Introduction

Embedded performance validity tests (PVTs) allow for continuous and economical validity assessment during neuropsychological evaluations; however, similar to their freestanding counterparts, a limitation of well-validated embedded PVTs is that the majority are memory-based. This study cross-validated several previously identified non-memory-based PVTs derived from language, processing speed, and executive functioning tests within a single mixed clinical neuropsychiatric sample with and without cognitive impairment.

Method

This cross-sectional study included data from 124 clinical patients who underwent outpatient neuropsychological evaluation. Validity groups were determined by four independent criterion PVTs (failing ≤1 or ≥2), resulting in 98 valid (68% cognitively impaired) and 26 invalid performances. In total, 23 previously identified embedded PVTs derived from Verbal Fluency (VF), Trail Making Test (TMT), Stroop (SCWT), and Wisconsin Card Sorting Test (WCST) were examined.

Results

All VF, SCWT, and TMT PVTs, along with WCST Categories, significantly differed between validity groups (η_p2 =.05-.22) with areas under the curve (AUCs) of.65-.81 and 19-54% sensitivity (≥89% specificity) at optimal cut-scores. When subdivided by impairment status, all PVTs except for WCST Failures to Maintain Set were significant (AUCs =.75–94) with 33-85% sensitivity (≥90% specificity) in the cognitively unimpaired group. Among the cognitively impaired group, most VF, TMT, and SCWT PVTs remained significant, albeit with decreased accuracy (AUCs =.65-.76) and sensitivities (19-54%) at optimal cut-scores, whereas all WCST PVTs were nonsignificant. Across groups, SCWT embedded PVTs evidenced the strongest psychometric properties.

Conclusion

VF, TMT, and SCWT embedded PVTs generally demonstrated moderate accuracy for identifying invalid neuropsychological performance. However, performance on these non-memory-based PVTs from processing speed and executive functioning tests are not immune to the effects of cognitive impairment, such that alternate cut-scores (with reduced sensitivity if adequate specificity is maintained) are indicated in cases where the clinical history is consistent with cognitive impairment. In contrast, WCST indices generally had poor accuracy.

中文翻译：

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基于非内存的嵌入式性能有效性测试的交叉验证，可在有无神经认知障碍的患者中检测无效性能。

介绍

嵌入式性能有效性测试（PVT）允许在神经心理学评估期间进行连续且经济的有效性评估；但是，与其独立的同类产品类似，经过充分验证的嵌入式PVT的局限性在于，大多数都是基于内存的。这项研究交叉验证了多个先前确定的基于非记忆的PVT，这些PVT来自单个混合临床神经精神病学样本（具有或没有认知障碍）中的语言，处理速度和执行功能测试。

方法

这项横断面研究包括来自124位接受门诊神经心理学评估的临床患者的数据。有效性组由四个独立的标准PVT（失败≤1或≥2）确定，导致98次有效（68％认知障碍）和26次无效表现。总共检查了23种先前确定的嵌入式PVT，这些嵌入式PVT是从口语流利度（VF），跟踪制作测试（TMT），Stroop（SCWT）和威斯康星卡片分类测试（WCST）中得出的。

结果

所有VF，SCWT，和TMT PVTS，与WCST分类，有效性基（间显著差异沿着η _p 2  = 0.05，0.22）与区域下的曲线（的AUC）of.65-0.81和19-54％的灵敏度（≥89％特异性）达到最佳切割分数。按损伤状态细分时，在无认知障碍的人群中，除WCST不能维持组外的所有PVT均显着（AUC = .75–94），敏感性为33-85％（特异性≥90％）。在认知障碍组中，大多数VF，TMT和SCWT PVT仍然显着，尽管准确性（最佳切分评分）降低（AUC = .65-.76）和敏感性（19-54％），而所有WCST PVT均不显着。在各个群体中，SCWT嵌入的PVT表现出最强的心理测量特性。

结论

VF，TMT和SCWT嵌入式PVT通常在识别无效的神经心理表现方面显示出中等的准确性。但是，处理速度和执行功能测试对这些基于非内存的PVT的性能不能免于认知障碍的影响，因此，在以下情况下，应显示出替代的得分（如果保持足够的特异性，敏感性会降低）。临床病史与认知障碍一致。相反，WCST索引的准确性通常较差。