Abstract

There is a need to develop performance validity tests (PVTs) that accurately identify those with severe cognitive decline but also remain sensitive to those suspected of invalid cognitive testing. The TOMM1 Discrepancy Index (TDI) attempts to address both of these issues. Veterans diagnosed with dementia (n = 251) were administered TOMM1 and the MSVT in order to develop the TDI (TOMM1 percent correct minus MSVT Free Recall percent correct). Cut offs based on the dementia sample were then used to identify those in the non-dementia sample (n = 1,226) suspected of invalid test performance (n = 401). Combining TOMM1 and the TDI in the dementia sample greatly reduced the false positive rate (specificity = 0.97) at a cut off of 28 points or less on the TDI. Those suspected of invalid testing were identified at much higher rates (sensitivity = 0.75) compared to the MSVT genuine memory impairment profile (GMIP, sensitivity = 0.49). By utilizing a neurologically plausible pattern of scores across two PVTs, the TDI correctly classified those with dementia and identified a large percentage with invalid test performance. PVTs utilizing a complex pattern of performance may help reduce one’s ability to fabricate cognitive deficits.

摘要

需要开发性能有效性测试 (PVT)，以准确识别那些认知能力严重下降的人，同时对那些怀疑进行无效认知测试的人保持敏感。TOMM1 差异指数 (TDI) 试图解决这两个问题。被诊断患有痴呆症的退伍军人 ( n  = 251) 接受了 TOMM1 和 MSVT 以开发 TDI（TOMM1 正确率减去 MSVT 自由回忆正确率）。然后使用基于痴呆症样本的截断值来识别非痴呆症样本 ( n  = 1,226) 中疑似无效测试表现的样本 ( n = 401）。在痴呆症样本中结合 TOMM1 和 TDI，在 TDI 的 28 点或更少分界点处大大降低了假阳性率（特异性 = 0.97）。与 MSVT 真正的记忆障碍概况（GMIP，灵敏度 = 0.49）相比，那些怀疑无效测试的人的识别率（灵敏度 = 0.75）要高得多。通过在两个 PVT 中使用神经学上合理的分数模式，TDI 正确地对患有痴呆症的人进行了分类，并确定了很大一部分测试表现无效。利用复杂的表现模式的 PVT 可能有助于降低一个人制造认知缺陷的能力。