Word Memory Test Research Articles

The utility of Green's word memory test in the early detection of dementia in a sample of Puerto Rican elders

The utility of Green's word memory test in the early detection of dementia in a sample of Puerto Rican elders

Validation of Symptom Validity Tests Using a "Child-model" of Adult Cognitive Impairments

Validation studies of symptom validity tests (SVTs) in children are uncommon. However, since children's cognitive abilities are not yet fully developed, their performance may provide additional support for the validity of these measures in adult populations. Four SVTs, the Test of Memory Malingering (TOMM), the Word Memory Test (WMT), the Amsterdam Short-Term Memory (ASTM) test, and the Word Completion Memory Test (WCMT), along with several neuropsychological instruments were administered to 48 Dutch school children aged 7-12. All children scored above the established adult cut-offs on the TOMM and the WMT. They could pass the ASTM test if their reading skills were at a level equivalent to that of 9 year olds. All children passed our criterion of a negative WCMT score. However, the WCMT does seem sensitive to the level of verbal fluency. Implications for the applicability of these SVTs in adult populations are discussed.

Detection of Simulated Memory Impairment in 6- to 11-Year-Old Children

The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are measures designed to detect poor effort that have been extensively used with adults. Little research has been conducted examining whether these tests are suitable for use in children. The aims of the present study were to (a) examine if children between the ages of 6 and 11 years were able to obtain scores above cutoffs recommended for adults on the TOMM, (b) identify clinically useful cutoff scores for the oral WMT, (c) determine whether the TOMM and the oral WMT were able to differentiate controls (n = 50) and coached simulators (n = 40) aged 6 to 11 years, and, lastly, (d) reading ability, nonverbal reasoning and vocabulary level were measured to determine if these factors affected performance on the TOMM and oral WMT. Results revealed that 98% of children instructed to perform at their best were able to meet criteria on the TOMM. Based on a cutoff score of less than 78.5% on the mean of the Immediate and Delayed Trials of the oral WMT, 98% of the controls and 90% of the coached simulators were correctly identified. Results indicated that the TOMM and oral WMT are useful measures for the detection of enactment in children as young as 6.

Functional Neuroimaging of Symptom Validity Testing in Traumatic Brain Injury

The Word Memory Test (WMT) is a commonly used symptom validity test (SVT) that assesses recognition verbal memory. The task has been adapted for use within a functional magnetic resonance imaging (fMRI) paradigm so the neural correlates of WMT activation patterns can be studied. In the current investigation, performance on the delayed recognition subtest of the WMT was examined in two patients who sustained severe TBI and compared to ten healthy controls. The patients underwent comprehensive neuropsychological evaluations and structural MRI. All participants completed two versions of the WMT: full-effort and simulated poor effort conditions. Despite extensive structural brain damage, the fMRI activation patterns during full-effort WMT performance were somewhat similar in the two TBI patients and likewise, somewhat similar to controls. The fMRI activation pattern in both patients demonstrated intact activation of the basic neural structures necessary to perform the WMT. Dissimilar patterns of activation were obtained during the simulated poor effort condition of WMT performance suggesting that fMRI techniques may be sensitive in demonstrating non-credible cognitive performance. The results of our study represent the first fMRI investigation of normal and simulated poor effort SVT performance in individuals with documented brain damage. The implications of fMRI techniques in SVT research and their clinical application are discussed.

Using Grip Strength Force Curves to Detect Simulation: A Preliminary Investigation

Analysis of grip strength force curves has successfully detected suboptimal effort in industrial rehabilitation research. This study examined force curve analysis as an effort measure when grip strength was administered according to standardized neuropsychological procedures in a sample without reported neurologic and upper extremity injury. Eighty-two undergraduates were randomized to control (n = 26), naïve simulator (n = 28), and coached simulator (n = 28) conditions. Outcome measures included grip strength in kilograms, variables calculated from grip strength force curves, and the Word Memory Test (WMT). While average force in kilograms was not significantly different between groups, significant differences were found on the average to peak force ratio as calculated from grip strength force curves. The classification accuracy of average to peak force ratio was lower than the WMT, but comparable to other effort measures. Force curve analysis may warrant further study in a clinical sample.

Different patterns of cerebral activation in genuine and malingered cognitive effort during performance on the Word Memory Test

Primary objective: The Word Memory Test (WMT) is a popular symptom validity test in which individuals are required to remember and recall semantically-related word pairs. Research shows successful WMT completion employs a wide neural network which is involved in tasks requiring high cognitive effort. The primary purpose of this study was to replicate earlier fMRI findings using a larger sample and extend previous findings by including male and female subjects. The second purpose was to investigate the neural networks involved during intentional malingering on the WMT.Research design: For all trials, a time-series ANCOVA design was implemented using SPM5 software.Methods and procedures: Ten subjects (five male and five female) underwent fMRI imaging while completing the WMT in full-effort and simulated poor effort conditions.Main outcome and results: Full-effort trials found activation peaks in dorsolateral prefrontal cortex, superior parietal lobe, anterior cingulate, bilateral lingual cortices and anterior insula/frontal operculum, supporting earlier findings. Simulated poor effort trials had similar foci of activation, with additional peak strength in surrounding cortical regions identified previously as relevant to simulated malingering. No sex differences were observed in either condition.Conclusions: These findings demonstrate the neural underpinnings of WMT performance in normal and simulated performance.

Memory Malingering: Evaluating WMT Criteria

The Word Memory Test (WMT) has been considered one of the best assessment tools for assessing memory malingering in spite of some reported false-positive results. Our goal was to examine the sensitivity and specificity of Green's 2003 criteria for memory malingering using a Portuguese adaptation of the WMT. We applied the WMT to three groups of participants, including 20 healthy subjects asked to simulate memory impairment, 29 healthy adults asked to produce their best performance, and 21 patients with the diagnosis of mild cognitive impairment (MCI). Using Green's 2003 criteria, based on scores below cutoffs on the easy subtests, 67% of the MCI patients were classified as “poor effort.” However, the sensitivity and specificity of the diagnosis could be raised to 95% using an alternative set of criteria, relying on comparisons between easy and hard subtest scores. We conclude that Green's original criteria based on easy subtest scores alone seem to be of low specificity for the diagnosis of memory impairment simulation, but the WMT is a good instrument for identifying simulation if the alternative criteria are applied.

Bowden, shores, & mathias (2006): failure to replicate or just failure to notice. Does effort still account for more variance in neuropsychological test scores than tbi severity?

Several studies have reported that traumatic brain injury (TBI) has a smaller effect on neuropsychological test scores, in contrast to the large effect of poor effort on test performance. Consequently, many authors have concluded that effort needs to be measured routinely and that it is necessary to control for poor effort when measuring the effects of brain disease or injury on performance. Recently, however, Bowden, Shores, and Mathias (2006) have challenged these notions. They argued that the Immediate Recognition subtest of the Word Memory Test (Green & Flaro, 2003), an effort measure, is another verbal memory test rather than a measure of cognitive effort. In this study we re-examine the data from Bowden et al. (2006) and Green, Rohling, Lees-Haley, and Allen (2001) to identify differences between the two studies that might account for their contradictory conclusions. In both sets of data, reanalysis showed that effort explains approximately five times more of the variance in composite neuropsychological test scores than TBI severity. Importantly, scores on the Word Memory Test–Immediate Recognition (WMT-IR) were not correlated with measures of TBI severity, and were not found to correlate with major variables known to be measuring ability (e.g., years of education). These findings challenge the conclusions offered by Bowden and colleagues (2006).

Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.

Methodological Challenges in Assessment of Cognition following Mild Head Injury: Response to Malojcic et al. 2008

Journal of NeurotraumaVol. 26, No. 12 Letter to the EditorMethodological Challenges in Assessment of Cognition following Mild Head Injury: Response to Malojcic et al. 2008Scott R. MillisScott R. MillisSearch for more papers by this authorPublished Online:23 Dec 2009https://doi.org/10.1089/neu.2008.0530AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Methodological Challenges in Assessment of Cognition following Mild Head Injury: Response to Malojcic et al. 2008." , 26(12), pp. 2409–2410FiguresReferencesRelatedDetailsCited byAn Experimental Study of the Effects of Biased Responding on the Modified Rivermead Post-concussion Symptoms Questionnaire and Validity Indicators17 July 2021 | Psychological Injury and Law, Vol. 14, No. 3Neuropsychology in the Outcome of Severe Traumatic Brain InjuryPerformance of the Immediate Post-Concussion Assessment and Cognitive Testing Protocol Validity Indices27 October 2017 | Archives of Clinical Neuropsychology, Vol. 33, No. 5Comparisons of Five Performance Validity Indices in Bona Fide and Simulated Traumatic Brain Injury1 July 2014 | The Clinical Neuropsychologist, Vol. 28, No. 5Neuroimaging Biomarkers in Mild Traumatic Brain Injury (mTBI)24 August 2013 | Neuropsychology Review, Vol. 23, No. 3Symptom Validity Testing, Effort, and Neuropsychological Assessment8 May 2012 | Journal of the International Neuropsychological Society, Vol. 18, No. 4Traumatic Brain Injury Alters Word Memory Test Performance by Slowing Response Time and Increasing Cortical Activation: An fMRI Study of a Symptom Validity Test19 August 2011 | Psychological Injury and Law, Vol. 4, No. 2 Volume 26Issue 12Dec 2009 InformationCopyright 2009, Mary Ann Liebert, Inc.To cite this article:Scott R. Millis.Methodological Challenges in Assessment of Cognition following Mild Head Injury: Response to Malojcic et al. 2008.Journal of Neurotrauma.Dec 2009.2409-2410.http://doi.org/10.1089/neu.2008.0530Published in Volume: 26 Issue 12: December 23, 2009Online Ahead of Print:November 3, 2009Online Ahead of Editing: August 6, 2009PDF download

The Warrington Recognition Memory Test for Words as a Measure of Response Bias: Total Score and Response Time Cutoffs Developed on "Real World" Credible and Noncredible Subjects

Several studies have examined the usefulness of the Warrington Recognition Memory Test-Words as a measure to detect suspect effort, although samples have generally been small and/or comprised of simulators rather than "real world" credible and noncredible patients. The current study examined the Warrington Recognition Memory Test-Words total score and response time of "real world" noncredible patients (as determined by motive to feign, failure on > or =2 independent measures of response bias, low cognitive scores inconsistent with normal ADLs; n = 190) versus credible patients (as determined by no motive to feign, failure of < or =1 measure of response bias; n = 124) derived from an archival database of individuals from the Harbor-UCLA Medical Center, Department of Psychiatry, Outpatient Neuropsychology Service, and the private practice of the second author. Noncredible patients obtained significantly lower total scores and longer times to complete the task. A total correct cutoff of < or =42 was found to have excellent specificity (91.9%) and sensitivity (88.9%), whereas a time cutoff of > or =207'' was associated with 65.5% sensitivity at 90.7% specificity, and when the time cut-score was used in combination with the total score cutoff, an additional 5% of the noncredible participants were captured, raising overall sensitivity to 93.7% (at 87.1% specificity). Thus, the Warrington Recognition Memory Test-Words, although not originally created for the purposes of measuring suspect effort, appears to be an excellent measure for detecting response bias on neuropsychological testing.

The Diagnostic Accuracy of Symptom Validity Tests when Used with Postsecondary Students with Learning Disabilities: A Preliminary Investigation

The current exploratory investigation examined the diagnostic accuracy of the Word Memory Test (WMT), Test of Memory Malingering (TOMM), and Word Reading Test (WRT) with three groups of postsecondary students: controls, learning disability (LD) simulators, and a presumed honest LD group. Each measure achieved high overall diagnostic accuracy, yet each contributed differently to suboptimal effort detection. False-negative classifications varied by measure, yet no simulator went undetected by all three tests. The WMT and WRT identified different members of the presumed honest LD group as demonstrating poor effort, whereas the TOMM identified none. Each measure contributed unique variance in a logistic regression, with effort status best predicted by WMT Consistency. Findings provided preliminary evidence that all three measures may be useful when assessing effort during postsecondary LD evaluations. Implications for future practice and research are discussed.

Reference Data for the Word Memory Test

Many studies have evaluated the utility of the Word Memory Test (WMT) as a symptom validity test. However, there is a lack of reference data for the WMT conventional memory subtests. The present study examined the demographic characteristics that influence performance on these subtests, in order to develop demographically corrected reference data. For this purpose, we administered the Dutch version of the WMT to 115 healthy Dutch controls, aged 20-80 years. Furthermore, we demonstrated the equivalence of the English and Dutch language versions of the WMT. Stepwise linear regression analyses of the combined Canadian and Dutch samples (N = 155) showed that the memory scores declined with increasing age. Participants with lower levels of education performed worse than more highly educated subjects. Reference data stratified by age and level of education are presented for use in research and clinical settings.

Comparable performance of patients with obsessive–compulsive disorder (OCD) and healthy controls for verbal and nonverbal memory accuracy and confidence:: Time to forget the forgetfulness hypothesis of OCD?

The memory deficit or forgetfulness hypothesis of obsessive–compulsive disorder (OCD) has received considerable attention and empirical effort over the past decades. The present study aimed to provide a fair test of its various formulations: (1) memory dysfunction in OCD is ubiquitous, that is, manifests irrespective of modality and material; (2) memory dysfunction is found for nonverbal but not verbal material, (3) memory dysfunction is secondary to executive impairment; and (4) memory dysfunction affects meta-memory rather than memory accuracy. Participants comprised 43 OCD patients and 46 healthy controls who were tested on the Picture Word Memory Test (PWMT), which provides several unconfounded parameters for nonverbal and verbal memory accuracy and confidence measures across different time-points. In addition, the Trail-Making Test B was administered to test assumption number 3. Replicating earlier work of our group, samples displayed similar performance on all indices. None of the different formulations of the memory deficit hypothesis were supported. In view of waning evidence for a global memory deficit in OCD, neuropsychological research on OCD should more thoroughly investigate moderators and triggers of occasional instances of impaired performance, particularly cognitive biases such as perfectionism and an inflated sense of responsibility.

Evaluating Constructs Represented by Symptom Validity Tests in Forensic Neuropsychological Assessment of Traumatic Brain Injury

This study uses a new method to summarize diagnostic validity information to explore which constructs are captured by malingering tests. The Test Validation Summary applies mixed-groups validation to investigate the meaning of test constructs and to estimate test classification characteristics when test validation groups are not "pure" criterion groups (ie, "compliant" vs "malingering"), but members have variable probability of malingering. The method permits the use of tests with relatively low validity to validate tests of greater validity. In our initial analysis, we argue that the Rey 15-Item Memory Test is best construed as an "intention test" (capturing the intention of testtakers when taking a test) as opposed to an "effort test." Using the Test Validation Summary and mixed-groups validation, we demonstrate that as an indicator of "intention to feign cognitive impairment," the Rey 15-Item Memory Test has estimated false-positive rate (FPR) = 0.02 and true-positive rate (TPR) = 0.57. We then explore the meaning of failure on the Word Memory Test (WMT), which uses a dichotomous classification of performance as valid or invalid. Although the WMT is commonly referred to as an "effort test," we argue that it likely captures both "intention" and "effort" but collapses this information into a single dichotomous classification of symptom validity. We demonstrate that, as a result of this dichotomous classification process, the WMT likely has a problematic FPR. In our analysis of previously published WMT data, the WMT FPR is estimated at 0.12 when there is no predisposition to perform poorly but rises dramatically and unrealistically as the predisposition to perform poorly increases. We compare these findings to those of the Validity Indicator Profile (VIP), which captures both intent and effort to classify 4 different sorts of response styles in cognitive testing. In our analyses, the VIP demonstrates that FPR = 0 and TPR = 0.86 when the construct being measured is "intent to perform poorly," and reveals that FPR = 0.06 and TPR = 0.63 when the construct being measured is "inconsistent responding" or "poor effort." We were able to demonstrate for the VIP the same "oversensitivity" shown by the WMT when the VIP was interpreted only as a dichotomous classification test. These results indicate that researchers who attempt to generate classification characteristics for malingering tests must carefully consider what constructs are being captured by the test.

Rates of Below-Chance Performance in Forced-Choice Symptom Validity Tests

The rates of significantly below-chance results on three neuropsychological symptom validity tests (SVTs) including the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) were compared in a private practice forensic sample of 1032 examinees with alleged mild traumatic brain injury, moderate to severe traumatic brain injury, alleged toxic exposure, and reported chronic pain. The PDRT and WMT were equivalent to one another in the rates of below-chance results, with both yielding more frequent below-chance results than the TOMM. Seemingly more difficult sections of the PDRT and WMT had higher yields than seemingly easier sections. Multiple SVTs were more likely to yield below-chance results than a single test, supporting the use of multiple SVTs in forensic neuropsychological evaluations.

Examining false positives on the Word Memory Test in adults with mild traumatic brain injury

Primary objective: Many adults with mild traumatic brain injury (MTBI) fail effort tests, indicating poor effort and invalid test results. However, two studies have suggested a high rate of false positives on the Word Memory Test (WMT) in adults with MTBI. This study examines the question of false positives in adults with MTBI who failed the effort subtests of the WMT.Research design: A modified and shortened version of the WMT, the Medical Symptom Validity Test (MSVT) was given to adults with MTBI, some of whom failed the WMT. It was also given to samples of schoolchildren in grades two and above, to several hundred children with developmental disabilities and to healthy adults.Outcomes and results: Failures on the MSVT were far more frequent in adults with MTBI than in second grade children or in children with developmental disabilities. Adults with MTBI who failed the WMT scored much lower on the MSVT effort subtests than children with a mean FSIQ of 63 and much lower than children with impaired memory.Conclusions: Comparison with developmentally disabled children on the MSVT suggests that the adults with MTBI who failed the WMT were not making an effort to do well on either the WMT or the MSVT. Their results were invalid. False positives on the WMT in adults with mild TBI are very rare.

Word memory test performance in amnesic patients with hippocampal damage.

Many symptom validity tests (SVTs) assess performance validity via declarative memory paradigms. One widely used SVT, the Word Memory Test (WMT), uses a variety of memory tests to assess performance. It is well known that declarative memory requires the hippocampus and related medial temporal lobe structures. In the present study, WMT performance was examined in nonlitigating amnesic subjects (n = 3) with well-documented focal bilateral hippocampal atrophy who were nondemented and otherwise cognitively unimpaired compared with matched controls. The amnesic subjects had no external incentives. Amnesic subjects performed significantly below the level of matched comparison subjects but above established cutoff scores on the immediate recognition and delay recognition subtests and consistency component. In contrast, the amnesic subjects were impaired relative to our comparison subjects on the multiple-choice, paired associate, free-recall, and long delay free-recall subtests and had extremely low performance on these measures. Thus, there was a differential effect of hippocampal damage on WMT performance where the recognition subtests were performed within the normal range, yet the free recall was profoundly impaired in amnesic subjects. Such an approach where SVT performance is assessed in populations with well-known cognitive impairments adds breadth to SVT clinical interpretations.

The effect of distraction on the Word Memory Test and Test of Memory Malingering performance in patients with a severe brain injury

This research compares the performance of a sample of non-litigating participants with severe brain injury on both the WMT and TOMM under conditions of (1) full effort, (2) distraction, or (3) simulated malingering. The study included 60 participants with a severe brain injury and used restricted randomization to assign participants to the groups. Following Craik (1982) an auditory distraction task was used during the learning phase of each test in the distraction group, while a scenario adapted from Tombaugh (1997) was used to encourage simulation of memory impairment in the simulated malingering group. The results of this study clearly showed that while both tests demonstrated excellent sensitivity, the false positive rates for the WMT were significantly greater than those for the TOMM. It was concluded that the so-called "effort" components of the WMT required more cognitive capacity than was previously believed.

Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests

Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests. Clinical and research implications are discussed.