Use of the Multiple Errands Test-Simplified Version in the assessment of suboptimal effort

The night out task and scoring application: an ill-structured, open-ended clinic-based test representing cognitive capacities used in everyday situations

OBJECTIVE

The night out task (NOT) was developed as a naturalistic, open-ended, multitasking measure that requires individuals to complete eight subtasks comparable to those encountered during real-world functioning (e.g., pack travel bag, prepare tea). We examined psychometric properties and administration feasibility of this direct observation measure within a clinic-like setting using a tablet-based coding application.

METHOD

A sample of 148 community-dwelling older adults (82% cognitively healthy; 18% mild cognitive impairment) and 57 younger adults completed the NOT along with other neurocognitive tests and questionnaires.

RESULTS

Inter-rater reliability across NOT primary (i.e., time, accuracy, efficiency) and process-related (e.g., error-types, self-corrections) variables was mostly excellent. NOT primary measures showed expected patterns of convergent and discriminant validity with measures of cognition, demographics, and well-being. External validity was established by the NOT ability to distinguish between age and diagnostic (cognitively healthy vs. mild cognitive impairment) groups. Demonstrating incremental validity, the NOT primary variables (execution time in particular) were predictive of self-reported functional abilities and completion quality of in-home everyday tasks over and earlier variables such as demographics, cognition, and mobility.

CONCLUSIONS

These findings suggest that the NOT and its app interface, which allows for continuous logging of observations, are a feasible in-clinic measure to assess cognitive capacities important for real-world functioning. With further validation, the NOT may allow for earlier detection of functional difficulties. Understanding errors and strategies used during NOT performance could also have implications for individualized interventions.

Identifying Feigned Cognitive Impairment: Investigating the Utility of Diffusion Model Analyses

Forced-choice performance validity tests are routinely used for the detection of feigned cognitive impairment. The drift diffusion model deconstructs performance into distinct cognitive processes using accuracy and response time measures. It thereby offers a unique approach for gaining insight into examinees' speed-accuracy trade-offs and the cognitive processes that underlie their performance. The current study is the first to perform such analyses using a well-established forced-choice performance validity test. To achieve this aim, archival data of healthy participants, either simulating cognitive impairment in the Word Memory Test or performing it to the best of their ability, were analyzed using the EZ-diffusion model (N = 198). The groups differed in the three model parameters, with drift rate emerging as the best predictor of group membership. These findings provide initial evidence for the usefulness of the drift diffusion model in clarifying the cognitive processes underlying feigned cognitive impairment and encourage further research.

The validity, reliability and clinical utility of a performance-based executive function assessment in people with mild to moderate dementia

Objective: Performance-based evaluation of executive function by using real-world daily living activities is an important area of study. This approach has been used extensively in evaluating patients after stroke or traumatic brain injury and patients with schizophrenia. Most important is the fact that until now, there has been no validated performance-based evaluation of executive function in people with dementia.Methods: To address that knowledge gap, this study recruited 80 patients diagnosed with dementia and 80 demographically matched healthy controls. The participants were administered tests for evaluating their performance-based executive function (Chinese Multiple Errands Test), their instrumental activities of daily living (Lawton Instrumental Activities of Daily Living Scale, Chinese Version), and their functional disability (Chinese Version of the Disability Assessment for Dementia), along with a cognitive screening test (Montreal Cognitive Assessment, Hong Kong Version) and a neuropsychological test of executive function (Trail-making Test).Results: The Chinese Multiple Errands Test demonstrated excellent inter-rater reliability, test-retest reliability and high internal consistency. Results revealed that the healthy controls out-performed the dementia patients in the performance-based executive function and cognitive screening, but not in the instrumental activities of daily living tests. Additionally, the performance efficiency scores of the older adults with dementia on the Chinese Multiple Errands Test correlated significantly with their performance results on the neuropsychological test of executive function and on the tests of functional disability and cognitive function.Conclusion: Our results indicated that the Chinese Multiple Errands Test is a reliable and valid instrument for assessing executive function in Chinese older people with dementia.

Eye tracking as a mean to detect feigned cognitive impairment in the word memory test

Eye movements showed initial promise for the detection of deception and may be harder to consciously manipulate than conventional accuracy measures. Therefore, we integrated an eye-tracker with the Word Memory Test (WMT) and tested its usefulness for the detection of feigned cognitive impairment. As part of the study, simulators (n = 44) and honest controls (n = 41) performed WMT's immediate-recognition (IR) subtest while their eye movements were recorded. In comparison to the control group, simulators spent less time gazing at relevant stimuli, spent more time gazing at irrelevant stimuli, and had a lower saccade rate. Group classification using a scale that combined the eye movement measures and the WMT's accuracy measure showed tentative promise (i.e., it enhanced classification compared to the use of the accuracy measure as the sole predictor of group membership). Overall, integration of an eye-tracker with the WMT was found to be feasible and the eye movement measures showed initial promise for the detection of feigned cognitive impairment. Moreover, eye movement measures proved useful in enhancing our understanding of strategies utilized by the simulators and the cognitive processes that affect their behavior. While the findings are clearly preliminary, we hope that they will encourage further research of these promising psychophysiological measures.

Effects of Depression and Antidepressant Use on Cognitive Deficits and Functional Cognition Following Severe Traumatic Brain Injury

OBJECTIVE

To use a Rehabilomics framework to evaluate relations hips between post-traumatic brain injury (TBI) depression (PTD) and potential associated factors, including antidepressant use, on cognitive recovery following severe TBI.

PARTICIPANTS

Severe TBI survivors (n = 154), recruited from a level 1 trauma center.

DESIGN

Prospective cohort study with assessments at 6 and 12 months postinjury.

MAIN MEASURES

Patient Health Questionnaire-9 (PTD symptoms); cognitive composite score from a neuropsychological assessment battery (cognitive impairment); and Functional Independence Measure-Cognition (FIM-Cog, self-reported functional cognition).

RESULTS

Individuals with and without PTD did not differ with respect to cognitive impairment. However, antidepressant use, regardless of PTD status, was associated with cognitive impairment. Individuals with PTD reported lower FIM-Cog scores at both time points compared with those without PTD. In a post hoc longitudinal analysis, individuals with late-onset PTD had worse cognitive impairment.

CONCLUSION

These results suggest that antidepressant use impairs cognition among individuals without PTD. Also, PTD did not directly affect cognitive impairment but may affect functional cognitive limitations through self-evaluation and apathy/motivation factors.

Assessment of feigned cognitive impairment in severe traumatic brain injury patients with the Forced-choice Graphics Memory Test

INTRODUCTION

The Forced-choice Graphics Memory Test (FGMT) is a newly developed measure to assess feigned cognitive impairment. This study investigated the ability and reliability of FGMT for identification of malingering in patients with traumatic brain injury (TBI).

METHODS

The FGMT was administered to 40 healthy volunteers instructed to respond validly (Healthy Control, H-C), 40 healthy volunteers instructed to feign cognitive impairment (Healthy Malingering, H-M), 40 severe TBI patients who responded validly (TBI control, TBI-C), and 30 severe TBI patients who evidenced invalid performance (TBI malingering, TBI-M).

RESULTS

Both malingering groups (H-M and TBI-M) performed much more poorly than the nonmalingering groups (H-C and TBI-C). The FGMT overall total score, score on easy items, and score on hard items differed significantly across the four groups. The total score showed the highest classification accuracy in differentiating malingering from nonmalingering. A cutoff of less than 18 (total items) successfully identified 95% of TBI-C and 93.3% of TBI-M participants. The FGMT also demonstrated high test-retest reliability and internal consistency. FGMT scores were not affected by TBI patients' education, gender, age, or intelligence.

CONCLUSION

Our results suggest that the FGMT can be used as a fast and reliable tool for identification of feigned cognitive impairment in patients with TBI.