Symptom and Performance Validity Assessment in Older Adults and Patients with Dementia and Claimed Dementia

Abstract

Individual test scores are not automatically valid reflections of the underlying attributes; they may be distorted due to a variety of reasons. Symptom and performance validity assessment is the method of choice to arrive at determinations about the credibility of symptom reports and the trustworthiness of test profiles. Reliable prevalence estimates about feigned symptom presentations in older adults are not available, and published case studies about malingered dementia are scarce. In forensic assessment contexts, implicit malingering of dementia (i.e., presentations suggestive of a dementing condition without explicit claims of dementia) are expected to occur more frequently than explicitly malingered dementias. The bulk of empirical studies is focused on two problems: (1) the applicability of validity tests in persons of advanced age, with or without known cognitive impairment, and (2) the adaptation of existing cut scores to geriatric samples or patients with dementia. Geriatric neuropsychologists are confronted with a double challenge when evaluating older adults; they should be knowledgeable both in the differential diagnosis of the dementias and in symptom and performance validity assessment.