Psychiatric norms for the Rey 15-item Visual Memory Test

Preliminary Validation of the Rey 15-Item Test and Reliable Digit Span in Native Japanese Samples

The Rey 15-Item Test and reliable digit span were evaluated in Japan. Participants were controls ( n = 15), healthy volunteers instructed to simulate memory impairment ( n = 12; 5 of 17 volunteers did not comply with instructions and were dropped), healthy elderly ( n = 12), and cognitively disabled nursing home residents ( n = 8). On the 15-Item Test, controls and elderly performed similarly and were combined. Nursing home residents could not cope with the 15-Item Test and were dropped. Total score was a fair predictor of dissimulation using a cutoff ≤ 8. Rows were fair predictors using a ≤2 cutoff. Sensitivities were low and specificities were excellent. Reliable digit span contrasts between simulators and each of the other groups demonstrated that reliable digit span discriminated controls and elderly from simulators (≤6 and ≤5 cutoffs). Sensitivities were moderate and specificities were excellent. Reliable digit span did not differentiate simulators from nursing home residents.

The Performance of Schizophrenics on Three Cognitive Tests of Malingering, Rey 15-Item Memory Test, Rey Dot Counting, and Hiscock Forced-Choice Method

The performance of individuals with severe psychiatric disturbance such as schizophrenia on tests designed to detect malingering of cognitive symptoms (e.g., Rey 15-Item Memory Test, RMT; Rey Dot Counting Test, RDC; Hiscock Forced-Choice, F-C, method) has not been formally investigated. Some malingerers feign cognitive impairment in the context of a pseudopsychotic presentation; thus, it is essential that we understand how actual psychotic individuals perform on these measures. In our sample of 30 schizophrenic patients, 13% failed the RMT, 13% failed the RDC, and 27% failed the F-C measure. The RMT performance appeared to be significantly affected by lowered educational level. In contrast, both RDC and F-C performances were related to presence of cognitive impairment, and the RDC was also significantly affected by increasing age. No test score was significantly related to psychiatric disturbance.

Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy

Objective:

Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains.

Methods:

Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population.

Results:

Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40–58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as “The Hummingbird sign,” was observed in eight CI-MS and in three PSP patients.

Discussion:

Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs.

Prevalence and Assessment of Malingering in Homicide Defendants Using the Mini-Mental State Examination and the Rey 15-Item Memory Test

This study surveyed malingering prevalence in pretrial homicide defendants and assessed the usefulness of the Mini-Mental State Examination (MMSE) and the Rey 15-Item Memory Test (FIT) in detecting malingering among them. Malingering prevalence was 17%. MMSE and FIT scores were positively correlated. The MMSE and FIT had modest positive predictive value (67% and 43%), but reasonably good negative predictive value (93% and 89%), for malingering. Overall, the MMSE outperformed the FIT, with no advantage to combined use of the MMSE and FIT over the MMSE. The widely used MMSE, traditionally a bedside test of cognition, may have a role in malingering assessment.

An investigation into the validity of effort tests in a working age dementia population

OBJECTIVES

Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort.

METHOD

Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs.

RESULTS

There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant.

CONCLUSION

Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.

The Relationship of IQ to Effort Test Performance

The relationship between IQ and nine effort indicators was examined in a sample of 189 neuropsychology clinic outpatients who were not in litigation or attempting to obtain disability. Participants with the lowest IQ (50-59) failed approximately 60% of the effort tests, while patients with an IQ of 60 to 69 failed 44% of effort indicators, and individuals with borderline IQ (70 to 79) exhibited a 17% failure rate. All patients with IQ < 70 failed at least one effort test. Cutoffs for the Warrington Recognition Memory Test (Words) and Finger Tapping maintained the highest specificities in low IQ samples.

Comparison of the Effectiveness of Two Versions of the Rey Memory Test in Discriminating between Actual and Simulated Memory Impairment, with and without the Addition of a Standard Memory Test

The superiority of the modified 16-item Rey memory test over the original 15-item test has yet to be established in relation to the detection of feigned memory deficits. This study compares the effectiveness of these two versions of the test in combination with a standard memory test. Sixty-four participants, equally divided into "controls" and "simulators", and 32 "memory-impaired" volunteers completed the WAIS-III Digit Span test and either the 15-item or 16-item Rey test. The median scores of the simulators were worse than those of both the controls and the memory-impaired subjects on two types of score on the 16-item test compared to just one on the 15-item test. However, combining the total score from the 16-item test with the digits forward span accurately detected 63% of simulators (with only 6% of nonsimulators wrongly classified as simulators). This performance was better than that obtained from any of the test scores taken singly or from any other combination of a digit span score with a Rey score. It is concluded that the addition of a standard memory test to the Rey memory test improves the detection of individuals feigning memory impairment.

Dementia and mental retardation markers on the Rey 15-item Visual Memory Test

This study examined the qualitative errors of repetitions and confabulations on the Rey 15-item Visual Memory Test among 500 psychiatric patients who were divided into groups with (1) low IQ scores, (2) a diagnosis of dementia, and (3) other psychiatric diagnoses. These groups were compared on the presence of confabulated figures and repetitions on the Rey. The low IQ patients had the highest rate for both confabulations (48.2%) and repetitions (43.6%). Demented patients had the next highest rate of confabulations (39.8%) and repetitions (39.8%). The general psychiatric patients had the lowest rates on confabulations (16.2%) and repetitions (26.8%). Chi squared analysis showed that both confabulations and repetitions significantly differentiated these patients of low IQ and demented patients from general psychiatric patients. These results suggest that clinicians who use the Rey 15-item Visual Memory Test and find either confabulated or repeated figures should further explore the possibility that the patient might have low intellectual functioning or dementia.

Comparison of the Shipley Institute of Living Scale and WAIS-R IO scores for a sample of public sector psychiatric inpatients

This study examined the use of the Shipley Institute of Living Scale as a screening device in an intellectually low functioning psychiatric population of 40 inpatients. Shipley IQ scores were significantly correlated .72 with Full Scale WAIS-R IQ scores. There was no significant difference between the mean IQ scores generated from the two measures. These findings suggest that the Shipley scale may be used in this population despite a caution by the test's publisher that the test should not be used in assessing intellectual functioning in individuals with borderline or lower intelligence.

WAIS-R profile variability of psychiatric inpatients

This study examined the variability of WAIS-R profiles using the subtest range and profile variance in a large sample ( N = 1,684) of psychiatric inpatients.

Practical guidelines in the use of symptom validity and other psychological tests to measure malingering and symptom exaggeration in traumatic brain injury cases

The detection of malingering or symptom exaggeration has become an essential component in forensic neuropsychological evaluations, particularly in cases involving personal injury claims. Symptom Validity Tests refer to those measures that can be utilized to detect test performance that is so poor that it is below the level of probability, often times even among brain-damaged populations. This article outlines legal standards for expert testimony in regard to forensic neuropsychological personal injury evaluations. The article provides an outline of specific Symptom Validity Tests and Indicators, and reviews literature supporting test sensitivity and validity. In addition, the use of symptom checklists and questionnaires is discussed, as well as the appropriate use of Symptom Validity Tests and Indicators to establish the presence or absence of malingering or symptom exaggeration.

The detection of exaggerated or simulated memory disorder by neuropsychological methods

Some neuropsychological tests devised to detect exaggeration and simulation of memory disorder are reviewed with reference to models of memory and our current knowledge of the behaviour of amnesic patients. These tests are based on the assumption that naive simulators or exaggerators do not know either that amnesic patients can perform them normally, or near normally, or that subjects can only fail them by deliberate suppression of the correct response. It is concluded that several such tests show promise and are worthy of further development.

Trail Making Test norms for psychiatric patients

The Trail Making Test was administered to a sample of 661 inpatients in a publicly supported psychiatric hospital. The patients' mean IQ of 83.7 (SD = 13.0) was in the low end of the low average range. Multiple regression analysis of the scores showed significant IQ and age components of Trail Making Test scores; however, education and gender differences in performance were not significant once IQ and age were factored into the regression equation. Ability-based norms using time in seconds to completion as the score and IQ as a moderator variable are presented. Such norms allow more appropriate evaluation of the differential cognitive functioning of this population than previously published norms. Normal standard score conversions from raw scores, the intercept, regression weights for IQ and age, and standard error of the regression for both the Trails tasks are provided for individuals desiring to write a program to provide scores corrected for IQ and age.