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The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a collateral-rated measure of behavioral and psychological symptoms commonly found in dementia (BPSD). Several factor structures have been published, but they have not been systematically compared. Furthermore, the possibility of hierarchical models or presence of measurement invariance around cognitive stage or dementia syndrome has not been previously evaluated. This study addressed these gaps with confirmatory factor analyses using a multicenter sample ( n = 41,801; M age = 71.4; 57% women; 79% White, 13% Black, 8% Hispanic; M education = 15.1) that was divided into exploratory, derivation, and holdover subsets for cross-validation. We found that a four-factor model had the best fit, with adequate reliability estimates, adequate τ-equivalence, and the least amount of measurement variance. Strict invariance across stage and syndrome was not supported, although there was adequate support for weaker restrictions (e.g., equal forms). Furthermore, all bifactor models had a significant increase in fit. In sum, the present study provides practical guidance on using NPI-Q factor-derived subscales and theoretical elaboration of BPSD's hierarchical and syndrome-variant structure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

This study investigated the utility of four Stroop Color and Word Test (SCWT) indices, including the raw score and T score for the word reading (WR) and color naming (CN) trials, as embedded performance validity tests (PVTs) within a sample referred for evaluation of suspected or known attention-deficit/hyperactivity disorder (ADHD). Data were analyzed from a final sample of 317 patients consecutively referred for ADHD evaluation, which was divided into groups with invalid ( n = 43; 14%) and valid neuropsychological test performance ( n = 274; 86%). A subset of the valid group with confirmed ADHD diagnoses ( n = 226; 71%) were also analyzed separately. Classification accuracy for the overall valid sample was in the acceptable range (AUCs = .757-.794), with optimal cut scores of WR raw ≤75 (54% sensitivity/90% specificity), WR T score ≤ 28 (54% sensitivity/88% specificity), CN raw ≤57 (42% sensitivity/90% specificity), and CN T score ≤ 30 (40% sensitivity/90% specificity). Classification accuracy was also in the acceptable range for the ADHD-confirmed subgroup (AUCs = .750-.790), with optimal cut scores of WR Raw ≤ 75 (54% sensitivity/89% specificity), WR T score ≤ 28 (54% sensitivity/87% specificity), CN Raw ≤ 57 (42% sensitivity/90% specificity), and CN T score ≤ 30 (40% sensitivity/90% specificity). These findings indicate that embedded PVTs derived from the SCWT, particularly those derived from the WR trial, are effective measures for determining validity status in samples with suspected or confirmed ADHD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A forced-choice (FC) recognition trial was recently developed as an embedded validity indicator for the Rey Auditory Verbal Learning Test (RAVLT), although it has not been replicated outside of the initial validation study. This study cross-validated the RAVLT FC trial for detecting invalid neuropsychological test performance and assessed the degree to which material-specific verbal memory impairment severity impacts its classification accuracy as a performance validity test (PVT). This cross-sectional study included 172 neuropsychiatric patients who completed the RAVLT and 4 independent criterion PVTs, which were used to classify validity groups (134 valid/38 invalid). Overall results showed the RAVLT FC had excellent classification accuracy for detecting invalid performance at a ≤13 cut-score (66% sensitivity/87% specificity). When patients were subdivided by memory impairment status, FC retained excellent classification accuracy among the normal memory and mild memory impairment groups with 66%-82% sensitivity and ≥89% specificity. Accuracy decreased among those with severe memory impairment, but remained significant with a lower, alternative cut-score of ≤11 (37% sensitivity/88% specificity). Findings were consistent with FC trials developed for other memory measures and support the utility of this novel RAVLT FC index for reliably identifying invalid performance, even in the context of significant verbal memory impairment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Although performance validity tests (PVTs) are an integral element of neuropsychological assessment, most PVTs have historically been restricted to the memory domain. The Dot Counting Test (DCT) is a nonmemory PVT shown to reliably identify invalid performance. Although several traditional and abbreviated scoring methods have been derived, no study to date has directly compared the available scoring approaches within a single sample. This cross-sectional study cross-validated 4 different DCT scoring approaches, including the traditional rounded E-score proposed within the manual, an unrounded E-score, and 2 abbreviated scoring procedures based on 4- and 6-card versions (DCT-4 and DCT-6, respectively) in a diverse mixed clinical neuropsychiatric sample ( N = 132). Validity groups were established by 5 independent criterion PVTs (102 valid and 30 invalid). Receiver operating characteristic curve analyses yielded significant areas under the curve (AUCs = .84-.86) for the overall sample, with sensitivities of 50%-67% at ≥ 89% specificity. The DCT scores had outstanding classification accuracy (AUCs ≥ .92; sensitivities = 80%-83%) in the unimpaired group and excellent classification accuracy in the impaired group (AUCs = .79-.81; sensitivities = 43%-60%). Whereas negligible differences emerged between the 4 scoring methods for the cognitively intact group, the DCT-4 showed notably stronger psychometric properties among the overall sample in general and the mild cognitive impairment group in particular. Results corroborate previous findings suggesting that the DCT is a robust PVT, regardless of the employed scoring procedure, and replicate support for the abbreviated DCT-4 as the recommended validity indicator. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study examined the effect of increasing material-specific verbal and visual memory impairment severity on Rey 15-Item Test (RFIT) and RFIT/Recognition Trial performance. Data from 146 clinically referred patients (109 valid/37 invalid) who completed the RFIT, Brief Visuospatial Memory Test-Revised, and Rey Auditory Verbal Learning Test were analyzed. Rey Auditory Verbal Learning Test/BVMT memory impairment was operationalized as ≥40T (no memory impairment), 30T-39T (mild memory impairment), or ≤29T (severe memory impairment). Medium-to-large correlations emerged between the RFIT and memory measures. Significantly more patients with impaired visual memory, and to a lesser extent verbal memory, failed the RFIT and RFIT/Recognition. RFIT and RFIT/Recognition produced areas under the curve = .80-.90 for detecting invalidity and strong associated psychometric properties among patients without memory impairment, but both yielded low and largely unacceptable accuracy (areas under the curve = .57-.71) when verbal or visual memory impairment of any severity was present. In sum, RFIT performance was significantly affected by increasing material-specific memory deficits, such that it produced acceptable accuracy among unimpaired patients, but accuracy greatly diminished with memory impairment, which is antithetical to a sound performance validity test. (PsycInfo Database Record (c) 2020 APA, all rights reserved).