Official Position of the American Academy of Clinical Neuropsychology Social Security Administration Policy on Validity Testing: Guidance and Recommendations for Change.

UNLABELLED: The milestone publication by Slick, Sherman, and Iverson (1999) of criteria for determining malingered neurocognitive dysfunction led to extensive research on validity testing. Position statements by the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology (AACN) recommended routine validity testing in neuropsychological evaluations. Despite this widespread scientific and professional support, the Social Security Administration (SSA) continued to discourage validity testing, a stance that led to a congressional initiative for SSA to reevaluate their position. In response, SSA commissioned the Institute of Medicine (IOM) to evaluate the science concerning the validation of psychological testing. The IOM concluded that validity assessment was necessary in psychological and neuropsychological examinations (IOM, 2015 ). OBJECTIVE: The AACN sought to provide independent expert guidance and recommendations concerning the use of validity testing in disability determinations. METHOD: A panel of contributors to the science of validity testing and its application to the disability process was charged with describing why the disability process for SSA needs improvement, and indicating the necessity for validity testing in disability exams. RESULTS: This work showed how the determination of malingering is a probability proposition, described how different types of validity tests are appropriate, provided evidence concerning non-credible findings in children and low-functioning individuals, and discussed the appropriate evaluation of pain disorders typically seen outside of mental consultations. CONCLUSIONS: A scientific plan for validity assessment that additionally protects test security is needed in disability determinations and in research on classification accuracy of disability decisions.

Normative data for a six-trial administration of the Verbal Selective Reminding Test.

Normative data for 267 neurologically normal adults (age range 18-91) are provided for a six-trial administration of Form I of the Verbal Selective Reminding Test (VSRT; Hannay & Levin, 1985). Gender corrections were generated by age- and education-matched pair analyses of the VSRT performance of 82 males and 82 females. Normative data are grouped by seven age cohorts: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-91. A regression-based procedure is provided, so that existing delayed recall norms, based on a 12-trial administration, can be utilized, following a 6-trial administration.

Association between IQ and neuropsychological test performance: commentary on Tremont, Hoffman, Scott, and Adams (1998).

Recently, Tremont, Hoffman, Scott, and Adams (1998) demonstrated an association between Halstead-Reitan (HRB) and Wechsler Memory Scale (WMS) performance and WAIS-R IQ scores, and recommended that premorbid intellectual estimates be utilized as general indicators of expected neuropsychological test performance. The commentary presented here demonstrates that the relationship between IQ, HRB and WMS is due to shared common factors, and argues against the use of premorbid IQ estimates, because of significant regression to the mean. "Intelligence" is redefined as the composite of neurobehavioral abilities covered in comprehensive neuropsychological assessment.

A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies.

We conducted a meta-analytic review of neuropsychological studies of mild head trauma (MHT). Studies were included if they met these criteria: patients studied at least 3 months after MHT; patients selected because of a history of MHT rather than because they were symptomatic; and attrition rate of less than 50% for longitudinal studies. Studies of children were not considered. We found a total of 8 published papers with 11 samples that met these criteria. Using the g statistics, the overall effect size of 0.07 was nonsignificant, but the d statistic yielded an effect size of 0.12, p < .03. Measurers of attention had the largest effect, g = 0.17. p < .02 and d = 0.20, p < .006. Severity of injury accounted for far more variance than did specific neuropsychological domain, however. The small effect size suggests that the maximum prevalence of persistent neuropsychological deficit is likely to be small and neuropsychological assessment is likely to have positive predictive value of less than 50%. Consequently, clinicians will more likely be correct when not diagnosing brain injury than when diagnosing a brain injury in cases with chronic disability after MHT.

Construct validity of various verbal and visual memory tests.

Factor analysis was conducted on attention, information processing, verbal and visual memory scores of 112 patients. Factor structure did not vary as a function of age. The Expanded Paired Associates Test, Verbal Selective Reminding Test, Continuous Recognition Memory Test, and Continuous Visual Memory Test defined a general memory factor. The PASAT, WMS Mental Control, and WAIS-R Digit Span defined an attention/information processing factor. Immediate Visual Reproduction (VR) loaded primarily on visual/nonverbal intelligence, whereas delayed VR loaded primarily with the memory factor. The Trail Making Test, Part B was more closely associated with visual/nonverbal intelligence than with attention/information processing. Serial Digit Learning was more closely associated with attention/information processing than with general memory.

Structure of everyday memory in adults with Age-Associated Memory Impairment.

Everyday memory was tested in a group of adults manifesting Age-Associated Memory Impairment; a computerized battery of tests was constructed to simulate memory tasks of daily life. Confirmatory and other structural equation models were estimated for the entire sample of 273 Ss and for 3 age groups. A 4-factor model was found to fit the data well and was invariant across age and gender. After education had been controlled, only the General Recall factor was found to be consistently related to age in both men and women; the other 3 factors--Narrative Memory, Digit Recall, and Visual Memory--were related to age only in men. Confirmatory factor analyses of the everyday memory tests combined with several psychometric memory tests suggested that some of the latter (the Benton Visual Retention Test and Wechsler Memory Scale Hard Paired Associates) load on more than 1 factor of everyday memory, suggesting complex relationships between the 2 types of tests.

Estimated prevalence of age-associated memory impairment derived from standardized tests of memory function.

Recent research on the prevalence of age-associated memory impairment (AAMI) has reflected considerable variability, with estimates ranging from 35% to 98%. This variability is attributed to (a) failure to employ the complete diagnostic criteria for AAMI and (b) failure to consider age as a variable in estimating prevalence. Analysis of published normative data on both standard clinical memory tests and computer-simulated everyday memory tests shows a clear increase in the percentage of persons meeting the AAMI memory performance criterion as a function of age. These data are offered as an upper-bound estimate of the prevalence of AAMI, by age decade.

Memory self-report in Alzheimer's disease and in age-associated memory impairment.

We investigated memory self-report in Alzheimer's disease (AD) and age-associated memory impairment (AAMI). AD and AAMI patients and healthy elderly subjects were administered a self-report memory questionnaire, memory tests, a family-rated memory questionnaire, and a depression scale. The AD group reported worse memory than the control group, but many individual AD subjects reported normal memory. This finding confirms clinical observations that unawareness of memory loss is common in AD but variable across patients. Multiple regression analysis revealed that worse memory self-ratings were associated with greater dementia severity and higher depression scores. In the AAMI group, memory self-ratings were predicted by family ratings of memory ability but not by memory test scores. There was a nonsignificant trend for depression scores to predict memory self-ratings. Finally, level of self-reported memory ability did not differ for AD and AAMI, contradicting clinical lore that memory complaint is a useful diagnostic indicator.

Accelerated forgetting in Alzheimer-type dementia.

Accelerated forgetting of name-face associations and grocery list items within the first hour postpresentation is demonstrated in 80 persons with Alzheimer's disease (AD) compared to 80 control subjects matched on age, education, and gender. Differences in forgetting which exceeded statistical regression effects remained, even when AD and control subjects were matched on rate of acquisition during the learning trials of name-face associations. Results are discussed in relation to the neuropathology of AD, organic amnestic disorders, and methodological factors concerning previous research on forgetting in persons with AD.

Do men show more rapid age-associated decline in simulated everyday verbal memory than do women?

Recent magnetic resonance imaging data suggest that men show more rapid age-associated atrophy of the left hemisphere than do women. To investigate whether a similar pattern occurs for functional decline, the authors tested 417 male-female pairs, ages 17-79 years and matched perfectly on age and education, on 3 computer-simulated everyday verbal memory tests: Name-Face Association, First-Last Name Associate Learning, and Grocery List Selective Reminding. Age and gender significantly predicted performance on all 3 tests. By contrast, only 1 of 15 Age x Gender interactions was significant, accounting for merely 1% of the test variance. These data suggest that although gender-based differences in rate of left-hemisphere structural decline may occur with normal aging, these apparently do not translate into differential functional decline in simulated everyday verbal memory.

Traditional and computerized assessment procedures applied to the evaluation of memory change after temporal lobectomy.

After establishing that 40 temporal lobectomy patients (20 right, 20 left) demonstrated the same pattern of memory compromise as has been reported in prior studies, we examined the sensitivity of computerized tests of everyday memory skills to the cognitive change associated with temporal resection. Multiple cognitive deficits occur after left, but not after right, temporal lobectomies. Memory impairment after surgery is not limited to traditionally structured memory tests but is also evident on tasks designed to simulate activities of daily life.

Age and incidental recall for a simulated everyday memory task.

We compared intentional learning on an everyday memory task, associate learning of name-face pairs, with Type II incidental recall of the city of residence for each of the name-face pairs. Performance on intentional and incidental learning was significantly associated with age and performance differences begun as early as the fifth decade. Age was more strongly associated with intentional than with incidental learning, and performance on the single incidental recall trial was most similar to the first trial of the intentional learning task.

Construct validity of the Continuous Visual Memory Test.

The construct validity of the Continuous Visual Memory Test (CVMT), a new measure of visual recognition memory was evaluated based on the performance of 92 healthy, normal adults. A series of factor analyses were conducted utilizing marker variables for verbal memory, visual memory, attention and concentration, and verbal and visual/nonverbal intellectual functions. CVMT acquisition scores were associated with verbal and visual/nonverbal intellectual factors as well as with attentional ability. The CVMT delayed recognition score was shown to be a factorially "pure" measure of visual memory.

Factors attenuating the validity of the Geriatric Depression Scale in a dementia population.

OBJECTIVE: The validity of the Geriatric Depression Scale (GDS) in cognitively impaired patients has been questioned. We investigated possible factors (memory loss, dementia severity, unawareness of illness) attenuating the validity of the GDS in patients with dementia. PATIENTS: Eighty-three patients who met research diagnostic criteria for "probable Alzheimer's disease." Subjects with major depressive disorder were excluded. Dementia severity ranged from mild to moderate. SETTING: Outpatient clinics, including institutional settings and private research settings. MEASUREMENTS: Depression--GDS; Hamilton Depression Scale. Memory--Wechsler Memory Scale; Benton Visual Retention Test. Dementia severity--Mini-Mental State Examination. Self-awareness of cognitive deficits--Difference score between a self-report memory questionnaire and an informant-rated memory questionnaire. RESULTS: Multiple regression analysis revealed that Hamilton scores were the major predictor of GDS scores. Memory scores and self-awareness scores were also significant predictors. Dementia severity scores were not a significant predictor. CONCLUSIONS: The GDS is a valid measure of mild-to-moderate depressive symptoms in Alzheimer patients with mild-to-moderate dementia. However, Alzheimer patients who disavow cognitive deficits also tend to disavow depressive symptoms, and the GDS should be used with caution in such patients. Finally, the argument that memory impairment precludes accurate self-report of recent mood is negated by our finding that many patients accurately reported depressive symptoms and that worse memory was associated with more self-reported depressive symptoms.

Changes in facial recognition memory across the adult life span.

We found significant and similar associations of facial recognition memory performance with age using two different methodologies: signal detection (SD) and delayed nonmatching-to-sample (DNM). These data demonstrate that previously reported associations between age and facial recognition memory performance were not specific to method of assessment, and that significant declines are seen as early as 50 years of age.

Assessment of memory complaint in age-associated memory impairment: the MAC-Q.

Few brief self-report memory questionnaires are available, and non has been well validated. We designed a brief questionnaire, the MAC-Q, to assess age-related memory decline. Validity and reliability of the MAC-Q were assessed in 232 subjects meeting diagnostic criteria for age-associated memory impairment (AAMI). Concurrent validity of the MAC-Q was supported by a significant correlation (r = .41, p < .001) with a lengthy, well-validated memory questionnaire. Multiple regression analysis indicated that memory test scores were significant predictors of MAC-Q scores. MAC-Q scores were not predicted by Hamilton Depression Scale scores, suggesting that memory complaint in AAMI is not related to affective status. Internal consistency and test-retest reliability of the MAC-Q were satisfactory. Our data support the validity and reliability of the MAC-Q, a new brief memory questionnaire. The MAC-Q is of particular relevance to the assessment of AAMI, but should also prove useful in any clinical or research setting requiring a brief index of memory complaint.