The Visual Association Test-Extended: a cross-sectional study of the performance validity measures

Abstract

Objective: Given the hazards of knowledge about performance validity tests (PVTs) being proliferated among the general public, there is a continuous need to develop new PVTs. The purpose of these studies was to validate the newly developed Visual Association Test-Extended (VAT-E). Method: The VAT-E consists of 24 pairs of line drawings; it is partly based on Green’s Word Memory Test (WMT) paradigm. In study 1, we compared VAT-E total scores of healthy controls (n = 226), patients with mild cognitive impairment (MCI) (n = 76), patients with Alzheimer’s disease (AD) (n = 26), and persons instructed to feign memory deficit (n = 29). In study 2, we compared litigating patients classified by Slick’s criteria as Malingering of Neurocognitive Dysfunction (MND) (n = 26) or non-MND (n = 67). In addition, we compared the VAT-E to the Test of Memory Malingering (TOMM) (study 1) and the WMT (study 2). Results: Results showed that the VAT-E differentiated patients with MCI (specificity 93–100%) or patients with AD (specificity 92–100%) from persons instructed to feign (sensitivity 86–100%). The VAT-E also differentiated MND from non-MND (sensitivity 54%, specificity 97%). The VAT-E was in perfect agreement with the TOMM in classifying healthy controls and persons instructed to feign, and it was in moderate agreement with the WMT in classifying non-MND and MND. Conclusion: Preliminary evidence shows that the VAT-E may be a useful PVT based on the ability to differentiate between those with genuine memory impairment, persons instructed to feign memory impairment, and a group suspected of malingering cognitive deficits.

Keywords:

• Performance validity test
• simulating
• malingering
• memory
• psychometrics

Acknowledgments

We would like to thank the Department of Geriatric Medicine of the Northwest Medical Center in Alkmaar, the Netherlands, for the opportunity to conduct our research. Also, we would like to thank Brenda Smolders, MSc, Sylvia Verwer, MSc, Lisa Stel, MSc, Sanne Verhagen, MSc, Merel Oudshoorn, MSc, and Rosalie van der Aa, MSc, for their work on the studies.