Normative problems for the Wechsler Memory Scale-revised logical memory test when used in litigation.

A sample of 100 neuropsychologically normal worker's compensation claimants was evaluated with the Trail Making Test, the Logical Memory Test of the Wechsler Memory Scale-Revised (WMS-R) (immediate and delayed) and the (MMPI) to determine the appropriateness of the Logical Memory norms for individuals in litigation. Results indicate these claimants performed below normal, possibly due to depression or poor motivation while age and education were not important factors. The danger of using such norms uncritically in litigation cases is discussed.     

MMPI-2 indices of psychological disturbance and attention and memory test performance in head injury

A number of studies have investigated the relationship between psychological disturbance and neuropsychological (NP) test performance. The current study is a replication and extension of who found that MMPI-2 indices of psychological disturbance are related to performance on NP tests of attention and memory in psychiatric and head-injured patients. In a large sample (N=381) referred for evaluation after sustaining presumed head injury, we examined the relationship between MMPI-2 indices of psychological disturbance and measures of attention and memory from the Wechsler Memory Scale-Revised (WMS-R), Wechsler Adult Intelligence Scale-Revised (WAIS-R), California Verbal Learning Test (CVLT), and the Memory Assessment Scales (MAS). Although related to other domains, MMPI-2 variables were most consistently related to measures of attention and List Learning. Even when demographic variables, injury severity, and litigation status were controlled, MMPI-2 indices significantly predicted performance on six out of eight tests. However, the correspondence between similar indices on the WMS-R and MAS were relatively low, especially for Verbal Memory and Visual Reproduction. Further, litigation was significant in predicting only 2 of 8 attention and memory indices.     

An investigation of the relationship between self-report of memory functioning and memory test performance.

Memory complaints are some of the most common cognitive problems presented to clinical psychologists and neuropsychologists. However, the probable validity of memory complaints presented to a psychologist rarely has been validated by objective memory tests. Using the Memory Functioning Questionnaire (MFQ; Gilewski et al., 1983), 62 relatively young adults reported the extent to which they were experiencing various types of memory problems. These data were compared with findings of memory and non-memory tests on an expanded Halstead-Reitan test battery and with the MMPI/MMPI-2. Results showed that with the exception of persons with more than one MMPI/MMPI-2 evaluation, memory complaints were not related more to memory than to non-memory tests.     

The question of validity of neuropsychological test scores among head-injured litigants: development of a dissimulation index.

Two groups of 20 head-injured subjects were studied. One group was involved in litigation related to the head injury and the other group was not involved in litigation. Every subject had been tested twice, with the intertest mean interval for the two groups ranging from 12.00 to 14.45 months, a statistically insignificant difference. Two indexes of consistency of test-retest performance, which have been reported previously (Reitan Dissimulation Index. Comparison of the distributions for the two groups on the Dissimulation Index revealed no overlap; in fact, a gap of several points separated the groups. Every litigation subject performed with less consistency than any nonlitigation subject. Using an approach based on intra-individual test comparisons shows promise of alleviating the vexing problem of invalidity of neuropsychological test results.     

Measuring effort in neuropsychological evaluations of forensic cases of Spanish speakers

Changing demographics indicate a dramatic growth in Spanish speakers in the USA. There is an increasing need to provide valid neuropsychological evaluations to these individuals as well as interest in providing the same in Latin American countries. This is especially the case with symptom validity testing, in general, and those involved with litigation in particular. To address this situation, the Dot Counting Test, the Rey 15-Item Test, and the Test of Memory Malingering were administered to clinical controls as well as individuals involved in litigation-forensic non-capital and forensic capital murder cases. The results represent a first step toward the determination of the utility of those tests to address effort in Spanish speakers in the USA.     

The validity of the modified word learning test

Inspected reports on 59 psychiatric patients who had completed the Modified Word Learning Test (MWLT), Memory for Designs Test, and the Wechsler Adult Intelligence Scale in order to assess the validity of the MWLT. It was found that MWLT scores were correlated with age, Verbal Scale and Full Scale IQs and Verbal-Performance Discrepancies. In addition, there was 61% agreement in classification with the Memory for Designs Test. It was suggested tentatively that the MWLT may misclassify patients with low Verbal Scale IQs.     

Wechsler memory scale is a poor screening test for brain dysfunction

The effectiveness of the Wechsler Memory Scale as a screening test for brain dysfuntion when used with “new” scoring procedures was assessed in this cross-validation study. The scoring procedures studied were those reported by Bachrach and Mintz (1974) and Kljajic (1975). In general, these procedures were found to be unreliable methods to separate brain dysfunctional patients from psychiatric patients. While the Wechsler Memory Scale may be a good test of short-term verbal memory, it samples too narrow a band of behaviors to be a reliable screening instrument of brain dysfunction in a large range of patients.     

Performance of alcoholic and brain-damaged subjects on the Luria memory words test

Verbal memory was evaluated in groups of 36 community controls, 50 pseudoneurological controls, 50 alcoholics, and 50 brain-damaged patients. All participants were men between the ages of 22-61. Groups did not differ in age or educational levels (F < 1). Groups were compared on their performance on the Luria Memory Words Test. Dependent variables included the number of correct words over learning trials, the trial of best performance, and the number of words recalled at three delayed trials (2, 8, and 30 min after learning). Brain-damaged subjects were inferior to community controls on all measures. Pseudoneurological controls were inferior to community controls on delayed recall, but were equivalent on measures of learning. Alcoholics were inferior to controls on measures of learning but did not differ on measures of recall. Implications regarding the underlying deficit in alcoholics' verbal memory, the use and interpretation of the Luria Memory Words test, and the use of pseudoneurological patients as controls are discussed.     

Concordance between the CVLT and the WMS-III word lists test.

The California Verbal Learning Test (CVLT) and the Word Lists Test (WLT) from the Wechsler Memory Scale-III are widely used tests of verbal learning and memory. To examine concordance between these popular tests, we administered both to a diagnostically diverse group of 25 patients. As expected, measures from the two tests were highly correlated, although level of concordance was not as high as might be expected. When diagnostic outcomes were discordant for free recall measures, the CVLT indicated impairment more often than did the WLT.     

Test of Memory Malingering Performance is unaffected by laboratory-induced pain: implications for clinical use.

The Test of Memory Malingering (TOMM) is a well-validated and widely used forced-choice symptom validity test. However, little is known about how TOMM performance is affected by pain. The present study evaluated the sensitivity of the TOMM to pain induced in healthy participants via the cold-presser test. Participants (n=20 per group) were administered the TOMM under one of three conditions: (1) standard instructions; (2) instructions to simulate pain-related memory deficit in pursuit of personal injury litigation; (3) while experiencing cold-induced pain. Results indicate that TOMM performance was unaffected by laboratory-induced moderate to severe pain and support the TOMM's use in evaluating clinical patients with pain.     

The effect of acute stress on subsequent neuropsychological test performance (2003).

Acute mental stressors have been implicated as variables that may deleteriously affect neuropsychological test performance by increasing distractibility and decreasing working memory function. This study examined 25 subjects with no known neurological or psychiatric impairment on a brief battery of neuropsychological measures on alternate days following either rest or induced mental stress in a counterbalanced design. The test battery consisted of the Rey Auditory-Verbal Learning Test, the Rey Complex Figure, and three Wechsler Memory Scale-III subtests (Logical Memory, Digit Span, and Visual Memory Span). The Ss average age was 24.8 years (S.D. = 10.1) and average education was 15.0 years (S.D. = 1.6). The mental stressor employed was a videotaped public-speaking exercise that has been shown in previous work to induce negative mood, cardiovascular reactivity, and perceived mental stress. Ss demonstrated statistically significant (P < .05) increases in negative mood, heart rate, diastolic blood pressure, and systolic blood pressure as well as elevated cortisol concentration following induced stress, suggesting substantially increased adrenocortical reactivity and cardiovascular stress response. There were, however, no statistically significant differences in any of the neuropsychological measures when stress versus rest days were compared. The results suggest that acute mental stressors may have no measurable effect on subsequent performance on selected neuropsychological tests in a normal population. Further work is suggested to determine whether pre-existing anxiety-related psychopathology or pre-existing neurological compromise might interact with induced mental stress to cause decrements in neuropsychological test performance.     

The effect of warning on malingering on memory and motor tasks in college samples.

The effect of a warning regarding detection of simulated cognitive and motor deficits on the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) and Grooved Pegboard (Klove, 1963; Matthews & Klove, 1964) was examined. Undergraduates (N = 87) were randomly assigned to one of three conditions: simulators without warning, simulators with warning, and controls. It was predicted that warning participants that simulation efforts will be detected would reduce malingering behavior and this hypothesis was generally supported. Analyses indicated simulators with warning frequently approximated control group performances and were significantly better than simulators without warning on some measures. Stepwise discriminant function analysis accurately classified 57% of all participants. Results provide support for effectiveness of warning in reducing malingering behavior on selected measures and are discussed in terms of the use of warning as an adjunct to existing procedures, role of the neuropsychologist, and informed consent for assessment in personal injury litigation.     

The use of the rey memory test to assess malingering in criminal defendants

An attempt was made to evaluate the utility of the Rey Memory Test (Rey, 1964) to assess malingering in criminal defendants referred for inpatient forensic evaluation. The performance of 14 diagnosed malingerers was compared to a control group of 14 forensic inpatients who had been acquitted by reason of insanity. Malingerers performed significantly less well on the test than did controls. A previously suggested cut-off score of 9 items remembered (Lezak, 1983) resulted in correct classification of 86% of the subjects as either malingering or not malingering. However, a cut-off of 3 rows remembered correctly was found to be inappropriate because 57% of the controls would have been labeled incorrectly as malingerers.     

Factor structure,factor indexes,and other useful statistics for interpretation of the Test of Memory and Learning (TOMAL)

Using the method of principal factors with varimax and promax rotations, the 14 subtests of the TOMAL were subjected to a factor analysis using correlation matrices derived from the standardization sample. A 4-factor solution was chosen as the overall best solution when mathematical and neuropsychological variables were considered jointly. These factors (Complex Memory, Sequential Memory, Backwards Memory, and Spatial Memory) were used to develop unit-weighted factor indexes based on responses of the original standardization sample. Normative tables, reliability data, and factor structures are reported for clinical use.     

Reading disability subtypes and the test of memory and learning.

For Study 1, 24 readers with dysphonetic dyslexia and 21 with dyseidetic dyslexia, classified by Boder criteria, were compared to 90 control group participants (45 matched for age and 45 for reading level) on the Composite Memory Index (CMI) score from the Test of Memory and Learning (TOMAL). CMI scores were significantly lower for children with dyslexia (p <.0001). Plotting average subtest score profiles for all reader groups revealed auditory sequential memory impairments for both types of readers with dyslexia, and multiple strengths for good readers. Dysphonetic and dyseidetic dyslexia profiles were nearly identical. For Study 2, average linkage cluster analysis was performed using principal components derived from subtests of the TOMAL. Homogeneous clusters of normal readers and children with reading disabilities emerged. Results indicated that qualitatively distinct subtypes of readers with dyslexia exist.     

The Memory Assessment Scales and lateralized temporal lobe epilepsy

We report Memory Assessment Scales (MAS) performance in 101 patients with unilateral temporal lobe epilepsy (TLE; left, n = 51; right, n = 50) with left cerebral language dominance. A significant multivariate group effect was present for the major summary indices (Verbal Memory, Visual Memory, and Global Memory, p < .04). Univariate analyses revealed no significant differences for either the Global Memory or Verbal Memory summary scores, although a significant group difference was present for Visual Memory (p < .04). The Verbal Memory-Visual Memory discrepancy score was significantly different between right and left TLE groups (p < .004). Verbal Memory scores were at least 14 points lower than Visual Memory scores in 34 patients (left = 20, 59%; right = 14, 41%). Visual Memory scores were at least 14 points lower than Verbal Memory performance in 20 patients (left = 5, 25%; right = 15, 75%). Diagnostic efficiency statistics show higher sensitivity but lower specificity in group classification for left TLE patients. These data suggest that the MAS is sensitive to material-specific memory deficits associated with a unilateral temporal lobe seizure focus. However, over one-third of the patients (19/54) with at least a 14-point Verbal Memory-Visual Memory discrepancy were classified incorrectly. The MAS, like other material-specific memory measures, should be interpreted within the context of other clinical findings.     

Patterns of performance preservation and loss in healthy aging

Cognitive performance was studied in 67 healthy and highly educated men, ranging in age from 21 to 92 years old. Principal component analysis yielded five independent factors: Perceptual Reasoning, Visuospatial Memory and Organization, Verbal Fund of Knowledge, Verbal Discourse Memory, and Verbal Memory and Organization. The first two factors declined significantly (p < .05) with advancing age, whereas the other factors were not significantly correlated with advancing age. Further analysis indicates that Factor 1 explains all significant age related variance in neuropsychological performance. The data suggest that decline in visuospatial performance with age occurs even in the absence of disease and that memory functions are relatively well preserved in healthy individuals.     

Language of administration and neuropsychological test performance in neurologically intact Hispanic American bilingual adults

This study compared the performance of Hispanic American bilingual adults on Spanish and English language versions of a neuropsychological test battery. Language achievement test scores were used to divide 36 bilingual, neurologically intact, Hispanic Americans from south Texas into Spanish-dominant, balanced, and English-dominant bilingual groups. They were administered the eight subtests of the Bateria Neuropsicologica and the Matrix Reasoning subtest of the WAIS-III in Spanish and English. Half the participants were tested in Spanish first. Balanced bilinguals showed no significant differences in test scores between Spanish and English language administrations. Spanish and/or English dominant bilinguals showed significant effects of language of administration on tests with higher language compared to visual perceptual weighting (Woodcock-Munoz Language Survey-Revised, Letter Fluency, Story Memory, and Stroop Color and Word Test). Scores on tests with higher visual-perceptual weighting (Matrix Reasoning, Figure Memory, Wisconsin Card Sorting Test, and Spatial Span), were not significantly affected by language of administration, nor were scores on the Spanish/California Verbal Learning Test, and Digit Span. A problem was encountered in comparing false positive rates in each language, as Spanish norms fell below English norms, resulting in a much higher false positive rate in English across all bilingual groupings. Use of a comparison standard (picture vocabulary score) reduced false positive rates in both languages, but the higher false positive rate in English persisted.     

The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluation

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) adults is difficult, as neither symptom report nor neuropsychological findings are specific to ADHD. Few studies address the possibility that noncredible performance influences both symptom report and neuropsychological findings. The present study utilized archival data from young adults referred for concerns about ADHD, divided into three groups: (1) those who failed a measure of noncredible performance (the Word Memory Test; WMT), (2) those who met diagnostic criteria for ADHD, and (3) controls with psychological symptoms but no ADHD. Results showed a 31% failure rate on the WMT. Those who failed the WMT showed clinical levels of self-reported ADHD symptoms and impaired neuropsychological performance. Neither self-report measures nor neuropsychological tests could distinguish ADHD from psychological controls, with the exception of self-reported current hyperactive/impulsive symptoms and Stroop interference. Results underscore the effect of noncredible performance on both self-report and cognitive measures in ADHD.     

Memory Complaints Inventory results as a function of symptom validity test performance

The extant literature has consistently outlined a limited relationship between peoples' subjective reports of defective memory and their corresponding performances on objective measures of memory functioning. Several variables have been proposed to explain this finding, but few studies have investigated test-taker effort as a variable of interest. The primary aim of the current study was to examine reported memory problems as a function of symptom validity test (SVT) performances in two independent samples comprising individuals involved in disability claims. The findings demonstrated that as various SVT performances worsened there was a corresponding increase in subjective reports of memory complaints as assessed by the Memory Complaints Inventory. Data also supported the previous literature demonstrating non-significant correlations between subjective reports of memory problems and objective memory functioning in those who passed SVTs. The potential implications for these findings are discussed.