Minimizing evaluation time while maintaining accuracy: Cross-validation of the Test of Memory Malingering (TOMM) Trial 1 and first 10-item errors as briefer performance validity tests.

Current standards of practice in neuropsychology advocate for including validity tests (PVTs). Abbreviating PVTs, such as the Test of Memory Malingering (TOMM), may help reduce overall evaluation time while maintaining diagnostic accuracy. TOMM Trial 1 performance (T1), as well as the number of errors within the first 10 items of Trial 1 (TOMMe10), have shown initial promise as abbreviated PVTs but require additional external cross-validation. This study sought to replicate findings from other mixed, diverse, clinical samples and provide further validation of abbreviated administrations of the TOMM. Data included 120 veterans who completed the TOMM and 3 criterion PVTs during clinical evaluation. In total, performance from 68% of the sample was classified as valid (52% met criteria for cognitive impairment), and performance from 32% of the sample was invalid. Group differences, diagnostic accuracy statistics, and receiver operating characteristic (ROC) curves were analyzed for relevant TOMM indices. There were large (η²p= .45-.66), significant differences between validity groups (p < .001) on TOMM T1 and TOMMe10, with lower TOMM T1 and higher TOMMe10 scores for participants with invalid performance. Using established cut-scores, sensitivities/specificities were: TOMMe10 ≥1 error: .84/.66; ≥2 errors: .74/.93; TOMM T1 ≤40: .82/.93. ROC curve analysis yielded significant areas under the curve for both TOMMe10 and T1 with respective optimal cut-scores of ≥2 errors (.74 sensitivity/.93 specificity) and ≤41 (.84 sensitivity/.91 specificity). TOMMe10 and T1 performances are minimally impacted by cognitive impairment. Although both evidenced robust psychometric properties, TOMM T1 continued to show greater accuracy than TOMMe10. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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

OBJECTIVE: 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.

It's not what you expect: feedback negativity is independent of reward expectation and affective responsivity in a non-probabilistic task.

ERP studies commonly utilize gambling-based reinforcement tasks to elicit feedback negativity (FN) responses. This study used a pattern learning task in order to limit gambling-related fallacious reasoning and possible affective responses to gambling, while investigating relationships between the FN components between high and low reward expectation conditions. Eighteen undergraduates completed measures of reinforcement sensitivity, trait and state affect, and psychophysiological recording. The pattern learning task elicited a FN component for both high and low win expectancy conditions, which was found to be independent of reward expectation and showed little relationship with task and personality variables. We also observed a P3 component, which showed sensitivity to outcome expectancy variation and relationships to measures of anxiety, appetitive motivation, and cortical asymmetry, although these varied by electrode location and expectancy condition. Findings suggest that the FN reflected a binary reward-related signal, with little relationship to reward expectation found in previous studies, in the absence of positive affective responses.

Slow and Steady Does Not Always Win the Race: Investigating the Effect of Processing Speed across Five Naming Tests.

OBJECTIVE: This retrospective study investigated the effect of processing speed on confrontation naming performance via five naming tests with varying time components. METHOD: The effect of processing speed, as measured by the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index (PSI), and cognitive impairment were examined using Boston Naming Test, Neuropsychological Assessment Battery Naming Test, Visual Naming Test (VNT), Auditory Naming Test (ANT), and Woodcock-Johnson III Rapid Picture Naming (RPN) performance among a mixed clinical sample of 115 outpatient veterans. RESULTS: PSI scores accounted for 5%-26% of the total variance in naming test performances. Comparison of cognitively impaired versus unimpaired participants found significant differences and medium to large effect sizes (η2 = .08-.20) for all naming measures except ANT tip-of-the-tongue responses. After controlling for the effect processing speed, VNT tip-of-the-tongue responses also became non-significant, whereas significant group differences remained present for all other naming test scores, albeit with notably smaller effects sizes (η2 = .06-.10). CONCLUSIONS: Confrontation naming test performance is related to cognitive processing speed, although the magnitude of this effect varies by the demands of each naming test (i.e., largest for RPN; smallest for VNT). Thus, results argue that processing speed is important to consider for accurate clinical interpretation of naming tests, especially in the context of cognitive impairment.

The effect of perceptual reasoning abilities on confrontation naming performance: An examination of three naming tests.

INTRODUCTION: Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual-perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy. METHOD: A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation. RESULTS: Multiple regression indicated that PRI accounted for 23%, 13%, and 15% of the variance in BNT, VNT, and NAB scores, respectively, but dropped out as a significant predictor once VCI was added. Follow-up bootstrap mediation analyses revealed that PRI had a significant indirect effect on naming performance after controlling education, primary language, and severity of cognitive impairment, as well as the mediating effect of general verbal abilities for the BNT (B = 0.13; 95% confidence interval, CI [.07, .20]), VNT (B = 0.01; 95% CI [.002, .03]), and NAB (B = 0.03; 95% CI [.01, .06]). CONCLUSIONS: Findings revealed a complex relationship between perceptual reasoning abilities and confrontation naming that is mediated by general verbal abilities. However, when verbal abilities were statistically controlled, perceptual reasoning abilities were found to have a significant indirect effect on performance across all three confrontation naming measures with the largest effect noted with the BNT relative to the VNT and NAB Naming Test.

Posterior cortical atrophy: a case study of Benson's syndrome that initially presented as anxiety disorder.

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.