Performance on Standard Indexes of Effort Among Patients with Dementia

Abstract

Assessment of response validity is an integral part of neuropsychological practice. Although many studies have demonstrated the efficacy of stand alone and embedded effort measures in a variety of medical and compensation-seeking contexts, much less is known about the robustness of these measures in elderly populations, particularly in patients with dementia. Although older adults may be viewed as less likely to intentionally feign symptoms for an external gain, there are a variety of other factors that could result in suboptimal effort, including fatigue, lack of interest or cooperation in the testing process, or failure to fully appreciate the implications of the assessment on treatment care and outcome. The current study examined the clinical utility of several stand alone and embedded effort measures including the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index, Trail-Making Test Ratio, Rey 15-Item Test, and the Test of Memory Malingering in a sample of patients with dementia. Results found that the majority of effort indexes demonstrated unacceptably high false-positive error rates with specificity levels as high as 83%. These findings demonstrate the need for caution in interpreting effort measure performance in dementia samples due to the fact that despite their best effort, many patients with dementia fail effort measures and are at risk for being misclassified.

Key words:

• dementia
• effort
• geriatric
• symptom validity testing

Notes

Note. Numbers indicate the number of patients in the good-effort group and suspect-effort group who passed or failed the effort measures. RBANS EI = Repeatable Battery for the Assessment of Neuropsychological Status Effort Index; TMT Ratio = Trail-Making Test Ratio; RFIT = Rey 15-Item Test.

Note. Numbers indicate the number of patients in the good-effort group and suspect-effort group who obtained scores either above or below identified ranges.

RBANS EI = Repeatable Battery for the Assessment of Neuropsychological Status Effort Index; TMT Ratio = Trail-Making Test Ratio; RFIT = Rey 15-Item Test.

Note. Ratios in parentheses indicate the number of patients who scored above (i.e., passed) the cutoffs. In some instances, not all participants were administered the effort measures, which accounts for the discrepancy between total sample size and ratio. None of the participants with CDR scores of 3 were able to complete both TMT-A and TMT-B, thus no TMT Ratio could be calculated. RBANS EI = Repeatable Battery for the Assessment of Neuropsychological Status Effort Index; TMT Ratio = Trail-Making Test Ratio; RFIT = Rey 15-Item Test.

RBANS EI = Repeatable Battery for the Assessment of Neuropsychological Status Effort Index; TMT Ratio = Trail-Making Test Ratio; RFIT = Rey 15-Item Test; AD = Alzheimer's dementia; VaD = vascular dementia; Mixed = mixed dementia; NOS = dementia not otherwise specified.

AD = Alzheimer's dementia; VaD = vascular dementia; Mixed = mixed dementia; NOS = dementia not otherwise specified.