Abstract

Objective: This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample (n = 76) and academic medical sample (AMC; n = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. Method: All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs. Neurocognitive test performance differences were examined based on number of PVT failures (0, 1, 2+) for both samples, and effect of number of criterion failures on embedded PVT performance was analyzed among the AMC sample. Results: Both groups with 0 or 1 PVT failures performed better than those with ≥2 PVT failures across most cognitive tests. There were nonsignificant differences between those with 0 or 1 PVT failures except for one test in the AMC sample. Receiver operator characteristic curve analyses found no differences in optimal cut score based on number of PVT failures when retaining/excluding one PVT failure. Conclusion: Findings support the use of ≥2 PVT failures as indicative of performance invalidity. These findings strongly support including those with one PVT failure with those with zero PVT failures in diagnostic accuracy studies, given that their inclusion reflects actual clinical practice, does not reduce sample sizes, and does not artificially deflate neurocognitive test results or inflate PVT classification accuracy statistics.

摘要

目标：这项横断面研究检查了性能有效性测试 (PVT) 失败次数对神经心理学测试性能的影响，这些测试在人口统计学上多样化的退伍军人 (VA) 样本 ( n  = 76) 和学术医学样本 (AMC; n  = 128) 中进行。次要目标是研究在交叉验证一系列嵌入式 PVT 时，包括与排除那些具有一次 PVT 失败的人的心理测量意义。方法：所有患者都完成了相同的六个标准 PVT，AMC 样本完成了三个额外的嵌入式 PVT。根据两个样本的 PVT 失败次数（0、1、2+）检查神经认知测试性能差异，并在 AMC 样本中分析标准失败次数对嵌入式 PVT 性能的影响。结果：在大多数认知测试中，0 次或 1 次 PVT 失败的两组都比 ≥2 次 PVT 失败的组表现更好。除了 AMC 样本中的一项测试外，0 次或 1 次 PVT 失败的测试之间没有显着差异。接受者操作员特征曲线分析发现，在保留/排除一个 PVT 失败时，基于 PVT 失败次数的最佳切割分数没有差异。结论：调查结果支持使用≥2 次 PVT 失败作为性能无效的指示。这些发现强烈支持在诊断准确性研究中包括一次 PVT 失败的患者和零次 PVT 失败的患者，因为它们的纳入反映了实际的临床实践，不会减少样本量，并且不会人为地缩小神经认知测试结果或夸大 PVT 分类准确性统计数据.