Specificity of Malingering Detection Strategies in Older Adults Using the CVLT and WCST

Abstract

Strategies for the detection of possible malingering have largely taken two forms. First is the development and validation of domain-specific measures of malingering designed specifically for the detection of malingering (e.g., Test Of Memory Malingering, Word Memory Test, and Word Completion Memory Test). The second has been the development and evaluation of performance patterns and cutoff scores applicable to commonly used neuropsychological instruments. Two such instruments that have been examined are the Wisconsin Card Sorting Test (WCST) and the California Verbal Learning Test (CVLT). While several studies propose possible cutoff scores and actuarial judgement strategies for these tests, the specificity of these strategies within older, nonimpaired adults has not been established. Without proper evaluation of potential age-related effects within these strategies, the actual utility of the strategies within suspected malingerers who are older adults is unknown. Therefore, the present study was conducted to evaluate the specificity of the proposed strategies for detecting possible malingering with the WCST and the CVLT in a sample of older, community-dwelling, nonimpaired adults. The results suggest that the currently existing WCST formulas may have limited utility for the detection of malingering with older adults while the CVLT strategies do appear to have potential clinical utility. The potential of these formulas for use with older adults is discussed.