Arch Clin Neuropsychol. 2023 Oct 8:acad067.200. doi: 10.1093/arclin/acad067.200. Online ahead of print.
OBJECTIVE: Determining performance validity is an imperative part of neuropsychological assessment in concussion management. Several existing embedded performance validity tests (PVTs) have been developed for popular measures of memory, Hopkins Verbal Learning Test Revised (HVLT-R) and Brief Visuospatial Memory Test Revised (BVMT-R). However, many PVTs utilize cognitive performance measures to classify performance invalidity, which increases the likelihood of false positives, especially in clinical populations. To reduce this possibility, a novel embedded PVT was developed utilizing infrequent patterns of performance in a primarily amnestic, dementia population.
METHOD: Neuropsychological data for 50 adult outpatients (Mean Age = 73, Range = 50-97) who met criteria for Major Neurocognitive Disorder (MND) were reviewed. Infrequent patterns of performance (IPOP) were identified on the HVLT-R and BVMT-R, including inconsistency between recall and recognition, unusually high intrusions, exceedingly poor learning, and lack of primary effect. Scaled scores were developed from the IPOP scores (0 = 0-74%, 1 = 75-94%, 2 = 95-99%). Total IPOP scaled scores were compared to existing embedded PVTs, which utilized recognition discrimination and percent retention scores, to examine classification rates.
RESULTS: Failure rates on the embedded PVTs for the HVLT-R were 16-42% and BVMT-R 38-58% whereas elevated IPOP scaled scores were identified in less than 15% of the sample.
CONCLUSIONS: High frequencies of embedded PVT failures were found in a clinical sample of patients with MND, which is concerning for false positive misclassification. Infrequent patterns of memory performances identified in a dementia population were less frequent and could potentially be utilized to examine performance validity in persons suspected of producing invalid memory performances.