department of Behavioral Medicine and Psychiatry, WVU Department of Neuroscience, West Virginia School of Medicine, Morgantown, VA, USA
| | - Zoe Proctor-Weber
- Department of Psychology, C.W. Bill Young Bay Pines VAHCS, Bay Pines, FL, USA
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25
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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders. Neuropsychol Rev 2020; 30:407-424. [PMID: 32766940 DOI: 10.1007/s11065-020-09448-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.
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Polsinelli AJ, Cerhan JH. Early Cutoff Criteria for Strong Performance on the Test of Memory Malingering. Arch Clin Neuropsychol 2020; 35:429-433. [PMID: 31867600 DOI: 10.1093/arclin/acz079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The Test of Memory Malingering (TOMM) is widely used to assess performance validity. To improve efficiency, we investigated whether abbreviated administration (i.e., only the first 25 items of Trial 1 [T1]) is possible when effort is very strong (≥49/50 on T1 or T2). METHOD We collected TOMM scores of 501 consecutive adult patients ranging in cognitive status who underwent standard neuropsychological evaluation at Mayo Clinic, Rochester, MN. RESULTS Receiver Operating Characteristic (ROC) analysis showed excellent area under the curve (AUC) (0.94; CI95% [0.92, 0.97]) and a cutoff of 25/25 had 100% specificity for identifying strong performance. Of the 224 patients who obtained a perfect score on the first 25 items, 197 (88%) obtained ≥49 on T1 and the remaining patients (n = 27) obtained ≥49 on T2. CONCLUSION A perfect score on the first 25 items of the TOMM predicted overall strong performance 100% of the time, supporting abbreviated administration in select cases in a general outpatient clinical setting.
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Affiliation(s)
| | - Jane H Cerhan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55904, USA
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27
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Chovaz CJ, Rennison VLA, Chorostecki DO. The validity of the test of memory malingering (TOMM) with deaf individuals. Clin Neuropsychol 2019; 35:597-614. [PMID: 31797722 DOI: 10.1080/13854046.2019.1696408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Administration of performance validity tests (PVT) during neuropsychological assessments is standard practice, with the Test of Memory Malingering (TOMM) being a commonly used measure. The TOMM has been well validated in hearing populations with various medical and psychiatric backgrounds. A major gap in the literature is the use of the TOMM amongst culturally Deaf individuals who use American Sign Language (ASL) as their first and preferred language. The purpose of this study was to explore the use of the TOMM with this population to determine if there may be differences related to the use of semantic knowledge and recall using signs rather than spoken phonemes. METHOD This study recruited 30 culturally Deaf, community-dwelling adults, who self-reported that they were not involved in litigation ordisability claims. In addition to the TOMM, participants were screened for cognitive ability using non-verbal components of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) and the Mini Mental State Examination: ASL Version (MMSE:ASL). RESULTS Nonverbal intelligence for this sample was within the average range of ability. No participants scored lower than the standard cut-off score for Trial 2 or the Retention Trial on the TOMM (≤44 raw score to indicate invalid responding). Trial 1 performances ranged from 44 to 50, Trial 2 performances ranged from 49 to 50, and Retention performances ranged from 49 to 50. CONCLUSION These results support the use of the same standard cut-off scores established for hearing individuals in culturally Deaf individuals who use ASL.
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Affiliation(s)
- Cathy J Chovaz
- Psychology Department, King's University College at Western University, London, Canada
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28
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Ventura LM, DeDios-Stern S, Oh A, Soble JR. They're not just little adults: The utility of adult performance validity measures in a mixed clinical pediatric sample. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:297-307. [PMID: 31703167 DOI: 10.1080/21622965.2019.1685522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Performance validity tests (PVTs) have become a standard part of adult neuropsychological practice; however, they are less widely used in pediatric testing. The current study aimed to obtain a better understanding of the application of PVTs within a mixed clinical pediatric sample with a wide range of diagnosis, IQ, and age. Cross-sectional data were analyzed from 130 consecutive pediatric patients evaluated as part of clinical care and diagnosed with a variety of medical/neurological, developmental, and psychiatric disorders. Patients were administered a battery of neuropsychological tests; results of intellectual functioning measures (i.e., Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV]), and PVTs (i.e., Test of Memory Malingering [TOMM] and Digit Span [DS] subtests of the WISC-V/WAIS-IV) were analyzed to assess PVT performance across the sample as well as age- and Full-Scale IQ-related (FSIQ) effects on pass rate. Results suggested that the TOMM is an effective validity test for youth, as the TOMM adult cutoff score was also valid for children (88% pass rate on TOMM trial 1 cut-score ≥41, 71% pass rate on TOMM trial 1 cut-score ≥45). In contrast, Reliable Digit Span (RDS) was less accurate (34% failed RDS [cut-score ≤6], 54% failed RDS-r [cut-score ≤10], and 25% failed DS ACSS [cut-score ≤5]) using standard adult cutoffs. Notably, although TOMM scores were not strongly influenced by IQ, DS scores increased as IQ increased. Overall, further analysis of PVTs can champion new standards of practice through additional research establishing PVT accuracy within pediatric populations.
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Affiliation(s)
- Lea M Ventura
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Illinois College of Medicine, Chicago, IL, USA
| | - Samantha DeDios-Stern
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Alison Oh
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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Neal J, Strothkamp S, Bedingar E, Cordero P, Wagner B, Vagnini V, Jiang Y. Discriminating Fake From True Brain Injury Using Latency of Left Frontal Neural Responses During Old/New Memory Recognition. Front Neurosci 2019; 13:988. [PMID: 31611760 PMCID: PMC6777439 DOI: 10.3389/fnins.2019.00988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health concern that affects 69 million individuals each year worldwide. Neuropsychologists report that up to 40% of individuals undergoing evaluations for TBI may be malingering neurocognitive deficits for a compensatory reward. The memory recognition test of malingering detection is effective but can be coached behaviorally. There is great need to develop a novel neural based method for discriminating fake from true brain injury. Here we test the hypothesis that decision making of faking memory deficits prolongs frontal neural responses. We applied an advanced method measuring decision latency in milliseconds for discriminating true TBI from malingerers who fake brain injury. To test this hypothesis, latencies of memory-related brain potentials were compared among true patients with moderate or severe TBI, and healthy age-matched individuals who were assigned either to be honest or faking memory deficit. Scalp signals of electroencephalography (EEG) were recorded with a 32-channel cap during an Old/New memory recognition task in three age- and education-matched groups: honest (n = 12), malingering (n = 15), and brain injured (n = 14) individuals. Bilateral fractional latencies of late positive ERP at frontal sites were compared among the three groups under both studied (Old) and non-studied (New) memory recognition conditions. Results show a significant difference between the fractional latencies of the late positive component during recognition of studied items in malingerers (averaged latencies = 396 ms) and the true brain injured subjects (mean = 312 ms) in the frontal sites. Only malingers showed asymmetrical frontal activity compared to the two other groups. These new findings support the hypothesis that that additional frontal processing of malingering individuals is measurably different from those of actual patients with brain injury. In contrast to our previous reported method using difference waves of amplitudes at frontal to posterior midline sites during new items recognition (Vagnini et al., 2008), there was no significant latency difference among groups during recognition of New items. The current method using delayed left frontal neural responses during studied items reached sensitivity of 80% and specificity of 79% in detecting malingers from true brain injury.
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Affiliation(s)
- Jennifer Neal
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Stephanie Strothkamp
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Esias Bedingar
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States.,Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Patrick Cordero
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Benjamin Wagner
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Victoria Vagnini
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States.,Louisville VA Medical Center, Louisville, KY, United States
| | - Yang Jiang
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
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Martin PK, Schroeder RW, Olsen DH, Maloy H, Boettcher A, Ernst N, Okut H. A systematic review and meta-analysis of the Test of Memory Malingering in adults: Two decades of deception detection. Clin Neuropsychol 2019; 34:88-119. [DOI: 10.1080/13854046.2019.1637027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Phillip K. Martin
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine –Wichita, Wichita, KS, USA
| | - Ryan W. Schroeder
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine –Wichita, Wichita, KS, USA
| | - Daniel H. Olsen
- University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Halley Maloy
- University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | | | - Nathan Ernst
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hayrettin Okut
- University of Kansas School of Medicine – Wichita, Wichita, KS, USA
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Czornik M, Merten T, Lehrner J. Symptom and performance validation in patients with subjective cognitive decline and mild cognitive impairment. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:269-281. [PMID: 31267787 DOI: 10.1080/23279095.2019.1628761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nonauthentic symptom claims (overreporting) and invalid test results (underperformance) can regularly be expected in a forensic context, but may also occur in clinical referrals. While the applicability of symptom and performance validity tests in samples of dementia patients is well studied, the same is not true for patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). A sample of 54 memory-clinic outpatients with evidence of SCD or MCI was studied. We evaluated the rate of positive results in three validity measures. A total of 7.4% of the patients showed probable negative response bias in the Word Memory Test. The rate of positive results on the Structured Inventory of Malingered Symptomatology was 14.8% while only one participant (1.9%) scored positive on the Self-Report Symptom Inventory using the standard cutoff. The two questionnaires were moderately correlated at .67. In a combined analysis of all results, five of the patients (9.3%) were judged to show evidence of probable negative response bias (or probably feigned neurocognitive impairment). In the current study, a relatively small but nontrivial rate of probable response distortions was found in a memory-clinic sample. However, it remains a methodological challenge for this kind of research to reliably distinguish between false-positive and correct-positive classifications in clinical patient groups.
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Affiliation(s)
- Manuel Czornik
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.,Institute of Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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32
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McGuire C, Crawford S, Evans JJ. Effort Testing in Dementia Assessment: A Systematic Review. Arch Clin Neuropsychol 2019; 34:114-131. [PMID: 29579143 DOI: 10.1093/arclin/acy012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/30/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Interpretation of neuropsychological test data is only valid when appropriate effort has been exerted. Research, however, suggests that neuropsychologists do not always formally test for effort and that this may especially be the case in the context of dementia assessment. This review systematically examined the literature that has investigated the use of both purpose-built and embedded effort-sensitive indices in dementia, mild cognitive impairment (MCI), and healthy control samples. The aim was to determine which tests of effort are most sensitive to suboptimal effort and least sensitive to the type of cognitive impairment seen in dementia. Methods A systematic search of databases was conducted to October 2017. There was no start date. Results Twenty-five studies were included for review. The studies were divided into two categories according to methodology. One category of studies (n = 5) was reviewed using a tailored methodological quality rating checklist whilst the remaining studies (n = 20) were reviewed using the Crowe Critical Appraisal Tool (CCAT). Conclusions The results of this review suggest that PVTs which take a hierarchical approach to effort testing such as the WMT, MSVT, and NV-MSVT are preferable for use with older adults who are under investigation for possible dementia. These tests go above and beyond the traditional pass/fail approach of more traditional tests of effort because they allow the examiner to analyze the examinee's profile of scores. The methodological limitations and challenges involved in this field of research are discussed.
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Affiliation(s)
- Claire McGuire
- NHS Greater Glasgow & Clyde, Older People's Psychology Service, Eastwood Health and Care Centre, Drumby Crescent, Clarkston, UK
| | - Stephanie Crawford
- NHS Greater Glasgow & Clyde, Older People's Psychology Service, Crown House, 30 King Street, Greenock, UK
| | - Jonathan J Evans
- Mental Health and Wellbeing, University of Glasgow, The Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, UK
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Maiman M, Del Bene VA, MacAllister WS, Sheldon S, Farrell E, Arce Rentería M, Slugh M, Nadkarni SS, Barr WB. Reliable Digit Span: Does it Adequately Measure Suboptimal Effort in an Adult Epilepsy Population? Arch Clin Neuropsychol 2019; 34:259-267. [PMID: 29659666 DOI: 10.1093/arclin/acy027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/21/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Assessment of performance validity is a necessary component of any neuropsychological evaluation. Prior research has shown that cutoff scores of ≤6 or ≤7 on Reliable Digit Span (RDS) can detect suboptimal effort across numerous adult clinical populations; however, these scores have not been validated for that purpose in an adult epilepsy population. This investigation aims to determine whether these previously established RDS cutoff scores could detect suboptimal effort in adults with epilepsy. Method Sixty-three clinically referred adults with a diagnosis of epilepsy or suspected seizures were administered the Digit Span subtest of the Wechsler Adult Intelligence Scale (WAIS-III or WAIS-IV). Most participants (98%) passed Trial 2 of the Test of Memory Malingering (TOMM), achieving a score of ≥45. Results Previously established cutoff scores of ≤6 and ≤7 on RDS yielded a specificity rate of 85% and 77% respectively. Findings also revealed that RDS scores were positively related to attention and intellectual functioning. Given the less than ideal specificity rate associated with each of these cutoff scores, together with their strong association to cognitive factors, secondary analyses were conducted to identify more optimal cutoff scores. Preliminary results suggest that an RDS cutoff score of ≤4 may be more appropriate in a clinically referred adult epilepsy population with a low average IQ or lower. Conclusions Preliminary findings indicate that cutoff scores of ≤6 and ≤7 on RDS are not appropriate in adults with epilepsy, especially in individuals with low average IQ or below.
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Affiliation(s)
- Moshe Maiman
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Victor A Del Bene
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Ferkauf Graduate School of Psychology, Clinical Health Psychology Program, Yeshiva University, Bronx, NY, USA
| | - William S MacAllister
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
| | - Sloane Sheldon
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Ferkauf Graduate School of Psychology, Clinical Health Psychology Program, Yeshiva University, Bronx, NY, USA
| | - Eileen Farrell
- Institute of Neurology and Neurosurgery, Saint Barnabas, Livingston, NJ, USA
| | - Miguel Arce Rentería
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,Psychology Department, Fordham University, Bronx, NY, USA
| | - Mitchell Slugh
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA.,School of Psychology, Farleigh Dickinson University, Teaneck, NJ, USA
| | - Siddhartha S Nadkarni
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
| | - William B Barr
- Department of Neurology, NYU-Langone Comprehensive Epilepsy Center, NYU-Langone Health, NYU School of Medicine, New York, NY, USA
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A Laboratory Word Memory Test Analogue Differentiates Intentional Feigning from True Responding Using the P300 Event-Related Potential. Brain Sci 2019; 9:brainsci9050109. [PMID: 31091738 PMCID: PMC6562842 DOI: 10.3390/brainsci9050109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
Symptom exaggeration and feigned cognitive impairment occur commonly in forensic and medicolegal evaluations. As a result, methods to detect feigned cognitive impairment are an indispensable component of neuropsychological assessments. This study reports the results of two neurophysiological experiments using a forced-choice recognition task built from the stimuli of the Word Memory Test and Medical Symptom Validity Test as well as a new linguistically informed stimulus set. Participant volunteers were instructed either to do their best or to feign cognitive impairment consistent with a mild traumatic brain injury while their brain activity was monitored using event-related potentials (ERP). Experiment 1 varied instructions across individuals, whereas Experiment 2 varied instructions within individuals. The target brain component was a positive deflection indicating stimulus recognition that occurs approximately 300 ms after exposure to a stimulus (i.e., the P300). Multimodal comparison (P300 amplitude to behavioral accuracy) allowed the detection of feigned cognitive impairment. Results indicate that, for correct responses, P300s were equivalent for the simulated malingering and good effort conditions. However, for incorrect responses, feigned impairment produced reliable but significantly reduced P300 amplitudes. Although the P300 is an automatic index of recognition—even when knowledge is hidden—its amplitude appears capable of modulation by feigning strategies. Implications of this finding are discussed for research and clinical applications.
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Oudman E, Krooshof E, van Oort R, Lloyd B, Wijnia JW, Postma A. Effects of Korsakoff Amnesia on performance and symptom validity testing. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:549-557. [DOI: 10.1080/23279095.2019.1576180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Erik Oudman
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, The Netherlands
| | - Emmy Krooshof
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, The Netherlands
| | - Roos van Oort
- Wettstein & Peterse Expertise (WPEX), Amersfoort, The Netherlands
| | - Beth Lloyd
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, The Netherlands
| | - Jan W. Wijnia
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, The Netherlands
| | - Albert Postma
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Center, Lelie Care Group, Rotterdam, The Netherlands
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36
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Bodner T, Merten T, Benke T. Performance validity measures in clinical patients with aphasia. J Clin Exp Neuropsychol 2019; 41:476-483. [DOI: 10.1080/13803395.2019.1579783] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Thomas Bodner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Rosenfeld JP, Davydova E, Labkovsky E, Ward A. Financial Incentive Does Not Affect P300 in the Complex Trial Protocol (CTP) Version of the Concealed Information Test (CIT) in Malingering Detection. II. Uninstructed Subjects. Front Psychiatry 2019; 10:189. [PMID: 31037057 PMCID: PMC6476237 DOI: 10.3389/fpsyt.2019.00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/14/2019] [Indexed: 11/15/2022] Open
Abstract
Well-known research showed that the skin conductance response (SCR) of the Autonomic Nervous System (ANS) in the Concealed Information Test (CIT) is usually augmented in participants who are financially and motivationally incentivized to beat the CIT. This is not what happens with Reaction Time (RT)-based CITs, P300 CITs based on the 3-stimulus protocol, nor on the P300-based complex trial protocol for detection of malingering (however these tests differ from forensic CITs). The present report follows up the Rosenfeld et al. (1, 2) study of motivated malingerers instructed how to beat the test, with uninstructed motivated (paid and unpaid) and unmotivated ("simple malingering") subjects, using episodic and semantic memory probes. The Test of Memory Malingering (TOMM) validated behavioral differences among groups. The "CIT effect" (probe-minus-irrelevant P300 differences) did not differ among incentive groups, although as previously, semantic memory-evoked P300s exceeded episodic memory evoked P300s. An effect of specific test-beating instructions was found to enhance the CIT effect for semantic information.
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Affiliation(s)
- J Peter Rosenfeld
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Elena Davydova
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Elena Labkovsky
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Anne Ward
- Department of Psychology, Northwestern University, Evanston, IL, United States
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Davis JJ. Performance validity in older adults: Observed versus predicted false positive rates in relation to number of tests administered. J Clin Exp Neuropsychol 2018; 40:1013-1021. [PMID: 29779432 PMCID: PMC6141322 DOI: 10.1080/13803395.2018.1472221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION This study examined false positive rates on embedded performance validity tests (PVTs) in older adults grouped by cognitive status. METHOD The research design involved secondary analysis of data from the National Alzheimer's Coordinating Center database. Participants (N = 22,688) were grouped by cognitive status: normal (n = 10,319), impaired (n = 1,194), amnestic or nonamnestic mild cognitive impairment (MCI; n = 5,414), and dementia (n = 5,761). Neuropsychological data were used to derive 5 PVTs. RESULTS False positive rates on individual PVTs ranged from 3.3 to 26.3% with several embedded PVTs showing acceptable specificity across groups. The proportion of participants failing two or more PVTs varied by cognitive status: normal (1.9%), impaired (6.6%), MCI (13.2%), and dementia (52.8%). Comparison of observed and predicted false positive rates at different specificity levels (.85 or .90) demonstrated significant differences in all comparisons. In normal and impaired groups, predicted rates were higher than observed rates. In the MCI group, predicted and observed comparisons varied: Predicted rates were higher with specificity at .85 and lower with specificity at .90. In the dementia group, predicted rates underestimated observed rates. CONCLUSIONS Despite elevated false positives in conditions involving severe cognitive compromise, several measures retain acceptable specificity regardless of cognitive status. Predicted false positive rates based on the number of PVTs administered were not observed empirically. These findings do not support the utility of simulated data in predicting false positive rates in older adults.
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Affiliation(s)
- Jeremy J Davis
- a Division of Physical Medicine & Rehabilitation , University of Utah School of Medicine , Salt Lake City , UT , USA
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Critchfield E, Soble JR, Marceaux JC, Bain KM, Chase Bailey K, Webber TA, Alex Alverson W, Messerly J, Andrés González D, O’Rourke JJF. Cognitive impairment does not cause invalid performance: analyzing performance patterns among cognitively unimpaired, impaired, and noncredible participants across six performance validity tests. Clin Neuropsychol 2018; 33:1083-1101. [DOI: 10.1080/13854046.2018.1508615] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Edan Critchfield
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jason R. Soble
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Janice C. Marceaux
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kathleen M. Bain
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - K. Chase Bailey
- Division of Psychology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Troy A. Webber
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - W. Alex Alverson
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Johanna Messerly
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - David Andrés González
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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40
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Further Validation of the Test of Memory Malingering (TOMM) Trial 1 Performance Validity Index: Examination of False Positives and Convergent Validity. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9335-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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41
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Holden HM, Milano NJ, Horner MD. Five-factor structure of the RBANS is supported in an Alzheimer's disease sample: Implications for validation of neuropsychological assessment instruments. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:232-242. [PMID: 30380924 DOI: 10.1080/23279095.2018.1529671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Development of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was theoretically driven, with the goal of providing an assessment of abilities across five cognitive domains. Since its development, numerous factor analytic studies have failed to provide empirical support for the proposed five-factor structure and, furthermore, have lacked consensus on the internal structure of this instrument. A key limitation of these prior studies is the use of normal or mixed clinical samples, a practice that can obscure distinctions that may be evident in specific homogeneous clinical samples. The current study examined the factor structure of the RBANS in a sample of 107 male Veterans diagnosed with probable Alzheimer's disease (AD). Confirmatory factor analysis of a model reflecting the five Index Scores (Immediate Memory, Visuospatial/Constructional, Language, Attention, and Delayed Memory) found that the proposed five-factor structure fit the data well. These findings suggest that the RBANS does measure five distinct constructs and use of Index Scores is appropriate. Furthermore, the current findings highlight the importance of testing construct validity of neuropsychological assessment instruments in specific homogeneous samples.
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Affiliation(s)
- Heather M Holden
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Nicholas J Milano
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.,Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael David Horner
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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42
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Why Children Fail the Test of Memory Malingering: Review of False Positive Performance in Pediatric Studies. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2018. [DOI: 10.1007/s40817-018-0059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Effect of Yin-Xing-Tong-Zhi Tablets on Improving Vascular Cognitive Impairment No Dementia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:6184260. [PMID: 29853963 PMCID: PMC5944287 DOI: 10.1155/2018/6184260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
Objective Observe the effect of the Chinese herbal extracts, Yin-Xing-Tong-Zhi, in tablet form, on improving vascular cognitive impairment no dementia (VCIND). Methods Sixty-eight patients with VCIND were divided randomly into treatment and placebo groups with oral administration of Yin-Xing-Tong-Zhi tablets (YXTZTs) or placebo, respectively, for 24 weeks. Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score, MMSE score, Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus) score, expression of interleukin- (IL-) 6, IL-8, and tumor necrosis factor- (TNF-) α in serum, and variation of blood-lipid levels were evaluated at different time points. Results At weeks 12 and 24, the scores for the ADAS-Cog, CIBIC-Plus, and MMSE of the treatment group were significantly lower than those of the control group (P < 0.05). All clinical scales at week 24 of the control group were significantly different from those before treatment (P < 0.05). Expression of IL-6, IL-8, and TNF-α in the two groups was reduced significantly with variation of the clinical scales of cognitive impairment. Conclusion YXTZTs may delay the development of cognitive impairment in VCIND patients by modulating expression of VCIND-associated proinflammatory factors.
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Staniloiu A, Markowitsch HJ, Kordon A. Psychological causes of autobiographical amnesia: A study of 28 cases. Neuropsychologia 2018; 110:134-147. [DOI: 10.1016/j.neuropsychologia.2017.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/26/2017] [Accepted: 10/15/2017] [Indexed: 12/28/2022]
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Tracy DK. Evaluating malingering in cognitive and memory examinations: a guide for clinicians. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.114.012906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryCognitive and memory testing are a common part of clinical practice, but professional concerns are sometimes raised that the individual being tested might be feigning deficits. Most clinicians have limited experience and training in detecting malingering in such cognitive testing, and the very issue raises considerable ethical dilemmas. Nevertheless, psychiatric work faces ever greater potential for legal scrutiny, and failure to appropriately evaluate potential malingering risks professional embarrassment and distress. There is a need for clinicians to make themselves aware of the ways in which malingered behaviour might be evaluated through the clinical history, the use of routine psychometric testing and, particularly, the use of symptom validity (‘malingering’) tests. This article describes these factors and gives guidance on the appropriate reporting of findings.Learning Objectives•Better understand the complexities in cognitive assessment where malingering is suspected.•Understand the types and limitations of the major symptom validity tests.•Be better prepared to produce documentation and reports stating test findings.
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Abstract
Many violent offenders report amnesia for their crime. Although this type of memory loss is possible, there are reasons to assume that many claims of crime-related amnesia are feigned. This article describes ways to evaluate the genuineness of crime-related amnesia. A recent case is described in which several of these strategies yielded evidence for feigned crime-related amnesia.
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Affiliation(s)
- Marko Jelicic
- Forensic Psychology Section, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Criminal Law and Criminology, Faculty of Law, Maastricht University, Maastricht, Netherlands
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47
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Webber TA, Soble JR. Utility of various WAIS-IV Digit Span indices for identifying noncredible performance validity among cognitively impaired and unimpaired examinees. Clin Neuropsychol 2017; 32:657-670. [DOI: 10.1080/13854046.2017.1415374] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Troy A. Webber
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jason R. Soble
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Departments of Psychiatry and Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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Wagner MT, Szeles DM, Mulder B, Sohn M, Walker A. Posterior cortical atrophy of a suspected non-Alzheimer type: a case report. Clin Neuropsychol 2017; 32:720-738. [PMID: 29072103 DOI: 10.1080/13854046.2017.1391331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A case of Posterior Cortical Atrophy syndrome of a suspected non-Alzheimer disease pathology type is presented to illustrate prospective diagnosis and course. METHOD A 54-year-old woman with vague memory complaints underwent serial neuropsychological assessment, MRI, PET, and CSF screening; data are reviewed. RESULTS While early diagnosis was confounded by multiple factors, classic visuospatial symptoms were later demonstrated using routine neuropsychological methods. Serial MRI, PET, and CSF screening argued strongly for an alternative underlying pathology to AD. At age 59, her condition had progressed to dementia. CONCLUSIONS Findings underscore the need for further research on suspected non-amyloid-based pathologies.
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Affiliation(s)
- Mark T Wagner
- a Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
| | - Dana M Szeles
- a Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
| | - Blakely Mulder
- a Department of Neurology , Medical University of South Carolina , Charleston , SC , USA.,b Department of Counseling, Higher Education, and Special Education , University of Maryland , College Park , MD , USA
| | - Mimi Sohn
- a Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
| | - Aljoeson Walker
- a Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
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49
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Paul R, Rhee G, Baker LM, Vaida F, Cooley SA, Ances BM. Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy. J Neurovirol 2017; 23:725-733. [PMID: 28895090 PMCID: PMC5656505 DOI: 10.1007/s13365-017-0557-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/05/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Abstract
The expression of cognitive symptoms associated with HIV varies over time and across individuals. This pattern may reflect transient contextual factors, including the degree of effort exerted by individuals undergoing cognitive testing. The present study examined whether effort corresponds to the expression of persistent HIV-related cognitive impairment among individuals receiving combination antiretroviral therapy (cART). HIV+ individuals (n = 111) averaged 48.2 (14.9) years of age and 13.0 (2.7) years of education and HIV- individuals (n = 92) averaged 34.9 (17.2) years of age and 13.5 (1.9) years of education. Participants completed a neuropsychological battery and a clinically validated measure of effort (Test of Memory Malingering, trial 1). Results revealed that the vast majority of HIV+ (85%) and HIV- (89%) individuals performed above published guidelines for adequate effort. Furthermore, the expression of cognitive impairment in HIV was not related to effort performance. The results were unchanged when examining HIV+ individuals with and without viral suppression. Finally, disability and disability-seeking status, and a proxy measure of apathy did not correspond to effort levels in HIV+ individuals. These findings suggest that variability in the expression of cognitive impairment in the cART era is unlikely to represent overt effort failures or other confounds unrelated to the disease. Persistent cognitive impairment in HIV likely represents historical and/or ongoing disease mechanisms despite otherwise successful treatment.
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Affiliation(s)
- Robert Paul
- Department of Psychological Sciences, University of Missouri- St. Louis, St. Louis, USA
- Missouri Institute of Mental Health, St. Louis, USA
| | - Gina Rhee
- Department of Neurology, Washington University in St. Louis, St. Louis, USA
| | - Laurie M Baker
- Department of Psychological Sciences, University of Missouri- St. Louis, St. Louis, USA
- Missouri Institute of Mental Health, St. Louis, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, Division of Biostatistics and Bio-informatics, University of California San Diego, San Diego, CA, USA
| | - Sarah A Cooley
- Department of Neurology, Washington University in St. Louis, St. Louis, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, St. Louis, USA.
- Department of Neurology, Washington University in Saint Louis School of Medicine, Campus Box 8111, 660 South Euclid Avenue, St. Louis, MO, 63110, USA.
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Validation of the Advanced Clinical Solutions Word Choice Test (WCT) in a Mixed Clinical Sample: Establishing Classification Accuracy, Sensitivity/Specificity, and Cutoff Scores. Assessment 2017; 26:1320-1328. [DOI: 10.1177/1073191117725172] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the Word Choice Test’s (WCT) utility as a performance validity test in a mixed clinical sample of veterans referred for neuropsychological evaluation. Participants completed Green’s Word Memory Test (WMT), WCT, and Test of Memory Malingering (TOMM) Trial 1. Using the WMT as the criterion for valid performance, logistic regressions examined the WCT and TOMM’s classification accuracy for those with and without cognitive impairment (CI). Receiver operating characteristic curves were used to establish cut scores which maximized the sensitivity/specificity of each measure. In those without CI, both tests showed good classification accuracy (86.7% and 85.0%, respectively). Among those with CI, the TOMM retained good classification accuracy (82.3%), while the WCT’s decreased considerably (69.4%). Optimal WCT cut scores differed based on impairment status, with a higher sensitivity/specificity trade-off among those with CI. Successful performance on the WCT appeared to rely more heavily on cognitive processes unrelated to performance validity.
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