Reading Ability as an Estimator of Premorbid Intelligence: Does It Remain Stable Among Ethnically Diverse HIV+ Adults?

The Wide Range Achievement Test, 3rd edition, Reading Recognition subtest (WRAT-3 RR) is an established measure of premorbid ability. Furthermore, its long-term reliability is not well documented, particularly in diverse populations with CNS-relevant disease. Objective: We examined test–retest reliability of the WRAT-3 RR over time in an HIV+ sample of predominantly racial/ethnic minority adults. Method: Participants (N = 88) completed a comprehensive neuropsychological battery, including the WRAT-3 RR, on at least two separate study visits. Intraclass correlation coefficients (ICCs) were computed using scores from baseline and follow-up assessments to determine the test–retest reliability of the WRAT-3 RR across racial/ethnic groups and changes in medical (immunological) and clinical (neurocognitive) factors. Additionally, Fisher’s Z tests were used to determine the significance of the differences between ICCs. Results: The average test–retest interval was 58.7 months (SD = 36.4). The overall WRAT-3 RR test–retest reliability was high (r = .97, p < .001) and remained robust across all demographic, medical, and clinical variables (all r’s > .92). ICCs did not differ significantly between the subgroups tested (all Fisher’s Z p’s > .05). Conclusions: Overall, this study supports the appropriateness of word-reading tests, such as the WRAT-3 RR, for use as stable premorbid IQ estimates among ethnically diverse groups. Moreover, this study supports the reliability of this measure in the context of change in health and neurocognitive status and in lengthy inter-test intervals. These findings offer strong rationale for reading as a “hold” test, even in the presence of a chronic, variable disease such as HIV.     

Excessive decline from premorbid functioning: detecting performance invalidity with the WAIS-IV and demographic predictions

Objective: Excessive Decline from Premorbid Functioning (EDPF) is presented as a construct and defined as a discrepancy between predicted premorbid ability and current test performance that is so atypical of individuals with true neurocognitive impairment that it is likely the product of performance invalidity. New embedded PVTs (EDPF-FSIQ, EDPF-VW, and EDPF-PP) were derived by comparing scores from the WAIS-IV to TOPF demographically predicted premorbid estimates and then examined for classification accuracy. Participants and methods: After excluding for dementia, intellectual disability, and left-sided stroke, participants (n = 230) were grouped according to number of PVTs failed. ROC analyses were conducted to determine the accuracy of EDPF indices in classifying patients as failing 0 or ≥2 PVTs within both a mixed neuropsychological outpatient sample and according to specific diagnostic criterion groups. Results: Significant group differences emerged for all EDPF indices (p < .001). EDPF-FSIQ resulted in an AUC of .837, classifying patients with 56% sensitivity at ≥90% specificity, and EDPF-VW resulted in an AUC of .850, classifying patients with 61% sensitivity at ≥90% specificity. Accuracy remained high across diagnostic groups (i.e. neurocognitive, moderate/severe TBI, and psychiatric) for EDPF-VW and EDPF-FSIQ, whereas specificity declined for EDPF-PP in patients with mixed neurocognitive disorders. Overall, classification accuracy rates exceeded those of Reliable Digit Span. Conclusions: Both EDPF-FSIQ and EDPF-VW demonstrated excellent discrimination between patients providing valid versus invalid test performance. Unique advantages of EDPF validity measures include incorporation of demographic estimates of premorbid ability and examination of performances on multiple tests spanning different cognitive domains.     

The power of timing: Adding a time-to-completion cutoff to the Word Choice Test and Recognition Memory Test improves classification accuracy

Introduction: The Recognition Memory Test (RMT) and Word Choice Test (WCT) are structurally similar, but psychometrically different. Previous research demonstrated that adding a time-to-completion cutoff improved the classification accuracy of the RMT. However, the contribution of WCT time-cutoffs to improve the detection of invalid responding has not been investigated. The present study was designed to evaluate the classification accuracy of time-to-completion on the WCT compared to the accuracy score and the RMT. Method: Both tests were administered to 202 adults (M_age = 45.3 years, SD = 16.8; 54.5% female) clinically referred for neuropsychological assessment in counterbalanced order as part of a larger battery of cognitive tests. Results: Participants obtained lower and more variable scores on the RMT (M = 44.1, SD = 7.6) than on the WCT (M = 46.9, SD = 5.7). Similarly, they took longer to complete the recognition trial on the RMT (M = 157.2 s,SD = 71.8) than the WCT (M = 137.2 s, SD = 75.7). The optimal cutoff on the RMT (≤43) produced .60 sensitivity at .87 specificity. The optimal cutoff on the WCT (≤47) produced .57 sensitivity at .87 specificity. Time-cutoffs produced comparable classification accuracies for both RMT (≥192 s; .48 sensitivity at .88 specificity) and WCT (≥171 s; .49 sensitivity at .91 specificity). They also identified an additional 6–10% of the invalid profiles missed by accuracy score cutoffs, while maintaining good specificity (.93–.95). Functional equivalence was reached at accuracy scores ≤43 (RMT) and ≤47 (WCT) or time-to-completion ≥192 s (RMT) and ≥171 s (WCT). Conclusions: Time-to-completion cutoffs are valuable additions to both tests. They can function as independent validity indicators or enhance the sensitivity of accuracy scores without requiring additional measures or extending standard administration time.     

Performance validity testing in a clinical sample of adults with sickle cell disease

Objective: Neuropsychologists utilize performance validity tests (PVTs) as objective means for drawing inferences about performance validity. The Test of Memory Malingering (TOMM) is a well-validated, stand-alone PVT and the Reliable Digit Span (RDS) and Reliable Digit Span-Revised (RDS-R) from the Digit Span subtest of the WAIS-IV are commonly employed, embedded PVTs. While research has demonstrated the utility of these PVTs with various clinical samples, no research has investigated their use in adults with sickle cell disease (SCD), a condition associated with multiple neurological, physical, and psychiatric symptoms. Thus, the purpose of this study was to explore PVT performance in adults with SCD. Method: Fifty-four adults with SCD (M_age = 40.61, SD = 12.35) were consecutively referred by their hematologist for a routine clinical outpatient neuropsychological evaluation. During the evaluation, participants were administered the TOMM (Trials 1 and 2), neuropsychological measures including the WAIS-IV Digit Span subtest, and mood and behavioral questionnaires. Results: The average score on the TOMM was 47.70 (SD = 3.47, range = 34–50) for Trial 1 and 49.69 (SD = 1.66, range = 38–50) for Trial 2. Only one participant failed Trial 2 of the TOMM, yielding a 98.1% pass rate for the sample. Pass rates at various RDS and RDS-R values were calculated with TOMM Trial 2 performance as an external criterion. Conclusions: Results support the use of the TOMM as a measure of performance validity for individuals with SCD, while RDS and RDS-R should be interpreted with caution in this population.     

Using the California Verbal Learning Test,Second Edition as an embedded performance validity measure among individuals with TBI and individuals with psychiatric disorders

Objective: Among embedded performance validity tests (PVTs), little research addresses the use of Total Hits and Total False Positives from the California Verbal Learning Test, Second Edition (CVLT-II) in spite of low sensitivity, particularly in psychiatric samples. Method: This study examined the classification accuracy of these two measures in individuals with psychiatric disorders or mild traumatic brain injury (MTBI). These samples were separated into two groups using the criteria of passing all PVTs versus failing 2 or more PVTs. They were also compared to a criterion group of moderate to severe traumatic brain injury (M-STBI) patients who passed all PVTs. The sample included 176 individuals consecutively referred for neuropsychological testing (mean age = 46.31, SD = 15.30; mean education = 13.07, SD = 2.50, 52.3% males; 91.2% Caucasian) who met study criteria. Results: For classification accuracy, Total Hits in the psychiatric group had excellent classification accuracy (Area Under the Curve [AUC] = .82; Sensitivity = .47; Specificity = .90), whereas Total False Positives (AUC = .49) demonstrated poor classification accuracy. The MTBI group had similar results, with Total Hits having excellent classification accuracy (AUC = .88; Sensitivity = .60; Specificity = .90), whereas Total False Positive (AUC = .62) did not. Conclusions: Results provide preliminary support for using Total Hits; however, Total False Positives were ineffective in identifying non-credible patients with psychiatric disorders or MTBI. Total Hits also compared favorably to other embedded CVLT measures.     

The relationship between smell identification and neuropsychological domains: Results from a sample of community-dwelling adults suspected of dementia

Objective: This study aimed to test the theoretical relationships between smell identification and cognitive tasks based on existing neuroimaging and anatomical findings.

Method: Utilizing data collected from a memory assessment clinic, theory-derived mediation and moderation models were tested. The sample used in this study consisted of 103 (39 male, 64 female) individuals referred for memory assessments. The sample’s mean education was 12.4 years (SD = 3.2), and the mean age of the sample was 77.2 years (SD = 6.3).

Results: The University of Pennsylvania Smell Identification Test (UPSIT) was a significant, partial mediator of the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Immediate and Delayed Memory indexes. Olfactory identification did not mediate list learning and retrieval; however, olfactory identification was a significant partial mediator of the relationship between story encoding and later memory retrieval of the story. Olfactory identification also fully mediated the relationship between a visuospatial construction task and its reconstruction from memory after a short delay. The relationship between processing speed and the olfactory identification was significantly mediated by semantic memory. Finally, the UPSIT moderated the relationship between a measure of premorbid ability, the Wechsler Test of Adult Reading, and current global cognitive functioning.

Conclusions: Our results support theoretical relationships between olfaction and neuropsychological domains. Additionally, our results suggest that the UPSIT may serve as a proxy for cerebral integrity and is likely related to the duration of neurodegeneration.     

Estimation of K-WAIS-IV Premorbid Intelligence in South Korea: Development of the KPIE-IV

Objective: The accurate estimation of premorbid intellectual functioning in patients with known or suspected cognitive impairment is crucial for clinicians. However, there is no reliable method for estimating premorbid intelligence in South Korea. The purpose of this study was to develop the Korea Premorbid Intelligence Estimate (KPIE) as an estimate of the premorbid intellectual functioning. Method: Data from the Korean WAIS-IV standardization sample were used to generate several Full Scale Intelligence Quotient (FSIQ) estimation formulas using demographic variables and current WAIS-IV subtest performance. The standardization sample (N = 1216) was randomly divided into two groups: the first group was used to develop the formulas and the second group was used to validate the prediction equations. Age, education, gender, region of the country, and select subtest raw scores (Vocabulary, Information, Matrix Reasoning, and Visual Puzzle) were used as predictor variables. Results: Five KPIE-4 equations were generated. Estimated FSIQ derived from the KPIE-4 equation is highly correlated with K-WAIS-IV FSIQ. Conclusions: The resulting formulas for estimating premorbid FSIQ were highly significant and precise in predicting FSIQ scores of participants in the K-WAIS-IV normative sample. These equations provide a means for clinicians to estimate intellectual functioning in adults, and can be utilized as a method of estimating individuals premorbid functioning.     

The 15-item version of the Boston Naming Test as an index of English proficiency

Objective: The present study was designed to examine the potential of the Boston Naming Test – Short Form (BNT-15) to provide an objective estimate of English proficiency. A secondary goal was to examine the effect of limited English proficiency (LEP) on neuropsychological test performance.Method: A brief battery of neuropsychological tests was administered to 79 bilingual participants (40.5% male, M_Age = 26.9, M_Education = 14.2). The majority (n = 56) were English dominant (EN), and the rest were Arabic dominant (AR). The BNT-15 was further reduced to 10 items that best discriminated between EN and AR (BNT-10). Participants were divided into low, intermediate, and high English proficiency subsamples based on BNT-10 scores (≤6, 7–8, and ≥9). Performance across groups was compared on neuropsychological tests with high and low verbal mediation.Results: The BNT-15 and BNT-10 respectively correctly identified 89 and 90% of EN and AR participants. Level of English proficiency had a large effect (partial η² = .12–.34; Cohen’s d = .67–1.59) on tests with high verbal mediation (animal fluency, sentence comprehension, word reading), but no effect on tests with low verbal mediation (auditory consonant trigrams, clock drawing, digit-symbol substitution).Conclusions: The BNT-15 and BNT-10 can function as indices of English proficiency and predict the deleterious effect of LEP on neuropsychological tests with high verbal mediation. Interpreting low scores on such measures as evidence of impairment in examinees with LEP would likely overestimate deficits.     

Multicomponent analysis of a digital Trail Making Test

Objective: The purpose of the current study was to use a newly developed digital tablet-based variant of the TMT to isolate component cognitive processes underlying TMT performance.Method: Similar to the paper-based trail making test, this digital variant consists of two conditions, Part A and Part B. However, this digital version automatically collects additional data to create component subtest scores to isolate cognitive abilities. Specifically, in addition to the total time to completion and number of errors, the digital Trail Making Test (dTMT) records several unique components including the number of pauses, pause duration, lifts, lift duration, time inside each circle, and time between circles. Participants were community-dwelling older adults who completed a neuropsychological evaluation including measures of processing speed, inhibitory control, visual working memory/sequencing, and set-switching. The abilities underlying TMT performance were assessed through regression analyses of component scores from the dTMT with traditional neuropsychological measures.Results: Results revealed significant correlations between paper and digital variants of Part A (r_s = .541, p < .001) and paper and digital versions of Part B (r_s = .799, p < .001). Regression analyses with traditional neuropsychological measures revealed that Part A components were best predicted by speeded processing, while inhibitory control and visual/spatial sequencing were predictors of specific components of Part B. Exploratory analyses revealed that specific dTMT-B components were associated with a performance-based medication management task.Conclusions: Taken together, these results elucidate specific cognitive abilities underlying TMT performance, as well as the utility of isolating digital components.     

Test of Memory Malingering (TOMM) Scores are not Affected by Chronic Pain or Depression in Patients with Fibromyalgia

Neuropsychologists routinely give effort tests, such as the Test of Memory Malingering (TOMM). When a person fails one of these tests, the clinician must try to determine whether the poor performance was due to suboptimal effort or to chronic pain, depression, or other problems. Participants were 54 community-dwelling patients who met American College of Rheumatology criteria for fibromyalgia (FM). In addition to the TOMM, they completed the Beck Depression Inventory–Second Edition, Multidimensional Pain Inventory–Version 1, Oswestry Disability Index–2.0, British Columbia Cognitive Complaints Inventory, and the Fibromyalgia Impact Questionnaire. The majority endorsed at least mild levels of depressive symptoms (72%), and 22% endorsed “severe” levels of depression. The average scores on the TOMM were 48.8 (SD = 1.9, range = 40–50) for Trial 1, 49.8 (SD = 0.5, range = 48–50) for Trial 2, and 49.6 (SD = 0.9, range = 45–50) for Retention. Despite relatively high levels of self-reported depression, chronic pain, and disability, not a single patient failed the TOMM. In this study, the TOMM was not affected by chronic pain, depression, or both.     

Base rate comparison of suboptimal scores on the RBANS effort scale and effort index in Parkinson’s disease

Objective: The effort index (EI) and the effort scale are commonly used embedded effort indicators on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). This investigation examined the rates of suboptimal scores on the EI and effort scale in a Parkinson’s disease (PD) sample. Method: One hundred and sixty-three participants who have been diagnosed with PD by a board-certified neurologist were included in the study. The base rate of suboptimal scores on the EI and effort scale was calculated for the entire group. Results: On average, participants were 66.8 years of age (SD = 9.5) and had a mean education of 13.5 years (SD = 2.79). The mean Mini-Mental State Examination score was 27.0 (SD = 3.1). Overall, 8% of participants scored below the cut-off for optimal performance on the EI while 62.6% performed in the suboptimal range for the effort scale. Conclusion: The utility of the EI and the effort scale in PD populations warrants further examination. Additionally, results demonstrate the need for validation of embedded RBANS effort measures in various disease populations.     

Performance validity and processing speed in a VA Polytrauma sample

Objective: While recognition memory has been the primary tool for the assessment of performance validity in neuropsychological evaluations, some consideration has also been given to embedded measures from other cognitive domains, including processing speed. The present study evaluated the classification accuracy of several speed-based measures in a Veterans Affairs Medical Center Polytrauma sample. Method: The present sample consisted of 114 military veterans (Mean age = 35.5, SD = 9.4) referred for a suspected history of mild traumatic brain injury who were administered a full neuropsychological protocol that included several validity checks. Veterans were assigned to Valid (n = 80) or Invalid (n = 34) groups based on outcomes of performance validity measures (PVMs). Results: Several processing speed measures yielded acceptable or excellent classification accuracy; sensitivity values ranged from 29 to 53% with specificity values above 90%. Efforts to identify an improved algorithm that would collapse across multiple processing speed PVMs were unsuccessful compared to classification based on single measures. Conclusions: Processing speed measures can serve as efficient performance validity assessment tools.     

Temporal Stability of the Dutch Version of the Wechsler Memory Scale—Fourth Edition (WMS-IV-NL)

Objective: The Wechsler Memory Scale—Fourth Edition (WMS-IV) is one of the most widely used memory batteries. We examined the test–retest reliability, practice effects, and standardized regression-based (SRB) change norms for the Dutch version of the WMS-IV (WMS-IV-NL) after both short and long retest intervals. Method: The WMS-IV-NL was administered twice after either a short (M = 8.48 weeks, SD = 3.40 weeks, range = 3–16) or a long (M = 17.87 months, SD = 3.48, range = 12–24) retest interval in a sample of 234 healthy participants (M = 59.55 years, range = 16–90; 118 completed the Adult Battery; and 116 completed the Older Adult Battery). Results: The test–retest reliability estimates varied across indexes. They were adequate to good after a short retest interval (ranging from .74 to .86), with the exception of the Visual Working Memory Index (r = .59), yet generally lower after a long retest interval (ranging from .56 to .77). Practice effects were only observed after a short retest interval (overall group mean gains up to 11 points), whereas no significant change in performance was found after a long retest interval. Furthermore, practice effect-adjusted SRB change norms were calculated for all WMS-IV-NL index scores. Conclusions: Overall, this study shows that the test–retest reliability of the WMS-IV-NL varied across indexes. Practice effects were observed after a short retest interval, but no evidence was found for practice effects after a long retest interval from one to two years. Finally, the SRB change norms were provided for the WMS-IV-NL.     

National Association of Psychometrists: 2015 professional practices and salary survey of U.S. and Canadian psychometrists

Objective: The National Association of Psychometrists (NAP) conducted a salary survey to collect data regarding common practices and income of individuals employed as psychometrists. Methods: An email with a survey link was sent to NAP members and posted on the NAP website. There were 118 responses; most from the United States. Results: Canadian data was excluded from compensation analysis due to imprecision in the survey/exchange rates. Most respondents reported full time employment. Respondents’ educations were equally split between bachelor’s and master’s degrees. More than half reported hourly compensation. Most psychometrists see one patient a day and the most frequent age range was adults between 17–59 years old. Administration times ranged from 3-5 h, except in young pediatric populations. Two hours was the most commonly reported amount of time needed to score a test battery. The average hourly wage was $23.00 ± 4.96. Certified psychometrists reported higher average hourly wages (M = 24.57, SD = 4.73) compared to those who are not certified (M = 21.53, SD = 4.76). This difference was statistically significant (p < .001) with a medium effect size (d = .64). Results of the survey also showed a significant increase in income based on years of experience as a psychometrist. Conclusions: The current survey may be used as a baseline for further study of the income and practices of psychometrists in the United States and Canada.     

Assessing the criterion validity of four highly abbreviated measures from the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS)

Objective: Cognitive dysfunction is prevalent in multiple sclerosis. As self-reported cognitive functioning is unreliable, brief objective screening measures are needed. Utilizing widely used full-length neuropsychological tests, this study aimed to establish the criterion validity of highly abbreviated versions of the Brief Visuospatial Memory Test – Revised (BVMT-R), Symbol Digit Modalities Test (SDMT), Delis–Kaplan Executive Function System (D-KEFS) Sorting Test, and Controlled Oral Word Association Test (COWAT) in order to begin developing an MS-specific screening battery. Method: Participants from Holy Name Medical Center and the Kessler Foundation were administered one or more of these four measures. Using test-specific criterion to identify impairment at both ?1.5 and ?2.0 SD, receiver-operating-characteristic (ROC) analyses of BVMT-R Trial 1, Trial 2, and Trial 1 + 2 raw data (N = 286) were run to calculate the classification accuracy of the abbreviated version, as well as the sensitivity and specificity. The same methods were used for SDMT 30-s and 60-s (N = 321), D-KEFS Sorting Free Card Sort 1 (N = 120), and COWAT letters F and A (N = 298). Results: Using these definitions of impairment, each analysis yielded high classification accuracy (89.3 to 94.3%). Conclusions: BVMT-R Trial 1, SDMT 30-s, D-KEFS Free Card Sort 1, and COWAT F possess good criterion validity in detecting impairment on their respective overall measure, capturing much of the same information as the full version. Along with the first two trials of the California Verbal Learning Test – Second Edition (CVLT-II), these five highly abbreviated measures may be used to develop a brief screening battery.     

Evaluation of performance validity using a Rey Auditory Verbal Learning Test forced-choice trial

Objective: Forced-choice (FC) recognition memory is a common performance validity assessment methodology. This study introduces and evaluates the classification accuracy of a FC recognition trial for the Rey Auditory Verbal Learning Test (RAVLT). Method: The present sample of 122 military veterans (Mean age = 35.4, SD = 9.3) were all administered the RAVLT along with the FC procedure as part of a full neuropsychological protocol. Veterans were assigned to valid (n = 94) or invalid (n = 28) groups based on outcomes of performance validity measures. Results: The FC procedure was found to have strong sensitivity (67.9%) and specificity (92.6%) in predicting validity group status based on a cutoff score of ≤ 13. The FC trial outperformed RAVLT recognition hits (sensitivity = 46.4%, specificity = 91.5%) as a predictor of invalid performance. Conclusions: The RAVLT FC is demonstrated to be an effective measure of performance validity and is recommended for use as an adjunctive trial for the RAVLT.     

Baseline cognitive test performance and concussion-like symptoms among adolescent athletes with ADHD: examining differences based on medication use

Objective: Youth with attention deficit hyperactivity disorder (ADHD) perform more poorly on preseason cognitive testing and report more baseline concussion-like symptoms but prior studies have not examined the influence of medication use on test performance or symptom reporting. This study investigated whether medication use is relevant when interpreting baseline ImPACT® results from student athletes with ADHD. Method: Participants were 39,247 adolescent athletes, ages 13–18 (mean age = 15.5 years, SD = 1.3), who completed baseline cognitive testing with ImPACT®. The sample included slightly more boys (54.4%) than girls. Differences in ImPACT® composite scores and concussion-like symptom reporting (between ADHD/No medication, ADHD/Medication, No ADHD/Medication, and Control groups) were examined with ANOVAs, conducted separately by gender. Results: In this large, state-wide data-set, youth with ADHD had greater rates of invalid ImPACT results compared to control subjects (ADHD/No Medication: girls = 10.9%, boys = 10%; ADHD/Medication: girls = 8.1%, boys = 9.1%; Controls: girls = 5.2%, boys = 6.7%). Groups differed across all ImPACT® composites (invalid profiles were removed), in the following order (from worse to better performance): ADHD/No Medication, ADHD/Medication, and Control participants. Pairwise effect sizes indicated that the largest differences were on the Visual Motor Speed composite, with the ADHD/No medication group performing worse than the ADHD/Medication group and the Controls. The ADHD/Medication group did not differ meaningfully from Controls on any composite, for either sex (d = 0 to .19). The ADHD groups did not differ on total symptom scores but both ADHD groups endorsed significantly more symptoms compared to Controls. Conclusions: Contrary to our hypothesis, we found medication use had only a subtle effect on cognitive performance and no significant effect on concussion-like symptom reporting. Student athletes reporting medication use for ADHD performed comparably to student athletes with no ADHD on baseline testing.     

The Dot Counting Test adds up: Validation and response pattern analysis in a mixed clinical veteran sample

Objective: This study cross-validated the Dot Counting Test (DCT) as a performance validity test (PVT) among a mixed clinical veteran sample. Completion time and error patterns also were examined by validity group and cognitive impairment status.

Method: This cross-sectional study included 77 veterans who completed the DCT during clinical evaluation. Seventy-four percent (N = 57) were classified as valid and 26% as noncredible (N = 20) via the Word Memory Test (WMT) and Test of Memory Malingering (TOMM). Among valid participants, 47% (N = 27) were cognitively impaired, and 53% (N = 30) were unimpaired.

Results: DCT performance was not significantly associated with age, education, or bilingualism. Seventy-five percent of the overall sample committed at least one error across the 12 stimulus cards; however, valid participants had a 27% higher rate of 0 errors, while noncredible participants had a 35% higher rate of ≥4 errors. Overall, noncredible individuals had significantly longer completion times, more errors, and higher E-scores. Conversely, those with cognitive impairment had longer completion times, but comparable errors to their unimpaired counterparts. Finally, DCT E-scores significantly predicted group membership with 83.1% classification accuracy and an area under the curve of .87 for identifying invalid performance. The optimal cut-score of 15 was associated with 70% sensitivity and 88% specificity.

Conclusion: The DCT demonstrated good classification accuracy and sensitivity/specificity for identifying noncredible performance in this mixed clinical veteran sample, suggesting utility as a non-memory-based PVT with this population. Moreover, cognitive impairment significantly contributed to slower completion times, but not reduced accuracy.     

Long-term test-retest reliability of the California Verbal Learning Test – second edition

Objective: Aging is often associated with declines in episodic memory. Reliable tracking of memory requires assessment instruments that are stable over time to better understand changes potentially attributable to neurodegenerative disease. While prior studies support the test–retest reliability of memory instruments over brief intervals, follow-up testing in clinical settings typically occurs at least one-year later. The present study evaluated the long-term test–retest reliability of the California Verbal Learning Test – second edition (CVLT-2), a widely used measure of episodic learning and memory. Method: One hundred and fifty seven healthy older adults (mean age = 68.47 years; education = 17.28 years) underwent repeat assessment at an average of 1.30 years apart. Participants underwent repeat assessment using either parallel or alternate forms at follow-up. We utilized a standardized regression-based (SRB) approach to determine statistically significant changes in test scores over time. Results: This study revealed modest 1-year test–retest correlation coefficients for the primary CVLT-2 measures (range = .57–.69) Results of SRB formulae are provided to assist clinicians with defining clinically relevant cognitive change on the CVLT-2 while controlling for confounding factors. Conclusions: Findings from this study support repeat test administration of the CVLT-2 over longer periods, and may enhance its applicability in determining longitudinal change in memory performance.     

Cross-validation of the Dot Counting Test in a large sample of credible and non-credible patients referred for neuropsychological testing

Objective: To cross-validate the Dot Counting Test in a large neuropsychological sample. Method: Dot Counting Test scores were compared in credible (n = 142) and non-credible (n = 335) neuropsychology referrals. Results: Non-credible patients scored significantly higher than credible patients on all Dot Counting Test scores. While the original E-score cut-off of ≥17 achieved excellent specificity (96.5%), it was associated with mediocre sensitivity (52.8%). However, the cut-off could be substantially lowered to ≥13.80, while still maintaining adequate specificity (≥90%), and raising sensitivity to 70.0%. Examination of non-credible subgroups revealed that Dot Counting Test sensitivity in feigned mild traumatic brain injury (mTBI) was 55.8%, whereas sensitivity was 90.6% in patients with non-credible cognitive dysfunction in the context of claimed psychosis, and 81.0% in patients with non-credible cognitive performance in depression or severe TBI. Thus, the Dot Counting Test may have a particular role in detection of non-credible cognitive symptoms in claimed psychiatric disorders. Alternative to use of the E-score, failure on ≥1 cut-offs applied to individual Dot Counting Test scores (≥6.0″ for mean grouped dot counting time, ≥10.0″ for mean ungrouped dot counting time, and ≥4 errors), occurred in 11.3% of the credible sample, while nearly two-thirds (63.6%) of the non-credible sample failed one of more of these cut-offs. Conclusions: An E-score cut-off of 13.80, or failure on ≥1 individual score cut-offs, resulted in few false positive identifications in credible patients, and achieved high sensitivity (64.0–70.0%), and therefore appear appropriate for use in identifying neurocognitive performance invalidity.