Dementia and effort test performance

Abstract

Research on the performance of patients with dementia on tests of effort is particularly limited. We examined archival data from 214 non-litigating patients with dementia on 18 effort indices derived from 12 tests (WAIS-III/WAIS-R Digit Span and Vocabulary, Dot Counting Test, Warrington Recognition Memory Test–Words, WMS-III Logical Memory, Rey Word Recognition Memory Test, Finger Tapping, b-Test, Rey 15-Item, Test of Memory Malingering, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test). Results indicated that recommended cut-offs for Digit Span indicators (Vocabulary Minus Digit Span and four-digit forward span time score) provided ≥90% specificity across participants, while the majority of other effort tests displayed specificities in the 30–70% range. Analyses of test specificity as a function of Mini Mental Status Examination (MMSE) score and specific dementia diagnosis are provided, as well as adjustments to cut-offs to maintain specificity where feasible.

Keywords:

• Effort
• Dementia
• Malingering
• Noncredible
• Alzheimer's
• Geriatric.

Acknowledgment

This study was graciously supported by a grant from the Borchard Center for Law and Aging. We would also like to thank Jill Razani, Ph.D., and Ashley R. Curiel, M.A. for their contributions to data collection/entry.

Notes

¹ Data from Clinic # 2 was collected for L. Philpott's (1993) doctoral dissertation. The Dot Counting data was subsequently published by Boone et al. (2002a) and comprises approximately 41% of the Dot Counting data currently described. The Rey 15-Item data have not been published outside of the dissertation manuscript.

² Approximately 60% of the current frontotemporal participants were previously used in studies by Boone et al. (1999) and Razani, Boone, Miller, Lee, and Sherman (2001). See these articles for further neuroimaging data and criteria for assignment to right/left cases of frontotemporal dysfunction.