Test Of Memory Malingering Research Articles

A preliminary examination of the TOMM2 in a sample of Spanish speakers in the United States.

The Test of Memory Malingering (TOMM) is a widely used performance validity measure that is available in both English and Spanish. The Spanish version, however, has historically lacked normative data from samples that are representative of the U.S. Hispanic/Spanish speaking population. The aim of the current study was to collect normative data on the update TOMM 2 for Hispanic individuals residing in the U.S. Normative data on the TOMM 2 was collected across 9 sites from different regions of the U.S. The total sample consisted of n = 188 cognitively healthy adults aged 18 and over with no current or prior history of neurological or psychiatric disorder. Descriptive analyses were performed on total raw scores. Participants obtained a mean score of 48.15 (SD = 2.81) on trial 1 of the TOMM 2, 49.86 (SD = 0.487) on trial 2, and 49.84 (SD = 0.509) on the recognition trial. Scores are provided for traditional cutoff scores as well as some popular cutoffs reported in the literature. Item level analyses were conducted as well as evaluation of performance based on a variety of demographics. When compared to the English-speaking normative sample used for the original TOMM, this sample demonstrated better performance on the TOMM 2 indicating better cultural appropriateness of the items. This is the first study conducted that provides culturally appropriate descriptive norms for use with Spanish speakers living in the U.S.

B - 139 A Bayesian Approach to Performance Validity in Neuropsychological Testing

Abstract Objective Using the Test of Memory Malingering (TOMM), this study seeks to explore the feasibility of a continuous approach to performance validity by simulating experiments using a Bayesian statistical algorithm. Methodology A literature review was carried out to conduct statistical analyses from data of two known groups (those putting forth credible effort and those not). TOMM scores were modeled using various statistical distributions, with the inflated Conway-Maxwell-Poisson (ICMP) distribution providing the best fit. Simulation experiments were conducted to test the Bayesian statistics model. This involved generating artificial data from known distributions and then seeing how well the algorithm could recover the probability of a score belonging to the credible effort group. We tested the algorithm’s robustness by intentionally starting with incorrect assumptions and seeing if it could still converge on the correct probabilities. Finally, the Bayesian model was applied to real TOMM data to estimate the probability of credible effort for each possible score. Results The simulation studies showed that the Bayesian approach was generally robust, even when starting with incorrect assumptions. When applied to real data, TOMM scores of 40, 45, and 50 were essential, with approximately 5% change occurring with each score. A score of 40 covers approximately 50% of scores, 45 covers approximately 75%, and, finally, 50 covers 95% of scores. A perfect score of 50 encompassed ~95% of credible performances but not 100%. Conclusion This study provides initial statistically derived evidence for the feasibility and potential value of a continuous, probabilistic approach to performance validity.

B - 144 Base Rates of Performance Validity Test Failure among Patients with Persistent COVID-Related Cognitive Concerns

Abstract Objective Data on performance invalidity in neuropsychological evaluations among patients with SARS-CoV-2-related cognitive concerns is limited. This study investigated the base rates of performance validity test (PVT) failure among a sample of neuropsychological referrals with persistent cognitive concerns following SARS-CoV-2 infection. Method Data were collected from 62 patients (27% male, 73% female) with subjective cognitive concerns following SARS-Cov-2 infection. The sample included ethnoracially diverse adult patients (M = 44.1 years, SD = 12.53) with an average of 15 years of education (SD = 2.97) who underwent comprehensive neuropsychological evaluations including freestanding (Test of Memory Malingering, Trial 1 [TOMM T1]) and embedded (Wechsler Adult Intelligence Scale-4th Edition Digit Span Reliable Digit Span [WAIS-IV DS RDS]; California Verbal Learning Test-Brief Form Forced Choice [CVLT-BF FC]; Brief Visuospatial Memory Test Recognition-Discrimination [BVMT RD]; Stroop Word Reading T-Score [Stroop Word T]) PVTs. Results A majority of the sample (63%) passed all PVTs, 9.7% of the sample failed ≥2 PVTs suggesting invalidity, and 27.4% of the sample failed exactly one PVT. On embedded PVTs, failure rates were as follows: WAIS-IV DS RDS: 11.3%, CVLT-BF FC: 1.6%, BVMT Rec-Dis: 8.1%, and Stroop Word T: 8.1%. The failure rate on TOMM Trial 1 was 19.4%. Conclusions Patients presenting with persistent cognitive concerns following SARS-CoV-2 infection demonstrated relatively low overall invalidity rates using an empirically established cut-off (≥2). Further research is needed to confirm the generalizability of the present findings, as well as to explore the implications of failure on one PVT and the implications of failure on embedded versus freestanding PVTs in this population.

B - 10 Performance Validity Test Failure Base Rates among Presurgical Epilepsy Referrals

Abstract Objective Patients with epilepsy undergoing presurgical workup are generally considered a population without clear incentive to perform invalidly during neuropsychological evaluation. This study investigated the base rates of performance validity test (PVT) failure among a sample of presurgical epilepsy patients. Participants and. Methods Data were collected from 68 consecutive patients with epilepsy undergoing outpatient neuropsychological evaluation for surgical candidacy. The sample included 33 males/35 females, had a mean age of 36.29 (SD = 12.07), mean education of 12.51 (SD = 2.23), and was racially and ethnically diverse. All patients were administered a number of freestanding (Test of Memory Malingering [TOMM], Dot Counting Test [DCT], Coin-in-Hand [CIH]) and embedded (Rey Auditory Verbal Learning Test-Forced Choice [RAVLT-FC], Wechsler Memory Scale–3rd Edition Digit Span Reliable Digit Span [WMS-III DS RDS]) PVTs within a comprehensive neuropsychological assessment battery. Results Overall, 9% of the sample failed ≥2 PVTs, suggesting invalidity. An additional 22% failed 1 PVT. However, a large portion of the sample (69%) passed all freestanding and embedded PVTs. Among the freestanding PVTs, the failure rates were TOMM: 4%, DCT: 21%, and CIH: 3%. Failure rates on embedded PVTs were RAVLT-FC: 15% and WMS-III DS RDS: 3%. Conclusions Although there is not an expected incentive for suboptimal neuropsychological performance among presurgical epilepsy patients, results show a critical need for objective validity assessment to guard against inaccurate surgical prognostication from invalid test data for patients undergoing high-stakes presurgical evaluations. Given the high invalidity rate on some individual PVTs, further research is necessary to cross-validate established PVT cut-scores in epilepsy-specific populations.

B - 138 Factors Influencing Performance Validity Test (PVT) Performance in a Clinical Multiple Sclerosis Sample

Abstract Objective Performance Validity Test (PVT) failure, originally designed to assess malingering in forensic settings, is remarkably common in the clinical setting. Though there are potentially numerous explanations for PVT failure, there is a paucity of research investigating its frequency, and contributing factors, in patients with neurological disorders. We aimed to identify factors associated with PVT failure among patients with multiple sclerosis (MS). Method A hierarchical logistic regression was performed on a dataset containing neuropsychological assessment results of 32 males (23.5%), and 104 females (76.5%) with MS (N = 106, Mean age = 47.9) to evaluate associations between depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Hospital Anxiety and Depression Scale, HADS-Anxiety) (step 1), fatigue (Fatigue Scale of Motor and Cognitive Functions, FSMC) (step 2), age/years of education (step 3), and PVT failure (Test of Memory Malingering, TOMM score < 45). Results The final model was significant and explained 40.8% of the variance in TOMM failure (χ2(6) = 21, p = 0.002). The odds of PVT failure increased by 22.1% (p = 0.04) for every 1 unit increase in z-score on the PHQ-9. The odds of PVT failure increased by 66.3% for every 1 point increase in total Cognitive Fatigue (p = 0.01). Age, education, HADS-Anxiety, and Motor-Fatigue were not significantly associated with TOMM failure. Conclusion It is commonly assumed that neurology patients who fail PVTs are seeking secondary gain (e.g., disability). This study provides some support for the hypothesis that psychological factors, such as depression and cognitive fatigue, may significantly contribute to PVT failure in some clinical populations.

A preliminary investigation of the utility of the Word Memory Test Immediate Recognition trial as a screener for noncredible performance

The assessment of performance validity is an important consideration to the interpretation of neuropsychological data. However, commonly used performance validity tests such as the Test of Memory Malingering (TOMM) and Word Memory Test (WMT) have lengthy administration times (20–30 minutes). Alternatively, utilizing a screener of performance validity (e.g., the TOMM T1 or TOMMe10) has proven to be an effective method of assessing performance validity while conserving time. The present study investigates the use of the WMT Immediate Recognition (IR) Trial scores as a screening measure for performance validity using an archival mTBI polytrauma sample (n = 48). Results show that the WMT IR demonstrates a high degree of accuracy in predicting WMT Delayed Recognition (DR) Trial performance across a range of base rates suggesting that the WMT IR is a useful screening measure for noncredible performance. Clinical implications and selection of optimal cutoff are discussed.

Validity of the Groningen Effort Test in patients with suspected chronic solvent-induced encephalopathy.

The use of performance validity tests (PVTs) in a neuropsychological assessment to determine indications of invalid performance has been a common practice for over a decade. Most PVTs are memory-based; therefore, the Groningen Effort Test (GET), a non-memory-based PVT, has been developed. This study aimed to validate the GET in patients with suspected chronic solvent-induced encephalopathy (CSE) using the criterion standard of 2PVTs. A second goal was to determine diagnostic accuracy for GET. Sixty patients with suspected CSE referred for NPA were included. The GET was compared to the criterion standard of 2PVTs based on the Test of Memory Malingering and the Amsterdam Short Term Memory Test. The frequency of invalid performance using the GET was significantly higher compared to the criterion of 2PVTs (51.7% vs. 20.0% respectively; p < 0.001). For the GET index, the sensitivity was 75% and the specificity was 54%, with a Youden's Index of 27. The GET showed significantly more invalid performance compared to the 2PVTs criterion suggesting a high number of false positives. The general accepted minimum norm of specificity for PVTs of >90% was not met. Therefore, the GET is of limited use in clinical practice with suspected CSE patients.

Measures of performance validity for Hispanic/Latin American adults: A PRISMA systematic review.

Use of performance validity tests (PVTs) to assess suboptimal performance has become a recommended feature in neuropsychological evaluations. However, most of the literature has examined the utility of PVTs in primarily non-Hispanic White, monolingual English-speaking samples. Given the continual growth of culturally and linguistically diverse (CALD) populations, especially Hispanic/Latin Americans (H/Ls), it is necessary to provide an updated review on the available literature involving the use of PVTs in H/L adults. We conducted a systematic review that examined the available literature surrounding use of performance validity measures in H/L adults. This review identified evidence for the utility of PVTs in assessing invalid performance in H/Ls and compiled psychometric properties related to these measures, specifically rates of specificity and sensitivity when available. We identified six standalone and four embedded performance validity measures that have been examined in H/Ls. The Test of Memory Malingering (TOMM) was identified as the PVT most studied in various H/L heritage groups. Across the studies reviewed, adjustments to cutoff scores are generally recommended for the majority of PVTs discussed. Within H/Ls, specificity rates tend to be bolstered when sociocultural factors, like education, are considered. Recommended cutoff scores across the different PVTs reviewed are not typically suitable for use in heritage groups of H/L adults, especially in groups that include adults with lower levels of education and literacy. Therefore, education may need to be considered when applying cutoffs to these populations.

Use of perceptual memory as a performance validity indicator: initial validation with simulated mild traumatic brain injury

ABSTRACT Introduction Many commonly employed performance validity tests (PVTs) are several decades old and vulnerable to compromise, leading to a need for novel instruments. Because implicit/non-declarative memory may be robust to brain damage, tasks that rely upon such memory may serve as an effective PVT. Using a simulation design, this experiment evaluated whether novel tasks that rely upon perceptual memory hold promise as PVTs. Method Sixty healthy participants were provided instructions to simulate symptoms of mild traumatic brain injury (TBI), and they were compared to a group of 20 honest responding individuals. Simulator groups received varying levels of information concerning TBI symptoms, resulting in naïve, sophisticated, and test-coached groups. The Word Memory Test, Test of Memory Malingering, and California Verbal Learning Test-II Forced Choice Recognition Test were administered. To assess perceptual memory, selected images from the Gollin Incomplete Figures and Mooney Closure Test were presented as visual perception tasks. After brief delays, memory for the images was assessed. Results No group differences emerged on the perception trials of the Gollin and Mooney figures, but simulators remembered fewer images than the honest responders. Simulator groups differed on the standard PVTs, but they performed equivalently on the Gollin and Mooney figures, implying robustness to coaching. Relying upon a criterion of 90% specificity, the Gollin and Mooney figures achieved at least 90% sensitivity, comparing favorably to the standard PVTs. Conclusions The Gollin and Mooney figures hold promise as novel PVTs. As perceptual memory tests, they may be relatively robust to brain damage, but future research involving clinical samples is necessary to substantiate this assertion.

The utility of the Poreh Nonverbal Memory Test (PNMT) for the detection of noncredible performance

Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and– at times– reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.

Validity assessment in Eastern Europe: cross-validation of the Dot Counting Test and MODEMM against the TOMM-1 and Rey-15 in a Romanian mixed clinical sample.

This study investigated performance validity in the understudied Romanian clinical population by exploring classification accuracies of the Dot Counting Test (DCT) and the first Romanian performance validity test (PVT) (Memory of Objects and Digits and Evaluation of Memory Malingering/MODEMM) in a heterogeneous clinical sample. We evaluated 54 outpatients (26 females; MAge = 62.02; SDAge = 12.3; MEducation = 2.41, SDEducation = 2.82) with the Test of Memory Malingering 1 (TOMM-1), Rey Fifteen Items Test (Rey-15) (free recall and recognition trials), DCT, MODEMM, and MMSE/MoCA as part of their neuropsychological assessment. Accuracy parameters and base failure rates were computed for the DCT and MODEMM indicators against the TOMM-1 and Rey-15. Two patient groups were constructed according to psychometrically defined credible/noncredible performance (i.e., pass/fail both TOMM-1 and Rey-15). Similar to other cultures, a cutoff of ≥18 on the DCT E score produced the best combination between sensitivity (0.50-0.57) and specificity (≥0.90). MODEMM indicators based on recognition accuracy, inconsistencies, and inclusion false positives generated 0.75-0.86 sensitivities at ≥0.90 specificities. Multivariable models of MODEMM indicators reached perfect sensitivities at ≥0.90 specificities against two PVTs. Patients who failed the TOMM-1 and Rey-15 were significantly more likely to fail the DCT and MODEMM than patients who passed both PVTs. Our results offer proof of concept for the DCT's cross-cultural validity and the applicability of the MODEMM on Romanian clinical examinees, further recommending the use of heterogeneous validity indicators in clinical assessments.

82 Single Errors on Trial 1 of the Test of Memory Malingering may be Indicative of Invalid Performance on Neuropsychological Measures in a Sample of Youth Athletes

Objective:The Test of Memory Malingering (TOMM) is a performance validity test (PVT) that aims to assess whether participants are giving adequate effort to perform well on tasks of memory performance (Tombaugh, 1996). Other PVTs, specifically the Forced Choice Recognition Trial in the California Verbal Learning Test, have shown that even single errors may indicate invalid performance (Erdodi et al., 2018). Finally, youth are often understudied in the PVT literature, and athletes are at increased risk of invalid performance on baseline testing due to many wanting to return to play following concussion (Erdal, 2012). Therefore, the objective of the current study is to examine whether single errors on TOMM Trial 1 are indicative of lower, and possibly invalid, cognitive performance in a youth sample, given that cognitive performance declines with even small decreases in effort (Green, 2007).Participants and Methods:Healthy youth athletes (n=174) aged 8-16 years (M=12.07) completed the TOMM as well as other neuropsychological measures during baseline neuropsychological evaluation in a clinical research program for sports concussion. Independent samples t-tests compared youth athletes who scored 49 points on the TOMM (n=28) to youth athletes who scored a perfect 50 (n=50) across several groupings of neuropsychological measures. Participants who scored less than 49 or who didn’t complete the TOMM were excluded from the analyses.Results:Participants scoring 50/50 on TOMM Trial 1 scored significantly higher on Stroop Color Naming task (p=0.036), Verbal Learning Delayed task from the second edition of the Wide Range Assessment of Learning and Memory (WRAML-2, p=0.018), and Letter Number Sequencing task from the Weschler Intelligence Scale for Children (WISC-IV, p=0.025), relative to participants scoring 49/50. Though not statistically significant, results also showed a trend toward participants scoring 50/50 scoring higher on nearly every test in the battery.Conclusions:Participants with a single error on TOMM Trial 1, as compared to participants with a perfect score, performed significantly worse on a processing speed task, a verbal learning task, and a working memory task as part of a comprehensive neuropsychological battery. The single-error group also trended toward scoring lower on nearly all of the remaining attention, processing speed, perceptual ability, memory, and executive functioning tasks in the battery. The results could lead to a more liberal interpretation of TOMM scores, given that the trend towards lower performance may be due to putting forth significantly less effort. These results point to the need for a similar comparison of the TOMM in a larger sample size, as greater power may reveal even more significant differences in performance. Findings also emphasize the importance of viewing performance validity on a continuum rather than as a dichotomous pass/fail. Understanding the TOMM and how single errors may be indicative of poorer performance in a youth sample could help to reframe the way PVT results are interpreted in clinical and forensic settings.

79 The Clinical Utility of Reliable Digit Span in Predicting Effort on the TOMM in Youth with a History of a Concussion

Objective:Performance validity testing (PVT) is important in neuropsychological evaluations to ensure accurate interpretation of performance. While research shows children pass PVTs with adult cut-offs, PVTs are more commonly used with adults (Lippa, 2018). The Test of Memory Malingering (TOMM), a standalone PVT, is commonly used with adults and children (DeRight &amp; Carone, 2015). The Reliable Digit Span (RDS), an embedded PVT derived from the Digit Span subtest of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children-4th Edition, WISC-IV; Wechsler, 2003), is less commonly used with children (DeRight &amp; Carone, 2015). RDS cut-off scores are associated with an increased rate of false positives in children, indicating mixed results regarding the clinical utility in pediatric populations (Welsh et al., 2012). Research shows that youth with a history of concussion (HOC) may demonstrate suboptimal effort for many reasons (e.g., external incentives, boredom, pressure), thus highlighting the need to investigate the utility of PVTs in this population (Araujo et al., 2014; DeRight &amp; Carone, 2015). The present study aimed to examine the clinical utility of RDS in detecting poor effort on the TOMM in youth athletes with a HOC.Participants and Methods:Participants included 174 youth athletes aged 8 to 18 (20.1% female; 42.5% people of color (POC)) who completed a baseline neuropsychological battery that included the TOMM and WISC-IV Digit Span. Of the sample, 29 youth athletes reported a HOC (13.8% female; 37.9 POC). RDS was calculated for each Digit Span administration, and sensitivity (SN) and specificity (SP) were calculated for RDS when invalid performance was operationalized by a more stringent cut-off score of &lt;49 to increase the SN of the TOMM Trial 1 (Stenclik et al., 2013). Receiver operator characteristics (ROC) curve analysis determined whether RDS performance accurately predicted participants’ performance on the TOMM.Results:The ROC curve analysis resulted in an area under the curve (AUC) of just 0.427 for RDS. A cut-off score of &lt;7 (as suggested by Kirkwood et al. (2011)) for RDS results in 100% SN, 8.3% SP, 5% positive predictive validity (PPV), and 95% negative predictive validity (NPV). However, a cut-off score of &lt;9 for RDS results in 75% SN, 15% SP, 25% PPV, and 75% NPV.Conclusions:Little research shows the utility of different PVTs predicting children’s performance on other PVTs, despite evidence that children with a HOC are vulnerable to variable or insufficient effort (Araujo et al., 2014; DeRight &amp; Carone, 2015). In a sample of 29 youth athletes with a HOC, RDS predicted TOMM performance at rates worse than chance. While RDS has advantages as an embedded PVT, its limited ability to predict performance on a standalone PVT suggests interpreting with great caution. These findings highlight the importance of implementing multiple PVTs throughout testing to ensure accurate findings and interpretations, particularly in youth with a HOC. The small sample size is a limitation that possibly impacted the ability of RDS to predict TOMM performance. Further research is needed to understand the utility of RDS as a predictor of PVT performance in different populations. Replication of these findings with a larger sample size is needed to provide confirmatory evidence of poor predictive performance of the RDS.

80 Demographic Factors Affecting Sensitivity Rates of Performance Validity Tests in Spanish-Speaking Forensic Litigants.

Objective:This retrospective study compared base rates of failure on a series of standalone and embedded performance validity tests (PVTs) in a sample of Spanish-speaking forensic litigants and explored the impact of demographic factors on PVT performance.Participants and Methods:62 Spanish-speaking participants involved in litigation (primarily for work-related mTBI) underwent outpatient neuropsychological evaluation. Country of origin spanned South American (56.5%), Caribbean (22.5%), Central American (16.1%), North American (3.2%), and Spanish (1.6%) regions. Of this sample, 56 completed the Test of Memory Malingering (TOMM), 45 completed the Rey Fifteen Item Test (RFIT), and 49 completed the Dot Counting Test (DCT). Embedded validity measures, Reliable Digit Span (RDS) and the WHO-Auditory Verbal Learning Test (WHO-AVLT) were completed by 32 and 48 participants, respectively.Results:Effects of age (M=42.4, SD=11.72) and region of origin did not significantly impact overall performance on any measure. Mean scores across all standalone PVTs were below cutoffs, which have been previously suggested for use with Spanish-speaking populations (TOMM &lt;40, RFIT total &lt;21, DCT e-score &gt;18). Overall base rates of failure were as follows: 52.5% TOMM (T1 M= 37.5, SD=10.7; T2 M=35.1, SD=10.6), 64.9% RFIT (M=17.8, SD=7.8) 57.6% DCT (M=18.3, SD=8.8), 51.1% RDS (M=6.1, SD=1.6), 29.4% WHO-AVLT (M=10.7, SD=3.9. Years of education (M=9.98, 3.96) was significantly correlated with RFIT total score (r(43) = .48, p&lt;.01) and DCT e-score (r(47) = -.34, p&lt;.05. When stratified by level of education (0-6, 7-11, and 12+), a large discrepancy in base rate of failure was observed on the RFIT, with failures in 92% of participants with less than six years of education, as compared to 52% and 59% failure in those with 7-11 and 12+ years, respectively. Variability in base rates of DCT failure across levels of education, although less extreme than on the RFIT, again demonstrated higher rates of failure in participants with less than six years of education (0-6: 71%, 7-11: 54%, 12+: 52%).Conclusions:These findings add to the existing literature surrounding measurement of suboptimal effort in Spanish-speaking populations. Base rates of PVT failure on both standalone and embedded measures were generally much higher than those reported in prior studies of forensic or compensation-seeking groups, including some with Spanish speaking participants. These high rates of failure are likely attributable, at least in part, to sample characteristics, due to the high proportion of individuals engaged in litigation associated with workplace injuries on construction sites at the study location. Such findings illustrate the importance of a thorough effort assessment for this population. Finally, results demonstrating reduced specificity of the RFIT in Spanish-speaking participants with less than six years of education, suggesting caution is warranted for its use in neuropsychological evaluations with such individuals.

51 The Minimal Effect of Depression on Cognitive Functioning when Accounting for Performance Validity

Objective:While much research has demonstrated a relationship between depression and cognitive deficits, most studies have neglected to include measurements of performance validity. The very small number of studies that have examined this relationship when accounting for performance validity have found that the relationship between depression and cognition is small or nonsignificant. The current study examined the relationship between depression (assessed through both clinical interview and self-report symptom measures) and multiple domains of cognition after accounting for noncredible performance on neuropsychological testing.Participants and Methods:Participants were veterans referred for outpatient clinical evaluation. Among other tests that varied across patients, the neuropsychological battery included: California Verbal Learning Test - second edition (CVLT-II) total immediate recall across trials 1–5, short delay free recall, and long delay free recall; Trail Making Test; FAS and Animal Fluency; Rey–Osterrieth Complex Figure Test (ROCF) copy and 3-minute delay recall; and Wisconsin Card Sorting Test (WCST) categories completed, total errors, and percent perseverative errors. These tests represent domains that have previously been examined in relation to depression (e.g., memory, processing speed, executive functioning). Evaluations were conducted for clinical purposes, so that some individuals who were not administered certain tests have missing data. The first set of regression analyses (N=206) included age, sex, and education at Step 1, Beck Depression Inventory-2 (BDI-2) total score at Step 2, and pass or failure of Trial 1 of the Test of Memory Malingering (TOMM) at Step 3 as predictors of performance on the 12 test indices. The second set of regression analyses (N=559) mirrored the first but with Major Depressive Disorder (MDD) diagnosis at Step 2 instead.Results:In the first set of analyses, after including TOMM in the model, only the relationship between BDI-2 and verbal fluency remained significant, but did not survive Bonferroni correction (p&lt;.004). In the second set of analyses, before including the TOMM, MDD diagnosis was significantly related only to worse performance on Trails A and CVLT-II Short and Long Delay Free Recall, with small effect sizes (rp=.06–.15). When TOMM Trial 1 was included in the model, MDD diagnosis became a nonsignificant predictor of CVLT-II Long Delay Free Recall but remained a significant predictor for Trails A and CVLT-II Short Delay Free Recall (p&lt;.05). After Bonferroni correction (p&lt;.004), with TOMM Trial 1 included in the model, MDD diagnosis remained a significant predictor only of CVLT-II Short Delay Free Recall, with a small effect size (rp=.17).Conclusions:After accounting for noncredible performance, there was little evidence for a relationship between depression diagnosis or symptoms and many cognitive domains. These results suggest that previously reported effects of depression on cognition are not mainly due to underlying neurological mechanisms, but rather to motivational factors. Future research could focus on the potential psychological mechanisms (e.g., negative attitudes, expectancy bias, low motivation, etc.) driving the relationship between depression and low effort on cognitive testing. If replicated, the current findings could be valuable to clinicians treating depressed individuals who have concerns about their cognitive functioning, by indicating psychoeducation and reassurance.

40 Performance validity in a presurgical epilepsy population

Objective:To examine whether suboptimal performance as determined by formal validity testing would predict neurocognitive scores in a sample of 83 pre-surgical, non-litigating epilepsy patients.Participants and Methods:Participants were 83 patients who underwent comprehensive outpatient neuropsychological testing as part as their evaluation as epilepsy surgery candidates. The sample consisted of 41 females and 42 males, with 72 patients identifying as White, 5 as Black, 2 as Hispanic, 1 as Asian, and 2 as other. Mean age was 36 (SD=12.4) mean FSIQ was 87 (SD=12.7), mean years of education of 12.9 (SD=2.1). Each patient’s assessment included a stand-alone performance validity test (PVTs)— Word Memory Test (WMT), the Test of Memory Malingering (TOMM), or the Medical Symptom Validity Test (MSVT)—as well as two embedded measures of validity—the California Verbal Learning Test Forced Choice (CVLT FC) and WAIS-IV Reliable Digit Span (RDS). Pass/fail rates were analyzed, with valid performance being defined as pass score on at least two of the completed PVTs (N=73 Pass Effort group 86.9%; N=10 Failed Effort group 11.9%). Point-biserial Pearson correlations were conducted to determine the relationship between validity pass/fail status and WAIS-IV FSIQ, VCI, and PRI scores, CVLT-II Trials 1-5 Total T scores, CVLT-II Long Delay Free Recall z scores, WMS-III Logical Memory II T scores, BVMT Total Recall T scores, BVMT Delayed Recall T scores, and Trail Making Test (TMT) B T scores.Results:Significant relationships were found between Failed Effort group and all neurocognitive scores except BVMT Total Recall. On average, the Failed Effort group obtained significantly lower FSIQ (M=76.57, SD=10.94), VCI (M=80.89, SD=16.03), PRI (M=81.00, SD=14.91), CVLT-II Trials 1-5 Total (M =34, SD=6.89), CVLT-II Long Delay Free Recall (M =-2.44, SD=1.43), WMS-IV Logical Memory II (M =4.83, SD=2.79), BVMT Delayed Recall (M=26.38, SD=6.41), and TMT B (M=29.70, SD=11.46) standard scores compared to the Pass Effort group (FSIQ M=88.09, SD=12.52; VCI M=92.13, SD=13.61; PRI M=91.14, SD=12.06; CVLT-II Trials 1-5 Total M=47.86, SD=12.02; CVLT- II Long Delay Free Recall M=-.44, SD=1.11; WMS-III Logical Memory II M=8.41, SD=3.17; BVMT Delayed Recall M=39.19, SD=12.66; TMT B M=39.34, SD=13.18). Correlation coefficients were r=-.266* (FSIQ), r=-.255* (VCI), r=-.271* (PRI), r=.361**(CVLT-II Total), r=-.474** (CVLT-II LDFR), r=-.298** (WMS-IV LM II), r=-.308** (BVMT DR), and r=-.240* (TMTB). All coefficients were significant at the .05 (*) or .01 (**) level.Conclusions:Results suggest that pass/fail status on formal validity testing predicts depressed performance on a variety of neurocognitive measures. Therefore, predicting surgical outcome of resection/ablation (e.g., compensation of contralateral hemisphere) should not be based upon neuropsychological memory performance alone when there are failures on tests of engagement as memory scores have strong correlations to pass/fail status on formal validity testing. Overall, this emphasizes the importance of routinely integrating PVTs as part of pre-epilepsy surgery neuropsychological evaluations.

32 A Comparison of Cut-Off Points for Invalid Cognitive Test Performance Established on Nonclinical Versus Clinical Samples for South African Educationally Disadvantaged Individuals

Objective:In South Africa, most of the cognitive tests employed for neuropsychological evaluation are those developed in educationally advantaged settings such as the US, but the normative data accompanying the tests are unsuitable for use with South African examinees who have a disadvantaged quality of education, and/or whose primary language is other than English. A recently completed collation of Africa-based normative data (Shuttleworth-Edwards &amp; Truter, 2022) includes a chapter on Performance Validity Tests (PVTs) with proposed cut-off points to assist in the identification of noncredible performance. The aim of this study was to compare the cut-off points established using educationally disadvantaged South African nonclinical normative samples for which only specificity percentages are available, with those established using clinical samples with designated valid and invalid performers for which both specificity and sensitivity data are available. A further aim was to compare the Africa-based cut-off points with age-equivalent cut-off points where available for US-based data on the targeted tests.Participants and Methods:The collation of Africa-based studies delineates cut-off scores for invalid test performance based on both nonclinical as well as clinical populations for three stand-alone PVTs especially developed to identify invalid performance including the Dot Counting Test (DCT), the Rey Fifteen Item Test (FIT), and the Test of Memory Malingering (TOMM); and three commonly employed cognitive tests for which there are embedded validity indicators including the Digit Span Age-Corrected Scaled Score (ACSS) and Reliable Digit Span (RDS), the Rey Auditory Verbal Learning Test (RAVLT), and the Trail Making Test A and B (TMT A and B). For studies using nonclinical norming data alone, specificity percentages to derive the cut-off points were set at a minimum of 90%. For studies using clinical samples specificity was set at a minimum of 90%, and the associated sensitivity percentages were reported indicating each test’s ability to correctly identify those with an invalid performance. The studies included participants stratified for both child and adult age groups (age 8 to 79 years) from South African educationally disadvantaged backgrounds. The data were tabled together for descriptive comparison purposes, including a column for the US-base cut-off points for equivalent age stages where available.Results:There was a high level of compatibility between the proposed cut-off points established for the South African nonclinical normative samples compared with those using clinical samples of designated valid and invalid performers. There was a trend for more lenient cut-offs for younger children and older adults compared to older children and younger adults. Compared with US-based data where available, adjustments towards leniency were called-for on all indicators.Conclusions:Cut-off scores for invalid cognitive test performance can be verified by perusing data derived from nonclinical norming samples as well as those from clinical samples, although the latter have the advantage of providing the sensitivity data to demonstrate the efficacy of a proposed cut-off score for identifying noncredible test performance. Adjustments towards leniency need to be made for cut-off scores for young children and older adults within an educationally disadvantaged population, and for disadvantaged adult populations compared with US-based educationally advantaged populations.

87 Examining the use of the Embedded Performance Validity Test in the Brief Visuospatial Memory Test-Revised Among Spanish-Speaking Patients

Objective:The Brief Visuospatial Memory Test-Revised (BVMT-R) Recognition Discrimination (RD) index has emerged as an embedded performance validity test (PVT). However, there do not appear to be any studies that have examined its utility in Spanish-speaking samples. This pilot study examined the classification accuracy of the BVMT-R RD for detecting performance invalidity in a Spanish-speaking forensic sample.Participants and Methods:This cross-sectional study utilized a sample of 89 Spanish speakers that were administered the BVMT-R during an outpatient neuropsychological evaluation. Out of the 89 Spanish speakers, 43 were subjects in litigation, 32 were neurological patients evaluated for clinical purposes, and 14 were healthy controls. The sample was 67% male/33% female, 53% South American, 33% Caribbean (Dominican, Puerto Rican, Cuban), 10% Central American, 3% North American (Mexican), and 1% Spanish, with a mean age of 44.2 years (SD = 14.2; range = 20-78) and mean education of 11 years (SD = 3.7; range = 0-20). Test administration for each patient was completed in Spanish by a fluent, Spanish-speaking examiner. In total, 64/89 (72%) were classified as valid and 25/89 (28%) as invalid based on performance across the Test of Memory Malingering (TOMM), at least one additional PVT (Rey-15 item memory test; Rey Dot Counting Test; Reliable Digit Span; WHO-AVLT recognition trial) and objective diagnostic criteria identifying invalid performance. Analyses included three univariate analyses of variance (ANOVA), with the groups (healthy vs neurological vs litigation) as independent variables and performance on BVMT-RD as the dependent variable.Results:Statistically significant differences among the groups were found F(2,86)=8.32, p &lt; .001). Post-hoc analysis (Scheffe test) showed the mean of the litigation group to be significantly lower than the means of the other two groups (healthy and neurological), which showed no difference between them. An ANOVA with validity groups as the fixed factor and BVMT-R RD index as the dependent variable was significant F(1,85)= 21.02, p &lt;.001). Results of a ROC curve analysis yielded statistically significant AUC (.794). The optimal cut-score was BVMT-R RD &lt; 5 (48% sensitivity/88% specificity).Conclusions:Results of the BVMT-R RD index in this Spanish-speaking population differed by subgroup, with worse performance seen in individuals involved in litigation, compared to those who were not (healthy and neurological). Notably, the BVMT-R RD index significantly differentiated validity groups, maintaining adequate sensitivity and good specificity. Overall, results demonstrate promise for BVMT-RD as a PVT for Spanish-speaking populations.

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.

64 Neuroimaging Evidence of Neurodegenerative Disease in Former Professional American Football Players Who “Fail” Validity Testing: A Case Series

Objective:Former professional American football players have a high relative risk for neurodegenerative diseases like chronic traumatic encephalopathy (CTE). Interpreting low cognitive test scores in this population occasionally is complicated by performance on validity testing. Neuroimaging biomarkers may help inform whether a neurodegenerative disease is present in these situations. We report three cases of retired professional American football players who completed comprehensive neuropsychological testing, but “failed” performance validity tests, and underwent multimodal neuroimaging (structural MRI, Aß-PET, and tau-PET).Participants and Methods:Three cases were identified from the Focused Neuroimaging for the Neurodegenerative Disease Chronic Traumatic Encephalopathy (FIND-CTE) study, an ongoing multimodal imaging study of retired National Football League players with complaints of progressive cognitive decline conducted at Boston University and the UCSF Memory and Aging Center. Participants were relatively young (age range 55-65), had 16 or more years of education, and two identified as Black/African American. Raw neuropsychological test scores were converted to demographically-adjusted z-scores. Testing included standalone (Test of Memory Malingering; TOMM) and embedded (reliable digit span, RDS) performance validity measures. Validity cutoffs were TOMM Trial 2 &lt; 45 and RDS &lt; 7. Structural MRIs were interpreted by trained neurologists. Aß-PET with Florbetapir was used to quantify cortical Aß deposition as global Centiloids (0 = mean cortical signal for a young, cognitively normal, Aß negative individual in their 20s, 100 = mean cortical signal for a patient with mild-to-moderate Alzheimer’s disease dementia). Tau-PET was performed with MK-6240 and first quantified as standardized uptake value ratio (SUVR) map. The SUVR map was then converted to a w-score map representing signal intensity relative to a sample of demographically-matched healthy controls.Results:All performed in the average range on a word reading-based estimate of premorbid intellect. Contribution of Alzheimer’s disease pathology was ruled out in each case based on Centiloids quantifications &lt; 0. All cases scored below cutoff on TOMM Trial 2 (Case #1=43, Case #2=42, Case #3=19) and Case #3 also scored well below RDS cutoff (2). Each case had multiple cognitive scores below expectations (z &lt; -2.0) most consistently in memory, executive function, processing speed domains. For Case #1, MRI revealed mild atrophy in dorsal fronto-parietal and medial temporal lobe (MTL) regions and mild periventricular white matter disease. Tau-PET showed MTL tau burden modestly elevated relative to controls (regional w-score=0.59, 72nd%ile). For Case #2, MRI revealed cortical atrophy, mild hippocampal atrophy, and a microhemorrhage, with no evidence of meaningful tau-PET signal. For Case #3, MRI showed cortical atrophy and severe white matter disease, and tau-PET revealed significantly elevated MTL tau burden relative to controls (w-score=1.90, 97th%ile) as well as focal high signal in the dorsal frontal lobe (overall frontal region w-score=0.64, 74th%ile).Conclusions:Low scores on performance validity tests complicate the interpretation of the severity of cognitive deficits, but do not negate the presence of true cognitive impairment or an underlying neurodegenerative disease. In the rapidly developing era of biomarkers, neuroimaging tools can supplement neuropsychological testing to help inform whether cognitive or behavioral changes are related to a neurodegenerative disease.