Cut Score Research Articles

Difference-Making Pathways to Frailty Through Social Factors: A Configurational Analysis.

Social disconnection is highly prevalent in older adults and is associated with frailty. It is unclear which aspects of social disconnection are most associated with frailty, which ones are difference-making, and which combination of social factors are directly linked to frailty. We conducted a secondary coincidence analysis (CNA) of 1,071 older adults from the Rush Memory and Aging Project (mean age 79.3±7.1; 75.8% female) to identify combinations of social factors that are difference-making for frailty. We included 7 demographic (e.g., age, sex, socioeconomic status) and structural (e.g., social network), functional (e.g., social support, social activity), and quality (e.g., loneliness) aspects of social connection. An established cut score of 0.2 on a frailty index was used to define frailty as the outcome. CNA produced 46 solution models for the presence of frailty in the data set. The top-scoring model was underfit, leaving a final complex solution path for frailty with the highest fit-robustness score that met the fit parameter cutoffs. We found that the combination of loneliness, low social activity, and older age was present 82% of the time when frailty was present. The combination of loneliness, social activity, and old age is difference-making for frailty, and supports the inclusion of social factors in frailty prevention and intervention. Further research is needed in diverse data sets to better understand the interrelationships between the 3 aspects of social connection and frailty.

Research on the Influence of Socialist Core Value System Construction on College Students’ Ideological and Political Education in the Context of Deep Learning

Abstract In this paper, the word-level N-gram language model applicable to Chinese word segmentation in ideological and political education is obtained through large-scale corpus training, and the Chinese word segmentation path in ideological and political education is calculated according to the conditional probability formula. On the basis of the deep learning algorithm, the Chinese participle algorithm is optimized by introducing word frequency deviation and sorted word frequency deviation indexes, and the cut score with the largest value of the participle indexes is taken as the final participle result output. Starting from the current situation, we determine the evaluation indexes of ideological and political education. Meanwhile, we complete the research design of the impact of the socialist core value system and use the SPSS22.0 and Origin2019 statistical software to carry out the research and analysis of ideological and political education. The results show that the index values of the Chinese word separation algorithm based on the 4-gram language model have also been improved by 1.15%, which means that there exists the possibility of practical application of the model in Chinese word separation in ideological and political education. The college students’ identification with the socialist core values at the national, social and personal levels are all at a high level, with values of 4.28±0.82, 4.32±0.75 and 4.61±0.62 respectively. This study improves students’ ideological-political literacy and provides references to their healthy growth.

Are South African children on track for early learning? Findings from the South African Thrive By Five Index 2021 Survey

We report on a national South African multistage cluster sampling survey of early development in 5,222 children aged 50-59 months enrolled in preschool programmes. Children were assessed on the Early Learning Outcomes Measure (ELOM 4&5), the ELOM Social-Emotional Rating Scale, and linear growth (height-for-age), in the last quarter of 2021. ELOM 4&5 is standardised for South Africa and measures development in five domains: Gross Motor, and Fine Motor Development, Numeracy and Mathematics, Cognition and Executive Functioning, and Literacy and Language skills. Cut scores are used to classify children as On Track, Falling Behind, or Falling Far Behind expected developmental standards. Post-survey weights were computed, permitting us to interpret results as representative of children attending early learning programmes. Only 45.7% of the sample were On Track overall. Apart from Literacy and Language (54.7%), no other domain exceeded 50% On Track. Children who were better off socio-economically achieved higher scores (except for Gross Motor Development). Height-for-age measurements revealed a stunting rate of 5.1%, (>8.8% in one province). A mixed linear model analysis showed that age, sex, quintile, growth status, and socio-emotional score were significant predictors of the total ELOM 4&5 score, with growth status and quintile being stronger predictors. The results indicate concerningly poor preparedness for school. Two further surveys prior to 2030 will be undertaken and used to establish the country’s progress toward meeting Sustainable Development Goal 4.2: “all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”.

Screening older adults for potential deficits in IADL using the Menu Task and Medi‐Cog‐R

AbstractBackgroundThe identification of deficits in functional performance is critical to sustaining the community independence of older adults. Screening for difficulties in the performance of cognitively demanding instrumental activities of daily living (IADL) can facilitate earlier identification of and intervention for people with impairment (Rodakowski et al., 2014). We examined whether two brief performance‐based screening measures ‐ the Menu Task and the Medi‐Cog‐R ‐ can identify those at risk of functional cognitive deficits as indicated by poor performance on the Weekly Calendar Planning Activity (WCPA).MethodUsing a cross‐sectional design we administered the Menu Task, Medi‐Cog‐R, and the WCPA to community dwelling adults 55 years of age and older (N = 280). Using established cut scores, we examined the sensitivity and specificity of the two screening measures to poor performance on WCPA Accuracy (≤ 20th percentile). Known‐group construct validity were examined by comparing impaired and unimpaired groups on the screening measures on subtests of the WCPA.ResultThe sample was 73.57% female and 73.57% white. Mean age was 69.72 (SD = 8.81) and mean education was 15.61 (SD = 3.30) years. The Menu Task demonstrated a sensitivity of .84 and a specificity of .62 and the Medi‐Cog‐R demonstrated a sensitivity of .77 and a specificity of .66 in correctly classifying individuals with potential for impaired IADL as indicated by a score at or below the 20th percentile on the WCPA. The impaired groups on both screening measures scored significantly lower on WCPA subtests of Accuracy, Appointments Entered, Efficiency, Rules, and Strategies than the unimpaired group (p < .001).ConclusionThe Menu Task and the Medi‐Cog‐R could both alert clinicians to the potential for functional cognitive deficits and need for IADL support in community dwelling older adults. Performance‐based screening measures of functional cognition can be used to prompt further assessment and intervention to promote community independence.

Do normative data specific to Greek Australian older adults improve validity of neuropsychological assessment results?

This study aimed to compare Greek Australian and English language normative data with regard to impairment rates yielded within a healthy Greek Australian older adult sample. We also examined whether optimal cut scores could be identified and capable of sensitively and specifically distinguishing between healthy Greek Australians from those with a diagnosis of Alzheimer's disease (AD). Ninety healthy Greek Australian older adults and 20 demographically matched individuals with a diagnosis of AD completed a range of neuropsychological measures, including the Wechsler Adult Intelligence Scale-Fourth Edition, Greek Adaptation (WAIS-IV GR), verbal and visual memory, language and naming, and executive functions. Impairment rates derived from the use of either Greek Australian or English language normative data were calculated and compared, using a 1.5 standard deviation criterion to denote impairment. Receiver operating characteristics curve analysis was used to investigate the sensitivity and specificity of alternate cut scores. Impairment rates derived from the Greek Australian normative data showed that rates of impairment generally fell within the expected 7% range. In contrast, impairment rates for all tests derived using English language normative data were significantly higher and ranged from 11%-66%. Comparisons between healthy and AD participants with moderate dementia showed significant differences across all measures. Area under the curve results ranged from .721 to .999 across all measures, with most tests displaying excellent sensitivity and specificity. English language normative data were found to be inappropriate for use with Greek Australian elders, potentially leading to erroneous diagnostic outcomes. The use of minority group specific normative data and associated cut points appear to partially ameliorate this issue. Clinical implications are discussed alongside future research directions.

Wilderness Paramedic—A Practice Analysis

Emergency medical services (EMS) has existed in its modern form for over 50 years. EMS has become a critical public safety net and access point to the larger health care system. Mature EMS systems are in place in most urban areas. However, EMS systems are not as developed in wilderness areas. A barrier to further development of these systems is the lack of an agreed-upon standard of minimum competence and validation of specialized practice. A practice analysis was completed to create such standards. The practice analysis was completed using a multi-step process. A group of subject matter experts constructed a survey of tasks and knowledge needed for wilderness EMS (WEMS) specialty practice. The tasks and knowledge were validated through an industry survey. A total of 947 surveys were submitted for analysis. Of these, 196 were at least 55% complete and used for analysis. North America was heavily represented as a primary practice location with 177 (90.3%) responses out of the 196 total. Of these 177 responses, 164 (92.7%) were from the United States and 12 (6.8%) were from Canada. One hundred seven of the 116 tasks identified by the subject matter expert group were passed by the survey group, and 164 of the 175 knowledge statements were passed by the survey group. An index of agreement (IOA) was calculated and found to be greater than 0.9 for each task and knowledge statement across all subgroups. A content coverage rating was also calculated and the results indicate survey participants felt the content was “adequate” to “well” covered. The survey results were used to construct a pilot examination. Beta testing of the pilot examination was performed. The beta test results were analyzed and a cut score was determined using the Angoff method with a Beuk compromise. The final product of this process is a defensible exam that will certify candidates’ cognitive knowledge of the specialty of WEMS. Completion of this practice analysis solidifies WEMS as distinct subspecialty of out-of-hospital medicine. Additionally, it establishes a consensus definition of wilderness paramedicine and standards that may be used by WEMS systems and regulatory entities.

A reform path for English learning based on data mining algorithms

Abstract This paper utilizes data mining algorithms to predict the evaluation value of new items by target users in an interactive learning environment. To enhance data quality, redundant data in the dataset is eliminated. To provide better learning recommendations and personalized services, prediction accuracy is assessed by calculating the deviation between predicted and actual ratings. Teachers and students can use the analysis results of feature weights, correct word cut scores, and other indicators obtained from data mining as key learning references. In the data mining analysis of students’ English learning data, the feature weight is 0.921, which helps to assess students’ knowledge mastery and learning effect more accurately.

Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships. Purpose: To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups. Methods: In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro. Results: Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]). Conclusion: Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.

27 Green’s Word Memory Test (WMT) Immediate Recall as a Screening Tool for Performance Invalidity

Objective:Assessment of performance validity during neuropsychology evaluation is essential to reliably interpret cognitive test scores. Studies (Webber et al., 2018; Wisdom, et al., 2012) have validated the use of abbreviated measures, such as Trial 1 (T1) of the Test of Memory Malingering (TOMM), to detect invalid performance. Only one study (Bauer et al., 2007) known to these authors has examined the utility of Green’s Word Memory Test (WMT) immediate recall (IR) as a screening tool for invalid performance. This study explores WMT IR as an independent indicator of performance validity in a mild TBI (mTBI) veteran population.Participants and Methods:Participants included 211 (Mage = 32.1, SD = 7.4; Medu = 13.1, SD = 1.64; 94.8% male; 67.8% White) OEF/OIF/OND veterans with a history of mTBI who participated in a comprehensive neuropsychological evaluation at one of five participating VA Medical Centers. Performance validity was assessed using validated cut scores from the following measures: WMT IR and delayed recall (DR); TOMM T1; WAIS-IV reliable digit span; CVLT-II forced choice raw score; Wisconsin Card Sorting Test failure to maintain set; and the Rey Memory for Fifteen Items test, combo score. Sensitivity and specificity were calculated for each IR score compared with failure on DR. In addition, sensitivity and specificity were calculated for each WMT IR score compared to failure of at least one additional performance validity measure (excluding DR), two or more measures, and three or more measures, respectively.Results:Results indicated that 46.8% participants failed to meet cut offs for adequate performance validity based on the standard WMT IR cut score (i.e., 82.5%; M = 81.8%, SD = 17.7%); however, 50.2% participants failed to meet criteria based on the standard WMT DR cut score (M = 79.8% SD = 18.6%). A cut score of 82.5% or below on WMT IR correctly identified 82.4% (i.e., sensitivity) of subjects who performed below cut score on DR, with a specificity of 94.2%. Examination of IR cutoffs compared to failure of one or more other PVTs revealed that the standardized cut score of 82.5% or below had a sensitivity of 78.2% and a specificity of 72.4%; whereas, a cut score of 65% or below had a sensitivity of 41% and a specificity of 91.3%. Similarly, examination of IR cutoffs compared to failure of two or more additional PVTs revealed that the cut score of 60% or below had a sensitivity of 45.7% and specificity of 93.1% ; whereas, a cut score of 57.5% or below had a sensitivity of 57.9% and specificity of 90.9% when using failure of three or more PVTs as the criterion.Conclusions:Results indicated that a cut score of 82.5% or below on WMT IR may be sufficient to detect invalid performance when considering WMT DR as criterion. Furthermore, WMT IR alone, with adjustments to cut scores, appears to be a reasonable way to assess symptom validity compared to other PVTs. Sensitivity and specificity of WMT IR scores may have been adversely impacted by lower sensitivity of other PVTs to independently identify invalid performance.

Mixed Methods Investigation into Test Score Users’ Perspectives about IELTS Reading Skill Profiles

Research on the use of standardized test scores in higher education reveals significant variations in attitudes and perceptions of language proficiency tests among test score users. Most test score users have limited knowledge about test score interpretations in terms of what English as additional language (EAL) students typically know and can do at the language proficiency levels associated with admission cut scores. To address this critical gap, the language testing field has actively investigated the potential of Diagnostic Classification Models (DCMs) to offer useful information, facilitating test score users in their decision-making processes. The present two-phase mixed methods study examined the characteristics of reading skill profiles across various IELTS band scores, specifically focusing on the most frequently used admission cut scores: 6.0, 6.5, and 7.0. The study further explored test score users’ perspectives about these admission test scores, challenges encountered by EAL students, and the usefulness of reading skill profiles derived from DCMs. Findings from the application of DCMs to IELTS reading test responses (N = 5,222) showed a lack of advanced skills, such as inferential reasoning, at these commonly employed cut scores. Test score users perceived the skill profiles as instrumental in distinguishing reading abilities across various band scores and discussed the EAL students’ lack of critical reasoning, especially in inferential and synthesis tasks in coursework. The results underscore the potential of DCM-based skill profiles in providing test score users with detailed information about test score interpretations.

92 Validation of Coin-in-Hand Procedure in a Veteran Population

Objective:Performance validity tests (PVTs) provide a methodological approach to detecting credible neurocognitive performances. This proves invaluable to the diagnostic process, as it allows neuropsychologists to objectively determine if an evaluation reflects a patient’s true neurocognitive abilities or if external factors are impacting the results. However, their addition to a testing battery can increase an already lengthy evaluation. As such, there is a need for sensitive but less time intensive PVTs. The purpose of this study is to validate the Coin-in-Hand (CIH) procedure as a quick and effective PVT within a veteran population.Participants and Methods:68 English-speaking patients were identified from an outpatient neuropsychological assessment dataset. Performances were correlated to the well- validated Reliable Digit Span (RDS), and several other soft indicators of task engagement including expanded COWAT, BVMT-False Alarms (FA), WCST Failure to Maintain Set (FTM), TOMM, and the RBANS Effort Index (EI). All participants attempted CIH and RDS, testing was discontinued if 2 or more PVTs were invalid. An AUC analysis was conducted to determine how well the CIH discriminated between valid and invalid performance and determine the tests optimal cut-off score (sensitivity > 0.90 while maintaining the highest possible specificity). Logistic Regression was conducted to determine how well the CIH predicted performance validity.Results:Subject mean(SD) age and education were 55.25 (16.06) and 13.41 (2.55) years, respectively. 17% female, 60% Caucasian, and 32% Black. Descriptive statistics for each of the other performance validity tests were gathered. The CIH demonstrated low diagnostic accuracy (AUC = .66; p >.05; CI = .51 -.81); a cut score of <8 resulted in a sensitivity of .96 and a specificty of .64. Logistic Regression showed that CIH performance significantly predicted performance validity (X2 = -0.93; df = 1; N = 68; p < .05), accounting for 18-28% of the variance in performance classification (Cox & Snell R2 = .18; Nagelkerke R2 = .28). It correctly classified 96% of valid performers, but only correctly classified 35% of invalid performers, with an overall correct prediction rate of 83%. A predicted chase in log odds (B= -.93) and odd ratio [Exp (B) =.40] indicated that every unit increase in CIH score was associated with a decrease probability of performance invalidity. Logistic regression was also used to calculate the probability of performance invalidity at each possible CIH score (Table 1).Conclusions:Results suggests that poor performance on CIH does not necessarily equate to invalid performances, but instead, should act as a screener to cue neuropsychologists working with Veterans that additional PVTs should be considered. Overall, it was determined that CIH was able to correctly predict 35% of invalid performers and 96% of valid performers, with an overall correct prediction rate of 83%, suggesting the procedure may be too simple to be an effective standalone PVT for clinical use. These results also highlight that every correct response on the CIH was associated with a decreased probability of performance invalidity. Additionally, an AUC analysis determined the tests optimal cut off score to be <8, suggesting that shortening the procedure may be as effective as giving the full 10 trials.

20 Clinical Utility of an Experimental Ds-ADHD Validity Scale in Detection of Feigned ADHD symptoms in a U.S. Military Population

Objective:Accurate identification of Attention-Deficit/Hyperactivity Disorder (ADHD) is complicated by possible secondary gain, overlap of symptoms with psychiatric disorders, and face validity of measures (Suhr et al., 2011; Shura et al., 2017). To assist with diagnostic clarification, an experimental Dissimulation ADHD scale (Ds-ADHD; Robinson & Rogers, 2018) on the MMPI-2 was found to distinguish credible from non-credible respondents defined by Performance Validity Test (PVT)-based group assignment in Veterans (Burley et al., 2023). However, symptom and performance validity have been understood as unique constructs (Van Dyke et al., 2013), with Symptom Validity Tests (SVTs) more accurately identifying over-reporting of symptoms in ADHD (White et al., 2022). The current study sought to evaluate the effectiveness of the Ds-ADHD scale using an SVT, namely the Infrequency Index of CAARS (CII; Suhr et al., 2011), for group assignment within a mixed sample of Veterans.Participants and Methods:In this retrospective study, 187 Veterans (Mage = 36.76, SDage = 11.25, Medu = 14.02, SDedu = 2.10, 83% male, 19% black, 78% white) were referred for neuropsychological evaluation of ADHD and administered a battery that included internally consistent MMPI-2 and CAARS profiles. Veterans were assigned to a credible group (n=134) if CII was <21 or a non-credible group (n=53) if CII was >21. The Ds-ADHD scale was calculated for the MMPI-2. Consistent with Robinson and Rogers (2018), “true” answers (i.e., erroneous stereotypes) were coded as 1 and “false” answers were coded as 2, creating a 10- to 20-point scale. Lower scores were associated with a higher likelihood of a feigned ADHD presentation.Results:Analyses revealed no significant differences in age, education, race, or gender (ps > .05) between credible and non-credible groups. An ANOVA indicated a significant difference between groups (F[1,185] = 24.78, p <.001; Cohen’s d = 0.80) for Ds-ADHD raw scores. Veterans in the non-credible group reported more “erroneous stereotypes” of ADHD (M raw score = 13.23, SD = 2.10) than those in the credible group (M = 14.94, SD = 2.13). A ROC analysis indicated AUC of .72 (95% CI = .64 to .80). In addition, a Ds-ADHD cut score of <12 resulted in specificity of 94.5% and sensitivity of 22.6%, whereas a cut score of <13 resulted in specificity of 85.8% and sensitivity of 50.9%. When analyzing other CII cut scores recommended in the literature, results were essentially similar. Specifically, analyses were repeated when group assignment was defined by cut score of CII<18 and by removing an intermediate group (CII = 18 to 21; n=24).Conclusions:The Ds-ADHD scale demonstrated significant differences between credible and non-credible respondents in a Veteran population. Results suggest a cut score of <12 had adequate specificity (.95) with low sensitivity (.23). This is consistent with findings using PVTs for group assignment that indicated a cut score of <12 had adequate specificity (.92) with low sensitivity (.19; Burley et al., 2023). Taken together, findings suggest that the Ds-ADHD scale demonstrates utility in the dissociation of credible from non-credible responding. Further research should evaluate the utility of the scale in other clinical populations.

56 Classification Accuracy of InformantReport on the Dementia Severity Rating Scale (DSRS) for Identifying Examinee-Generated Performance and Symptom Invalidity

Objective:Assessment of response validity is essential to neuropsychological assessment. Although informant report of examinee functioning has previously been associated with examinee-generated performance and cognitive symptom invalidity (PVT; SVT-C), empirically-derived guidelines for interpreting informantreport validity are lacking. This study sought to assess the classification accuracy of a widely used informant-report measure, the Dementia Severity Rating Scale (DSRS), for discriminating examinee-generated PVT and SVT-C.Participants and Methods:Data were collected from 145 examinee-informant dyads who completed neuropsychological batteries as part of a routine workup in an epilepsy monitoring unit. PVT status was determined by below-threshold performances on >2 indicators (Test of Memory Malingering, Wechsler Digit Span Age Corrected Scaled Score, Word Memory Test). SVT-C status was determined by above-threshold responses on both the Minnesota Multiphasic Personality Inventory-2-Restructured Form Response Bias Scale (MMPI-2-RF RBS) and Structured Inventory of Malingered Symptomatology Amnestic Disorders subscale (SIMS-AM). After assessing demographic and relational covariance via t-test and chi square analyses, receiver operator characteristic curves were derived to assess the classification accuracy of the DSRS for discriminating examinee PVT and SVT-C status.Results:DSRS total score demonstrated acceptable accuracy in classifying PVT status (AUC = .77), with cut scores of >21 and >15 yielding .93-.82 specificity and .44-.63 sensitivity. The DSRS also classified SVT-C status with acceptable accuracy (AUC = .71), with the aforementioned cut scores exhibiting .90-.78 specificity and .50-.64 sensitivity. The DSRS also classified SVT-C status using only one indicator (i.e., MMPI-2-RF RBS or SIMS-AM) with acceptable accuracy (AUC = .71-.72), with the aforementioned cut scores exhibiting .92 specificity and .37-.42 sensitivity.Conclusions:The DSRS can be used to classify examinee-generated PVT and SVT-C on an epilepsy monitoring unit. Results provide empirically-derived psychometric guidelines for interpreting informant-report response validity that are clinically useful and lay the groundwork for future investigations of informant-report response validity.

76 Cross-Cultural Utility of Performance Validity Indicators in a Community Sample from Kampala, Uganda

Objective:Empirical support for inclusion of performance validity testing (PVTs) in neuropsychological assessment continues to grow (Sweet et al., 2021). However, considerable validation is still needed to understand the impact of culturally mediated factors on the reliability of current, commonly used PVTs to accurately classify effort among various cultural groups. This study sought to contribute to the literature by examining the utility of several PVTs in a non-clinical, community-dwelling sample in Kampala, Uganda.Participants and Methods:Participants included 52 residents (25 Female, 27 Male) who were born between 1953-2003 from the Wabigalo community of central Kampala. Individuals were recruited by community leaders and volunteered to participate. All 52 participants were administered the Dot Counting Test (DCT; Boone et al., 2002), Test of Memory Malingering (TOMM; Tombaugh, 1997), and Rey 15-Item Memorization Test (Rey 15; Lezak, 1995). Twenty-five participants also completed Green’s Non-Verbal Medical Symptom Validity Test (NV-MSVT; Green, 2006). Data from three participants was excluded due to suspected memory concerns. Instructions for all tests were translated into Luganda by a professional translator with experience in Luganda and were administered by Luganda-speaking individuals.Results:Using test manual-derived cut scores, 71.4% (n = 35) participants scored in the invalid range on the DCT, 10.2% (n = 5) produced total combined scores in the invalid range on Rey 15, 6.1% (n = 3) failed TOMM Trial 2, and one participant (4.3%) exceeded cut-offs on Green’s NV-MSVT.Conclusions:In this non-clinical sample, manual cutoffs for DCT contributed to a high type-1 error rate. These findings suggest that culturally mediated factors may contribute to differences in engagement or performance on DCT. Future studies should explore these factors and continue to examine the utility of widely used tests in diverse samples.

44 Can Clinical Trial data Inform our Understanding of the role of Depressive Symptoms in Alzheimer's Disease?

Objective:Neuropsychiatric symptoms concerning mood are common in Alzheimer's disease (AD), but it is unclear if they are etiologically related to AD pathophysiology or due to factors considered to be non-pathogenic, such as small vessel cerebrovascular disease. New generation clinical trials for AD often enroll participants with evidence of AD pathophysiology, indexed by amyloid PET scanning, but who are cognitively asymptomatic. We used screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) study to examine the extent to which depressive symptoms are associated with amyloid pathophysiology and small vessel cerebrovascular disease, in the form of white matter hyperintensities (WMH).Participants and Methods:The A4 study randomizes cognitively healthy older adults with evidence of amyloid pathophysiology on PET scanning. We used screening data, which included amyloid status (positive, negative) by visual read, amyloid PET standard uptake value ratio (SUVR) in cortical regions, and MRI data acquired in a subset (n=1,197, mean age 71.6 +/- 4.8 years, 57% women) to quantitate total WMH volume. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, which we used both as a continuous variable and to define 'depressed' and 'non-depressed' groups, based on a cut score of > 5. We examined whether 1) depressive symptoms and proportion of depressed individuals differed between amyloid positive and negative groups, 2) there is a relationship between amyloid SUVR and depressive symptoms that differs as a function of amyloid positivity status, and 3) there is a relationship between WMH volume and depressive symptoms that differs as a function of amyloid positivity status.Results:Although depressive symptom severity did not differ between groups (t=0.14, p=0.88), a greater proportion of individuals were classified as depressed in the amyloid negative group than the amyloid positive group (3.5% vs. 1.9%, X2=4.60, p=0.032). Increased amyloid SUVR was associated with increased GDS scores among amyloid positive individuals (r=0.117, p=0.002) but not among amyloid negative individuals (r=0.006, p=0.68, Positivity Status x SUVR interaction on GDS: ß=0.817, p=0.029). Increased WMH was associated with higher GDS scores (ß=0.105, p=0.017) but not differentially in amyloid positive and negative participants (Positivity Status x WMH interaction on GDS: ß=-0.010, p=0.243).Conclusions:These analyses have several implications. First, individuals who are screened to participate in a clinical trial but do not have evidence of amyloidosis may be misattributing concerns about underlying AD pathophysiology to depressive symptoms. Second, the severity of AD pathophysiology, indexed by amyloid PET SUVR, may drive a small increase in depressive symptomatology among individuals over visual diagnostic thresholds. Third, small vessel cerebrovascular changes are additionally associated with depressive symptoms but in a manner that is independent of AD pathophysiology. Overall, depressive symptoms and depression are likely multiply determined among prospective clinical trial participants for preclinical AD.

Clinical cut scores for the Persian version of the personality inventory for DSM-5.

The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups. Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests. All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0SD and 0.5-1.0SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status. Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

Detecting Faking on Self-Report Measures Using the Balanced Inventory of Desirable Responding

We compared three methods for scoring the Balanced Inventory of Desirable Responding (BIDR) to detect faked responses on self-report measures: (1) polytomous, (2) dichotomous emphasizing exaggerating endorsement of socially desirable behaviors, and (3) dichotomous emphasizing exaggerating denial of such behaviors. The results revealed that respondents on average were able to fake good or fake bad and that faking markedly affected score distributions, subscale score intercorrelations, and overall model fits. When using the Impression Management scale, polytomous and dichotomous exaggerated endorsement scoring were best for detecting faking good, whereas polytomous and dichotomous exaggerated denial scoring were best for detecting faking bad. When using the Self-Deceptive Enhancement scale, polytomous and dichotomous exaggerated endorsement scoring again were best for detecting faking good, but dichotomous exaggerated denial scoring was best for detecting faking bad. Percentages of correct classification of honest and faked responses for the most effective methods for any given scale ranged from 85% to 93%, with accuracy on average in detecting faking bad greater than in detecting faking good and greater when using the Impression Management than using the Self-Deceptive Enhancement scale for both types of faking. Overall, these results best support polytomous scoring of the BIDR Impression Management scale as the single most practical and efficient means to detect faking. Cut scores that maximized classification accuracy for all scales and scoring methods are provided for future use in screening for possible faking within situations in which relevant local data are unavailable.

Cross validation of the Personality Assessment Inventory (PAI) Cognitive Bias Scale of Scales (CB-SOS) over-reporting indicators in a military sample

ABSTRACT Following the development of the Cognitive Bias Scale (CBS), three other cognitive over-reporting indicators were created. This study cross-validates these new Cognitive Bias Scale of Scales (CB-SOS) measurements in a military sample and contrasts their performance to the CBS. We analyzed data from 288 active-duty soldiers who underwent neuropsychological evaluation. Groups were established based on performance validity testing (PVT) failure. Medium effects (d = .71 to .74) were observed between those passing and failing PVTs. The CB-SOS scales have high specificity (≥.90) but low sensitivity across the suggested cut scores. While all CB-SOS were able to achieve .90, lower scores were typically needed. CBS demonstrated incremental validity beyond CB-SOS-1 and CB-SOS-3; only CB-SOS-2 was incremental beyond CBS. In a military sample, the CB-SOS scales have more limited sensitivity than in its original validation, indicating an area of limited utility despite easier calculation. The CBS performs comparably, if not better, than CB-SOS scales. CB-SOS-2ʹs differences in performance in this study and its initial validation suggest that its psychometric properties may be sample dependent. Given their ease of calculation and relatively high specificity, our study supports the interpretation of elevated CB-SOS scores indicating those who are likely to fail concurrent PVTs.

A - 178 Development and Psychometric Properties of an Abbreviated Version of the Identi-Fi: a Test of Visual Organization and Recognition.

There is a growing demand for efficient neuropsychological screening instruments to better triage referrals for more specialized evaluations. In particular, visuospatial problems tend to appear fairly early in Alzheimer's dementia. The Identi-Fi: A Test of Visual Organization and Recognition is a reliable and valid measure of visual organization ability. Administration and scoring take 15minutes, which precludes its use as a screening instrument. The current study aimed to create a brief version of the test for use in a standard screening battery. The normative sample participants (n = 901) and dementia clinical sample participants (n = 25) were administered the Identi-Fi. Item statistics were examined to develop short versions of the Visual Matching and Visual Recognition subtests with the goal of efficiently differentiating between the normative and dementia groups. Results yielded an 11-item VM (scores ranged from 0-11) and 11-item VR (scores ranged from 0-11) abbreviated subtest. Scores were then used in subsequent ROC curve analyses to determine appropriate cutoff scores with an intent to maximally balance sensitivity and specificity. ROC curve analyses were favorable for both subtests (i.e., AUC ≥ 0.85), with cut scores at ≤7 for VM and ≤ 8 for VR. Sensitivity values ranged from 0.76 to 0.80 and specificity values ranged from.79 to.83 for the measure. Results provide preliminary evidence of an abbreviated version of the Identi-Fi to assist in dementia screening.

B - 62 The Clinical Utility of the BAI Compared to the GAI in Community Dwelling Older Adults.

Given the potential impact anxiety may have on cognitive performance, the current study explored the relationship of both the Beck Anxiety inventory (BAI) and the Geriatric Anxiety Inventory (GAI) to cognitive performance in community dwelling older adults. Specifically, the correlation of anxiety and depression symptomatology to performance on measures of executive functioning and processing speed was explored (Dorekamp & Vik, 2018; Najimi et al., 2015; Vytal et al., 2012). Archival data from a sample of 60 community dwelling older adult participants (female n = 54; White n = 52), with an average education of 13.83years and an average age of 76years were included. The BAI and GAI were used to determine anxiety levels. Processing speed and executive functioning were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Coding subtest and Trail Making Test B respectively. Data was analyzed using Pearson's R product moment correlations. Pearson's R product moment correlations were significant between the BAI and RBANS Coding (r = -0.328; p = 0.011), Trails B (r = 0.295; p = 0.023), and the GAI (r = 0.268; p = 0.04). However, the GAI was only significantly associated with the BAI. While both the BAI and GAI are well established measures of anxiety in older adults, the BAI appears to be more sensitive to the effects of anxiety on executive functioning and processing speed in community dwelling older adults. Future directions related to exploration of severity and potential cut scores will be discussed.