Word Memory Test Research Articles

A signal detection–item response theory model for evaluating neuropsychological measures

ABSTRACTIntroduction: Models from signal detection theory are commonly used to score neuropsychological test data, especially tests of recognition memory. Here we show that certain item response theory models can be formulated as signal detection theory models, thus linking two complementary but distinct methodologies. We then use the approach to evaluate the validity (construct representation) of commonly used research measures, demonstrate the impact of conditional error on neuropsychological outcomes, and evaluate measurement bias.Method: Signal detection–item response theory (SD–IRT) models were fitted to recognition memory data for words, faces, and objects. The sample consisted of U.S. Infantry Marines and Navy Corpsmen participating in the Marine Resiliency Study. Data comprised item responses to the Penn Face Memory Test (PFMT; N = 1,338), Penn Word Memory Test (PWMT; N = 1,331), and Visual Object Learning Test (VOLT; N = 1,249), and self-report of past head injury with loss of consciousness.Results: SD–IRT models adequately fitted recognition memory item data across all modalities. Error varied systematically with ability estimates, and distributions of residuals from the regression of memory discrimination onto self-report of past head injury were positively skewed towards regions of larger measurement error. Analyses of differential item functioning revealed little evidence of systematic bias by level of education.Conclusions: SD–IRT models benefit from the measurement rigor of item response theory—which permits the modeling of item difficulty and examinee ability—and from signal detection theory—which provides an interpretive framework encompassing the experimentally validated constructs of memory discrimination and response bias. We used this approach to validate the construct representation of commonly used research measures and to demonstrate how nonoptimized item parameters can lead to erroneous conclusions when interpreting neuropsychological test data. Future work might include the development of computerized adaptive tests and integration with mixture and random-effects models.

Comparison of Performance of the VIP and WMT in a Criminal Forensic Sample.

To compare the efficacy of the Validity Indicator Profile (VIP) and Word Memory Test (WMT) in a criminal forensic population. Potential participants included 225 male evaluees from a maximum-security Federal prison referred for neuropsychological evaluation for either forensic purposes or for suspected neurocognitive dysfunction as part of a medical evaluation. Examinees were included in the analysis if administered the VIP (Verbal, Nonverbal, or both tests) and WMT along with at least two other freestanding PVTs; 74 satisfied these criteria. Participants were then categorized as having probable Malingered Neurocognitive Dysfunction (+MND) if they failed at least two freestanding validity indicators, negative for MND (-MND) if they passed all indicators, and Possible MND (pMND) if they failed one indicator. Groups were very demographically similar. There were significant differences in WMT scores and distribution of VIP profiles across groups. Whether using traditional or investigative cut scores, and whether using the WMT with or without consideration of a GMIP profile, the WMT demonstrated superior sensitivity and specificity on nearly every comparison. The VIP, when interpreted in the traditional fashion, and the WMT with GMIP, both had more than adequate psychometric properties when used with criminal forensic evaluees, strengthening the body of literature supporting their use for these types of evaluations. Counting a positive on either of the VIP subtests as an indication of +MND improves the psychometric properties of the VIP slightly, although the WMT had the better overall classification accuracy.

Effect of astaxanthin-rich extract derived from Paracoccus carotinifaciens on cognitive function in middle-aged and older individuals.

This study was conducted to investigate the effect of dietary supplement containing astaxanthin-rich extract derived from Paracoccus carotinifaciens (astaxanthin supplement) on cognitive function of subjects aged 45–64 years. Cognitive functions of 28 subjects orally administered 8 mg astaxanthin/day of astaxanthin supplement for 8 weeks (astaxanthin group) and 26 subjects given a placebo (placebo group) were compared by word memory test, verbal fluency test, and Stroop test. The astaxanthin group experienced significantly larger increase in blood astaxanthin level than the placebo group. However, there were no significant intergroup differences in the results of the tests. A subgroup analysis was performed after dividing subjects into the <55 years old and ≥55 years old age groups. The result of “words recalled after 5 minutes” in word memory test in <55 years old subjects showed significant improvement in the astaxanthin group than in the placebo group, which was not found in ≥55 years old subjects. Our results indicate that people aged 45–54 years may experience improved cognitive function after ingesting astaxanthin supplement for 8 weeks. On the basis of the parameters tested, administration of astaxanthin supplement was not associated with any problems related to safety.

Trial 1 versus Trial 2 of the Test of Memory Malingering: Evaluating accuracy without a "gold standard".

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment than Trial 2, which is the source for inference recommended by the original instruction manual (Tombaugh, 1996). We used latent class modeling (LCM) implemented in a Bayesian framework to evaluate archival Trial 1 and Trial 2 data collected from 1,198 adults who had undergone outpatient forensic evaluations. All subjects were tested with 2 other performance validity tests (the Word Memory Test and the Computerized Assessment of Response Bias), and for 70% of the subjects, data from the California Verbal Learning Test-Second Edition Forced Choice trial were also available. Our results suggest that not even a perfect score on Trial 1 or Trial 2 justifies saying that an evaluee is definitely responding genuinely, although such scores imply a lower-than-base-rate probability of feigning. If one uses a Trial 2 cut-off higher than the manual's recommendation, Trial 2 does better than Trial 1 at identifying individuals who are almost certainly feigning while maintaining a negligible false positive rate. Using scores from both trials, one can identify a group of definitely feigning and very likely feigning subjects who comprise about 2 thirds of all feigners; only 1% of the members of this group would not be feigning. (PsycINFO Database Record

First stages chronic kidney disease have mild effects on cognitive performance. Results of a 15,105 brazilian adult baseline cohort.

Introduction: The aging of the population may lead to an increased prevalence of dementia and chronic kidney disease (CKD) and their overlap.Objective:We investigated the association between CKD and cognitive performance among Brazilian adults (35-74 years).Methods:Baseline data analysis of the Longitudinal Study of Adults (ELSA-Brasil), a multicenter cohort comprising 15,105 civil servants, was performed. Kidney function was defined by the CKD-Epi-estimated GRF and albumin creatinin ratio (ACR). Cognitive performance was measured across tests that included the word memory tests, verbal fluency tests and Trail Making Test B. Multiple logistic and linear regressions were used to investigate the association between CKD and global as well as test-specific lowered cognitive performance.Results:More than 90% of participants did not present CKD even considering reduced GFR or increased ACR simultaneously. Lowered cognitive performance was detected among 15.8% of the participants and mean values of GFR were slightly higher among those with normal than with lowered cognitive performance (86 ± 15 mL/min/1.73 m2 x 85 ± 16 mL/min/1.73 m2, p < 0.01). Age, education, skin-color, smoking, drinking, hypertension, and diabetes were associated with lowered cognition. After adjustment for these variables, there was no association between CKD and lowered cognitive performance. Negligibly small beta values were observed when analyzing CKD and the scores of all tests.Conclusion:These results suggest that cognitive performance remains preserved until renal function reaches significant worsening. Preventive measures to maintain renal function may contribute to the preservation of cognitive function.

Methods of augmentation of antidepressant therapy (on the model of complex therapy with the inclusion of actovegin) in gerontopsychiatric hospital

Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine). The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock. It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning. Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.

Early and long-term cognitive disorders after carotid endarterectomy

To identify correlation of carotid endarterectomy with neurocognitive function and psycho-emotional state changes. There were 120 patients with internal carotid arteries (ICA) stenoses for the period from September 2013 to December 2016. The main group consisted of 100 patients undergoing carotid endarterectomy for internal carotid artery stenosis, control group - 20 patients who refused surgery in 2014-2016. Cognitive function and psycho-emotional state were assessed preoperatively, after 24 hours, 7 days and 3, 6 months postoperatively using the Mini Mental State Examination (MMSE), Frontal assessment battery (FAB), Information-Memory-Concentration Test, Clock Drawing Test and Schulte`s test, Luria Memory Words Test, Hospital Anxiety and Depression Scale (HADS) and Covi Anxiety Scale. Moderate preoperative cognitive impairment was observed in 39 (39%) patients of the main group. De novo postoperative cognitive dysfunction occurred in 65 patients on the 1st day after surgery (65%). Disturbances were noted after 1 week in 26%, after 3 months - in 15%, after 6 months - in 10% of patients. Improved status was noted in 31 (31%) patients of the main group within 1 day after surgery. Improved results were observed after 7 days in 52 (52%) patients, after 3 months - in 67 (67%), after 6 months - in 78 (78%) patients. Mean values of psycho-emotional testing in the main group were high before surgery and significantly decreased on the 1st day after operation. However, advanced anxiety and aggravation of depression occurred in 14% of patients (n=14) that affected cognitive sphere (p<0.01). Progressive cognitive impairment was noted in the control group. Carotid endarterectomy has a positive long-term effect on initially impaired neurocognitive functions (3 and 6 months) (p<0.05). There were no significant differences in cognitive testing data in subgroups of eversion and classical procedures (p>0.05). Early postoperative depressive disorders significantly increase the risk of postoperative cognitive dysfunction.

Performance of the Immediate Post-Concussion Assessment and Cognitive Testing Protocol Validity Indices.

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery. Athletes provide preseason baseline ImPACT scores to which post-injury scores can be compared to aid concussion diagnosis. However, if baseline scores are not accurately representative of abilities, the utility of post-injury score comparison is diminished. For this reason, ImPACT includes low score thresholds on five validity indices to identify insufficient effort at baseline, though evidence of these indices' performance is limited. The present study examines the classification accuracy and concurrent validity of the existing ImPACT validity indices and three proposed indices (Word Memory Correct Distractors, Design Memory Correct Distractors, Total Symptom Score). The ImPACT, Word Memory Test (WMT) and Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) were administered to 242 undergraduate students. Participants were instructed to either give full effort on testing or to simulate SRC. Sensitivity of the existing ImPACT validity indices was marginally improved with adjusted score thresholds while maintaining acceptable specificity (0.90). Alternative score thresholds and novel validity indices demonstrated adequate specificity while improving sensitivity overall. Positive and negative predictive powers are provided to inform use of protocol validity indices across diverse treatment settings. The existing ImPACT indices' high specificity at the expense of lower sensitivity compared to external validity measures may under-identify poor effort, resulting in premature return-to-play decisions for athletes with concussion. Improvements or additions to the existing indices may raise sensitivity while maintaining acceptable specificity, aiding in the protection of athletes and safe athletic participation.

Twelve-Week Exercise Influences Memory Complaint but not Memory Performance in Older Adults: A Randomized Controlled Study.

This study aimed to evaluate the effects of different types of exercise on memory performance and memory complaint after a 12-week intervention. Eighty community-dwelling volunteers, aged 66.96 ± 11.73years, were randomly divided into four groups: resistance, cardiovascular, postural, and control groups (20 participants for each group). All participants were tested for their cognitive functions before and after their respective 12-week intervention using Rey memory words test, Prose memory test, and Memory Complaint Questionnaire (MAC-Q). Statistical analysis showed that the three experimental groups significantly improved MAC-Q scores in comparison with the control group (p < .05). The variation of MAC-Q scores and the variations of Rey and Prose memory tests scores were not correlated. These results indicate that the 12-week interventions exclusively influenced memory complaint but not memory performance. Further investigations are needed to understand the relation between memory complaint and memory performance, and the factors that can influence this relationship.

Performance Validity in Deep Brain Stimulation Candidates

Effort and motivation are important factors that influence performance on neuropsychological tests. Performance validity tests (PVT) have not been investigated in a sample of individuals who are at risk for cognitive decline and are presumably highly motivated to do well. The aim of the current study is to investigate performance validity in individuals with Parkinson's disease and essential tremor who are being considered for deep brain stimulation (DBS) surgery. Thirty DBS surgical candidates underwent neuropsychological evaluation including completion of the Word Memory Test (WMT) as well as embedded PVTs. Sixteen DBS candidates (53.3%) obtained a passing WMT score, 11 patients (36.6%) obtained scores in the "caution" range, and three patients (10%) produced failing scores. None of the patients scored below an 82.5% on the first three WMT subtests. This pilot study is the first to describe PVT in DBS candidates and in a presumed highly motivated, older, and cognitively at-risk sample.

Validation of the Advanced Clinical Solutions Word Choice Test (WCT) in a Mixed Clinical Sample: Establishing Classification Accuracy, Sensitivity/Specificity, and Cutoff Scores.

This study examined the Word Choice Test's (WCT) utility as a performance validity test in a mixed clinical sample of veterans referred for neuropsychological evaluation. Participants completed Green's Word Memory Test (WMT), WCT, and Test of Memory Malingering (TOMM) Trial 1. Using the WMT as the criterion for valid performance, logistic regressions examined the WCT and TOMM's classification accuracy for those with and without cognitive impairment (CI). Receiver operating characteristic curves were used to establish cut scores which maximized the sensitivity/specificity of each measure. In those without CI, both tests showed good classification accuracy (86.7% and 85.0%, respectively). Among those with CI, the TOMM retained good classification accuracy (82.3%), while the WCT's decreased considerably (69.4%). Optimal WCT cut scores differed based on impairment status, with a higher sensitivity/specificity trade-off among those with CI. Successful performance on the WCT appeared to rely more heavily on cognitive processes unrelated to performance validity.

Performance on the Test of Memory Malingering is predicted by the number of errors on its first 10 items on an inpatient epilepsy monitoring unit

Objective: Performance validity testing is an increasingly vital component of neuropsychological evaluation, though administration of stand-alone performance validity tests (PVTs) can be time-consuming. As the Test of Memory Malingering (TOMM) is among the most commonly used and researched PVTs, much work has focused on creating abbreviated versions while preserving diagnostic accuracy. A recent addition to this effort, errors on the first 10 items of Trial 1 (TOMMe10), was analyzed for its utility in predicting TOMM performance. Method: Subjects were 180 veterans seen on a long-term epilepsy monitoring unit. TOMM learning trials, Word Memory Test (WMT), and WAIS-IV Digit Span (for Reliable Digit Span; RDS) were administered as part of a larger battery. Performance invalidity was classified using established cut scores. Diagnostic classification statistics were calculated predicting TOMM, WMT, and RDS performance, including sensitivity, specificity, receiver operating characteristics (ROC), and positive and negative predictive values for multiple TOMMe10 cut scores. Results: A cut score of ≥2 errors on TOMMe10 yielded the highest sensitivity (.88) while maintaining ≥.90 specificity when predicting TOMM (also supported by ROC analysis). This cut score was also optimal when validated against combinations of PVTs (e.g. two of TOMM, WMT, and RDS; WMT and/or RDS). Conclusions: TOMMe10 shows great promise in predicting future TOMM performance. In settings where time with patients is at a premium, ≥2 errors on TOMMe10 may be used as an early TOMM discontinue criteria, allowing examiners to use their limited time more effectively. The use of TOMMe10 in settings with varying TOMM failure base rates was discussed.

The Severe Impairment Profile: A Conceptual Shift

The current study sought to evaluate and replicate the severe impairment profile (SIP) of the Word Memory Test (WMT) in patients referred for dementia evaluations. The sample consisted of 125 patients referred for a neuropsychological evaluation at a large Veterans Affairs Medical Center. Patients were assigned a Clinical Dementia Rating (CDR) by blind raters, and were classified according to their performance on performance validity testing. Subsequent chart reviews were conducted to help in more accurately determining the presence of severe memory impairment likely due to an underlying dementing process versus poor effort/task engagement. In our sample, 51% of patients failed easy WMT subtests and 93% of these patients obtained the SIP. The rates of failure on these easy subtests generally coincided with both more severely impaired CDR ratings, as well as more impaired delayed memory composite scores. Upon chart review, it was determined that there were likely a significant portion of classification errors using the SIP, with a positive posttest probability of impairment based on having the SIP being 65% as opposed to 28% for a negative result. Our findings suggest that the SIP does not appear to function effectively in a mixed dementia sample where there is increased potential for secondary gain. Additional concern is expressed regarding the overall likelihood of obtaining the SIP and subsequent inferential decisions related to obtaining an SIP. Future research should examine more optimal cut scores or alternative methods for more accurately classifying patients in different clinical contexts and patterns of impairment.

Enhanced detection of feigned cognitive impairment using per item response time measurements in the Word Memory Test

ABSTRACTResponse time (RT) is a less obvious outcome measure than conventional accuracy measures used in performance validity tests (PVTs). It is also under less conscious control and is affected by cognitive processes associated with deception. Studies that assessed the utility of RT for the detection of feigned cognitive impairment are however numbered. Moreover, RT variability was not assessed in a clinically used PVT. In the current study, we assessed the utility of RT measures for the detection of feigned cognitive impairment in the Word Memory Test (WMT). Healthy participants (N = 90) were randomly assigned to a simulation or control condition and their per-item RTs were recorded while they performed the WMT’s immediate recognition (IR) subtest. Simulators had longer mean RTs and larger RT variance than controls. Combining RT measures and the IR-subtest’s accuracy score enabled a highly accurate detection of simulators. Moreover, the combined scale demonstrated incremental value (though slight) in predicting group membership beyond the use of the accuracy score as the sole PVT measure. The findings tentatively point toward the usefulness of RT measures to enhance the detection of feigned cognitive impairment. Further studies are needed, however, in order to explore the utility of these measures in clinical settings.

The Dot Counting Test adds up: Validation and response pattern analysis in a mixed clinical veteran sample

ABSTRACTObjective: This study cross-validated the Dot Counting Test (DCT) as a performance validity test (PVT) among a mixed clinical veteran sample. Completion time and error patterns also were examined by validity group and cognitive impairment status.Method: This cross-sectional study included 77 veterans who completed the DCT during clinical evaluation. Seventy-four percent (N = 57) were classified as valid and 26% as noncredible (N = 20) via the Word Memory Test (WMT) and Test of Memory Malingering (TOMM). Among valid participants, 47% (N = 27) were cognitively impaired, and 53% (N = 30) were unimpaired.Results: DCT performance was not significantly associated with age, education, or bilingualism. Seventy-five percent of the overall sample committed at least one error across the 12 stimulus cards; however, valid participants had a 27% higher rate of 0 errors, while noncredible participants had a 35% higher rate of ≥4 errors. Overall, noncredible individuals had significantly longer completion times, more errors, and higher E-scores. Conversely, those with cognitive impairment had longer completion times, but comparable errors to their unimpaired counterparts. Finally, DCT E-scores significantly predicted group membership with 83.1% classification accuracy and an area under the curve of .87 for identifying invalid performance. The optimal cut-score of 15 was associated with 70% sensitivity and 88% specificity.Conclusion: The DCT demonstrated good classification accuracy and sensitivity/specificity for identifying noncredible performance in this mixed clinical veteran sample, suggesting utility as a non-memory-based PVT with this population. Moreover, cognitive impairment significantly contributed to slower completion times, but not reduced accuracy.

Clinical utility of the Rey 15-Item Test, recognition trial, and error scores for detecting noncredible neuropsychological performance in a mixed clinical sample of veterans

Objective: This cross-sectional study examined the Rey 15-Item Test (RFIT), Recognition Trial, and Error Scores for identifying noncredible performance in a mixed clinical veteran sample compared to another widely used validity measure, the Test of Memory Malingering (TOMM). Method: Sixty-two veterans who completed the RFIT (Recall/Recognition Trials), TOMM, and Word Memory Test (WMT) during clinical evaluation were included. Using the WMT as the criterion, 71% (N = 44) were classified as valid and 29% (N = 18) as invalid. Results: Among valid participants, 25% failed the RFIT Recall, whereas 78% of invalid participants passed (sensitivity: 22%; specificity: 75%; diagnostic odds ratio [DOR]: .86). The Recognition Trial increased sensitivity to 39% for identifying invalid performance, but 25% of valid participants still scored below cut-off (specificity: 75%; DOR: 1.91). RFIT Recall and Recognition Trial logistic regression and receiver operating characteristic (ROC) analyses were nonsignificant, with respective classification accuracies of 71 and 72.6% and areas under the curve (AUCs) of .52 and .55. RFIT Error Scores also failed to differentiate validity groups. In contrast, TOMM had stronger psychometric properties (sensitivity: 50%; specificity: 97.7%; DOR: 43; classification accuracy: 82.3%; AUC: .91). Moreover, RFIT Recall and Recognition failure rates were 14 and 22% greater, respectively, among those with cognitive impairment, whereas 95% of those with impairment and 100% without passed the TOMM. Conclusion: Despite frequent use among VA neuropsychologists, the RFIT displayed limited ability to detect noncredible performance and misclassified a large percentage of valid participants in this mixed clinical veteran sample, suggesting limited utility with this population.

Performance and Symptom Validity Testing as a Function of Medical Board Evaluation in U.S. Military Service Members with a History of Mild Traumatic Brain Injury.

The study was designed to replicate and extend pervious findings demonstrating the high rates of invalid neuropsychological testing in military service members (SMs) with a history of mild traumatic brain injury (mTBI) assessed in the context of a medical evaluation board (MEB). Two hundred thirty-one active duty SMs (61 of which were undergoing an MEB) underwent neuropsychological assessment. Performance validity (Word Memory Test) and symptom validity (MMPI-2-RF) test data were compared across those evaluated within disability (MEB) and clinical contexts. As with previous studies, there were significantly more individuals in an MEB context that failed performance (MEB = 57%, non-MEB = 31%) and symptom validity testing (MEB = 57%, non-MEB = 22%) and performance validity testing had a notable affect on cognitive test scores. Performance and symptom validity test failure rates did not vary as a function of the reason for disability evaluation when divided into behavioral versus physical health conditions. These data are consistent with past studies, and extends those studies by including symptom validity testing and investigating the effect of reason for MEB. This and previous studies demonstrate that more than 50% of SMs seen in the context of an MEB will fail performance validity tests and over-report on symptom validity measures. These results emphasize the importance of using both performance and symptom validity testing when evaluating SMs with a history of mTBI, especially if they are being seen for disability evaluations, in order to ensure the accuracy of cognitive and psychological test data.

Detecting coached neuropsychological dysfunction: a simulation experiment regarding mild traumatic brain injury

Objective: Performance validity tests (PVTs) and symptom validity tests (SVTs) are often administered during neuropsychological evaluations. Examinees may be coached to avoid detection by measures of response validity. Relatively little research has evaluated whether graduated levels of coaching has differential effects upon PVT and SVT performance. Accordingly, the present experiment evaluated the effect of graduated levels of coaching upon the classification accuracy of commonly used PVTs and SVTs and the currently accepted criterion of failing two or more PVTs or SVTs. Method: Participants simulated symptoms associated with mild traumatic brain injury (TBI). One group was provided superficial information concerning cognitive, emotional, and physical symptoms. Another group was provided detailed information about such symptoms. A third group was provided detailed information about symptoms and guidance how to evade detection by PVTs. These groups were compared to an honest-responding group. Extending prior experiments, stand-alone and embedded PVT measures were administered in addition to SVTs. Results: The three simulator groups were readily identified by PVTs and SVTs, but a meaningful minority of those provided test-taking strategies eluded detection. The Word Memory Test emerged as the most sensitive indicator of simulated mild TBI symptoms. PVTs achieved more sensitive detection of simulated head injury status than SVTs. Conclusions: Individuals coached to modify test-taking performance were marginally more successful in eluding detection by PVTs and SVTs than those coached with respect to TBI symptoms only. When the criterion of failing two or more PVTs or SVTs was applied, only 5% eluded detection.

Symptom validity testing (SVT) and social security disability claims

Background and aimsOver 50% of adult disability claimants fail some form of SVT. While some over report psychological, affective symptoms, others may report incredible cognitive symptoms. We examined effects of different types of response bias on free recall and self-reported depression.Participants and methods This is a single site cross-sectional study using a convenience sample (n = 224) of disability claimants in the Netherlands. The Green Word Memory Test (GWMT) was administered to all subjects. The Amsterdam Short Term Memory Test (AKTG), the Structured Inventory of Malingered. Symptomatology (SIMS), and the beck depression inventory (BDI-II) were administered in subsamples. Participant classification according to GWMT and SIMS outcomes resulted in four groups, G+/S+, G+/S−, G−/S+ and G−/S−.ResultsAverage age of the participants was 46.3 years (SD 9.9), 41.5% were female, and 43% were higher educated. GWMT was positive in 48.2% of all subjects, and 27.6% scored positive on both GWMT and SIMS. Analysis of variance of GWMT Free recall and Beck depression scores showed significant group differences [F(3, 123) = 33.21, P = .000] and [F(3, 106) = 25.17, P = .000] respectively.ConclusionsNon credible test performance was prevalent in this Dutch study of disability claimants. Insufficient effort and over reporting of psychological symptoms are associated with different score profiles on regular tests and self-rating scales.Disclosure of interestThe author receives funding for his work as a neuropsychologist in an expertise setting.

Does depression explain poor effort on Symptom Validity Tests (SVT)?

Background and aimsValid assessments require sufficient effort from the part of the testee. Motivation may be compromised, particularly in psychiatric conditions. We examined associations between response bias on free recall and self-reported symptoms in depressed and PTSD patients.Participants and methodsThis is a cross-sectional study. Patients had depression (n = 48), or PTSD or other anxiety disorders (n = 37). A control group (n = 47%) had chronic pain disorder, fibromyalgia or chronic fatigue. The Green Word Memory Test (GWMT) was administered to all subjects. The Structured Inventory of Malingered. Symptomatology (SIMS), and the Beck Depression Inventory (BDI-II) were administered in subsamples. Study outcome was self-reported depressive symptoms in Symptom Validity Test (SVT) negative cases.ResultsAverage age of the participants was 45.1 years (SD 9.5), 48.5% were female. GWMT was positive in 52.3% of all cases, GWMT and SIMS were positive in 33.8%, and GWMT and SIMS were negative in 37.7%. No significant group effects on GWMT were found. Average BDI-II scores were 32.8 (SD 13.9) for depressed patients, 28.3 (15.5) for those with anxiety disorders, and 27.6 (14.1) for controls (P = 0.43). Seventy-eight percent of depressed GWMT negative cases reported at least moderate depressive symptoms (BDI-II &gt; 18), and 44.4% severe symptoms (BDI-II &gt; 29). Approximately half of the GWMT negative cases with anxiety disorders and controls scored BDI-II &gt; 18.ConclusionsNon credible test performance is prevalent in disability claimants with affective, mood disorders. However, depressive symptoms per se do not explain poor effort on cognitive tasks.Disclosure of interestThe authors have not supplied their declaration of competing interest.