Neuropsychological test validity in Veterans presenting with subjective complaints of ‘very severe’ cognitive symptoms following mild traumatic brain injury

Abstract

Objective: This study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI).

Background: Persistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings.

Methods: Self-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from ‘none’ to ‘very severe’. Veterans also completed brief neuropsychological testing which included measures of performance validity.

Results: Study 1 examined data from 122 participants and demonstrated that veterans reporting a ‘very severe’ cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test.

Conclusion: Veterans with suspected mTBI who report ‘very severe’ cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing.

Keywords:

• Cognition
• effort
• insight
• military
• psychometrics
• neuropsychological assessment
• self-report
• traumatic brain injury
• veterans

Acknowledgements

We would like to thank Lisa A. DiPonio, MD, and Heather A. Tree, PhD, for their assistance in data collection. Dr Waldron-Perrine is now with the Rehabilitation Institute of Michigan, Detroit Medical Center, Detroit, MI, and the Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI.

Declaration of interest

The authors report no conflicts of interest. This material is the result of work supported with resources and the use of facilities at the VA Ann Arbor Healthcare System in Ann Arbor, MI. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.