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Introduction: There are very few symptom validity indices directly examining overreported posttraumatic stress disorder (PTSD) symptomatology, and, until recently, there were no symptom validity indices embedded within the PTSD Checklist for the DSM-5 (PCL-5), which is one of the most commonly used PTSD measures. Given this, the current study sought to develop and cross-validate symptom validity indices for the PCL-5., Method: Multiple criterion groups comprised of Veteran patients were utilized ( N  = 210). Patients were determined to be valid or invalid responders based on Personality Asessment Inventory symptom validity indices. Three PCL-5 symptom validity indices were then examined: the PCL-5 Symptom Severity scale (PSS), the PCL-5 Extreme Symptom scale (PES), and the PCL-5 Rare Items scale (PRI)., Results: Area under the curve statistics ranged from .78 to .85. The PSS and PES both met classification accuracy statistic goals, with the PES achieving the highest sensitivity rate (.39) when maintaining specificity at .90 or above across all criterion groups. When an ad hoc analysis was performed, which included only patients with exceptionally strong evidence of invalidity, sensitivity rates increased to .60 for the PES while maintaining specificity at .90., Conclusions: These findings provide preliminary support for new PTSD symptom validity indices embedded within one of the most frequently used PTSD measures.

Objective: Social Security Disability is a common external incentive in neuropsychological evaluations. This study determined base rates of invalidity when patients referred for routine clinical evaluations have Social Security Disability as an external incentive. Method: Patients ( n  = 242) were grouped as validly or invalidly performing based on the use of multiple performance validity tests. Frequency analyses were then conducted. Results: As a whole, 46.0% of clinically referred patients with Social Security Disability as an external incentive produced invalid data. When divided by disability pursuit status, 58.6% of individuals already receiving Social Security Disability, 44.6% of individuals actively seeking Social Security Disability, and 39.3% of individuals considering seeking Social Security Disability produced invalid data. By comparison, only 8.5% of clinically referred patients without known external incentives produced invalid data. Conclusions: Beyond establishing base rates, these data indicate that the external incentive, not necessarily the evaluation setting, increases the rate of invalidity, as obtained base rates mirror those observed in independent medical examinations. In addition, this study highlights that even patients who report that they are considering but have not committed themselves to pursuing an external incentive frequently invalidate testing.

To provide education regarding the critical importance of test security for neuropsychological and psychological tests, and to establish recommendations for best practices for maintaining test security in forensic, clinical, teaching, and research settings. Previous test security guidelines were not adequately specified., Method: Neuropsychologists practicing in a broad range of settings collaborated to develop detailed and specific guidance regarding test security to best ensure continued viability of neuropsychological and psychological tests. Implications of failing to maintain test security for both the practice of neuropsychology and for society at large were identified. Types of test data that can be safely disclosed to nonpsychologists are described., Specific procedures can be followed that will minimize risk of invalidating future use of neuropsychological and psychological measures., Clinical neuropsychologists must commit to protecting sensitive neuropsychological and psychological test information from exposure to nonpsychologists, and now have specific recommendations that will guide that endeavor.

Objective: This study examined the specificity of both individual PVTs and three different PVT batteries in individuals undergoing neuropsychological evaluation for dementia in order to establish both appropriate individual test cutoffs and multiple-PVT failure criterion., Methods: Participants were 311 validly performing patients with no cognitive impairment (n = 24), mild cognitive impairment (MCI; n = 115), mild dementia (n = 122), or moderate dementia (n = 50). Cutoffs associated with ≥90% specificity were established for 11 individual PVTs across impairment severity groups. Aggregate false positive rates according to number of PVTs failed were examined for two 4-PVT batteries and one 7-PVT battery. One-way ANOVAs with post-hoc comparisons were conducted for each PVT., Results: Performance on 9 of 11 PVTs significantly differed according to impairment severity. PVT cutoffs achieving ≥90% specificity also generally varied by group. For PVTs previously validated in non-dementia samples, slight adjustments from established cutoffs were generally required to maintain adequate specificity in MCI and mild dementia groups, with greater modifications required in the moderate dementia group. A criterion of ≥2 PVT failures resulted in ≥90% specificity in both 4-PVT batteries across groups. In the 7-PVT battery, adequate specificity was achieved with ≥2 failures in MCI and ≥3 failures in the mild dementia group., Conclusions: The incorporation and interpretation of several easily assimilated multiple-PVT batteries in dementia evaluations are explored. Additionally, data regarding individual PVT performance according to cognitive impairment severity are provided to aide validity assessment of both patients undergoing dementia evaluation and examinees who are less impaired.

Introduction: Neuropsychologists play an important role on multidisciplinary teams with physicians from multiple specialties. The extent of residency training on the use of neuropsychological services is unclear. Medical residents across multiple specialties throughout the United States were surveyed to assess resident education, training, and understanding of neuropsychological services, along with their intent to consult neuropsychologists in the future., Methods: A survey was sent to residents in accredited psychiatry, neurology, family medicine, and internal medicine programs. After data were collected, chi-square group level analyses with post-hoc pairwise comparisons were used to analyze the data., Results: A total of 434 residents took the survey. The proportion of residents exposed to neuropsychology during residency varied significantly according to specialty (χ 2 (3, N = 419) = 51.4, p < 0.001), with more psychiatry and neurology residents reporting exposure than residents in family medicine or internal medicine. Similarly, the proportion of psychiatry and neurology residents who 'agree' or 'strongly agree' that they understand the nature of neuropsychological services differed significantly from family medicine and internal medicine residents (χ 2 (3, N = 415) = 40.4, p < 0.001). The majority of residents across all specialties (85.7%) reported they are likely to consult/order neuropsychological services in future practice., Conclusions: The majority of residents in all specialties reported exposure to neuropsychological services in some manner, but forms of exposure varied. Results indicated a need for increased education and training in neuropsychological services, especially within family medicine and internal medicine programs., (© 2021 The University of Kansas Medical Center.)

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Objective: Providing feedback to clinical patients who produce invalid neuropsychological test data presents with several potential challenges. Given the limited guidance available on the topic, neuropsychologists most likely utilize approaches that idiosyncratically incorporate professional values related to both assessment and patient care to address overarching feedback goals. The current article discusses professional values believed to inform feedback decisions and presents survey results regarding how neuropsychologists would approach feedback across various clinical scenarios where testing is invalid., Method: Participants were 209 adult-focused clinical neuropsychologists recruited via professional listservs, the majority of whom reported being board certified. Respondents were provided three case vignettes of clinical patients who produced invalid test data and were asked how they would provide feedback to each patient. Open-ended responses were coded to determine the relative frequency of feedback approaches, explicit statements, and implied goals., Results: Nearly all respondents (98%) indicated that feedback would include some description of the invalid findings, and most respondents indicated that they would provide explanations for the reasons of invalidity (67%) and statements regarding the impact of invalidity on test interpretation (75%). There was little agreement across respondents, however, regarding specific feedback approach. Feedback goals included to Inform, Investigate, Treat, Educate, and Correct, with the presence of these implied goals also varying across respondents., Conclusions: The findings indicate that there is minimal consensus regarding feedback approaches provided to patients who produce invalid test data and underscore a need for further development and validation of specific feedback methods. The results are discussed within the context of the potentially competing professional values of evidence-based assessment, patient-doctor collaboration, and aspirational principles of beneficence and fidelity.

Objective: To increase sensitivity of the Test of Memory Malingering (TOMM), adjustments have been proposed, including adding consistency indices. The Invalid Forgetting Frequency Index (IFFI) is the most recently developed consistency index. While strong classification accuracy rates were originally reported, it currently lacks cross-validation., Method: A sample of 184 outpatients was utilized. Valid performers passed all criterion performance validity tests (PVTs) and invalid performers failed two or more PVTs. Classification accuracy statistics were calculated., Results: AUC for the IFFI was 0.80, demonstrating adequate discrimination between valid and invalid groups. A score of 3 or more inconsistent responses resulted in sensitivity and specificity rates of 63% and 92%, respectively., Conclusions: This is the first article to cross-validate the IFFI. In both the original IFFI study and the current study, the same cut-off was found to maintain at least 90% specificity while producing higher sensitivity rates than those achieved by traditional TOMM indices., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Introduction: While use of performance validity tests (PVTs) has become a standard of practice in neuropsychology, there are differing opinions regarding whether to interpret cognitive test data when standard scores fall within normal limits despite PVTs being failed. This study is the first to empirically determine whether normal cognitive test scores underrepresent functioning when PVTs are failed. Method: Participants, randomly assigned to either a simulated malingering group ( n = 50) instructed to mildly suppress test performances or a best-effort/control group ( n = 50), completed neuropsychological tests which included the North American Adult Reading Test (NAART), California Verbal Learning Test - 2 nd Edition (CVLT-II), and Test of Memory Malingering (TOMM). Results: Groups were not significantly different in age, sex, education, or NAART predicted intellectual ability, but simulators performed significantly worse than controls on the TOMM, CVLT-II Forced Choice Recognition, and CVLT-II Short Delay Free Recall. The groups did not significantly differ on other examined CVLT-II measures. Of simulators who failed validity testing, 36% scored no worse than average and 73% scored no worse than low average on any of the examined CVLT-II indices. Conclusions: Of simulated malingerers who failed validity testing, nearly three-fourths were able to produce cognitive test scores that were within normal limits, which indicates that normal cognitive performances cannot be interpreted as accurately reflecting an individual's capabilities when obtained in the presence of validity test failure. At the same time, only 2 of 50 simulators were successful in passing validity testing while scoring within an impaired range on cognitive testing. This latter finding indicates that successfully feigning cognitive deficits is difficult when PVTs are utilized within the examination.

Objective: This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Method: A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics., Results: Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96-0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68-0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses., Conclusions: The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Base rates of invalidity in forensic neuropsychological contexts are well explored and believed to approximate 40%, whereas base rates of invalidity across clinical non-forensic contexts are relatively less known., Methods: Adult-focused neuropsychologists (n = 178) were surveyed regarding base rates of invalidity across various clinical non-forensic contexts and practice settings. Median values were calculated and compared across contexts and settings., Results: The median estimated base rate of invalidity across clinical non-forensic evaluations was 15%. When examining specific clinical contexts and settings, base rate estimates varied from 5% to 50%. Patients with medically unexplained symptoms (50%), external incentives (25%-40%), and oppositional attitudes toward testing (37.5%) were reported to have the highest base rates of invalidity. Patients with psychiatric illness, patients evaluated for attention deficit hyperactivity disorder, and patients with a history of mild traumatic brain injury were also reported to invalidate testing at relatively high base rates (approximately 20%). Conversely, patients presenting for dementia evaluation and patients with none of the previously mentioned histories and for whom invalid testing was unanticipated were estimated to produce invalid testing in only 5% of cases. Regarding practice setting, Veterans Affairs providers reported base rates of invalidity to be nearly twice that of any other clinical settings., Conclusions: Non-forensic clinical patients presenting with medically unexplained symptoms, external incentives, or oppositional attitudes are reported to invalidate testing at base rates similar to that of forensic examinees. The impact of context-specific base rates on the clinical evaluation of invalidity is discussed., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention. Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models. Results: For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59-0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96-0.98) and moderately sensitive (0.46-0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59-0.70) while maintaining adequate specificity (0.91-0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia. Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.

Introduction: "The Roth Project - Music and Memory" is a music-based intervention program, implemented by the Alzheimer's Association of Central and Western Kansas, which provides a non-pharmacological means for addressing neuropsychiatric symptoms in individuals with dementia., Methods: Participants were individuals with dementia who were enrolled in The Roth Project - Music and Memory. Post-intervention surveys were distributed to caregivers of participants which assessed caregiver satisfaction with the program as well as caregiver perception of the impact of individualized music on mood and behavioral symptoms., Results: Of returned surveys (n = 79), 99% of caregivers indicated they were satisfied or very satisfied with the program and 94% of caregivers perceived participants to like or very much like listening to the music. While a substantial number of participants required assistance with iPod use (95%), the majority of participants were observed to listen to the music with stable or increased frequency over time. Personalized music was observed to improve mood in 78% of cases, with the most frequent benefits being improved overall happiness, decreased anxiety, increased positive emotional expression, and decreased depression., Conclusions: The Roth Project - Music and Memory was well received by caregivers and was perceived to benefit mood of individuals with dementia. These results provided ongoing support for individualized music-based interventions and demonstrated that such interventions, when implemented by community agencies, can be well received by those who use them., (© 2019 The University of Kansas Medical Center.)

Objective: This study investigated sensitivity and specificity rates of four Test of Memory Malingering (TOMM) indices (Trial 1, Trial 2, Retention, and Albany Consistency Index (ACI)) and examined how classification accuracy rates change when utilizing these indices in various combinations. Method: A sample of 202 neuropsychological outpatients was utilized. Patients were categorized as valid performers if they passed all criterion performance validity tests (PVTs) and were determined to be invalid performers if they failed two or more criterion PVTs. Classification accuracy statistics were obtained for individual TOMM indices as well as combinations of TOMM indices. Results: When using only Trial 1 as a validity indicator, the TOMM identified 57% of invalidly performing individuals. When all TOMM indices were examined, the ACI demonstrated the highest sensitivity value (63%) but it also demonstrated the lowest specificity value (91%). Allowing for failure of any of the four TOMM indices provided the best overall sensitivity value (67%) while maintaining adequate specificity (90%). Finally, it was determined that failure of three or more TOMM validity indices resulted in a specificity rate of 97% and failure of four of more TOMM validity indices resulted in a specificity rate of 98%. Conclusions: Classification accuracy of TOMM validity indices are discussed in relation to positive and negative predictive values. Results suggest that clinicians can examine all four TOMM validity indices concurrently, particularly in settings where high base rates of invalidity occur.

Objective: This study investigated whether indices within the Brief Visuospatial Memory Test - Revised (BVMT-R) could function as embedded performance validity measures in an outpatient clinical sample., Method: A sample of 138 neuropsychological outpatients was utilized; approximately 45% had a known or suspected external incentive. Patients were determined to be valid performers if they passed all criterion performance validity tests (PVTs) and determined to be invalid performers if they failed two or more PVTs. BVMT-R indices met criteria for optimal embedded PVTs if they were not significantly correlated with genuine cognitive dysfunction and if they adequately differentiated the validly from invalidly performing patient groups. Classification accuracy statistics for the indices were then calculated. Supplementary analyses were also calculated for a separate dementia sample., Results: Recognition Hits and Recognition Discrimination were identified as two optimal embedded PVTs for patients without dementia. Recognition Hits showed a sensitivity rate of 41% and a specificity rate of 95%. Recognition Discrimination showed a sensitivity rate of 54% and a specificity rate of 93%., Conclusion: Embedded BVMT-R PVTs are discussed in relation to previous research findings, which were obtained from veteran samples. Recognition Hits and Recognition Discrimination are now validated in a non-veteran clinical sample.

Objective: Performance validity test (PVT) research studies commonly utilize a known-groups design, but the criterion grouping approaches within the design vary greatly from one study to another. At the present time, it is unclear as to what degree different criterion grouping approaches might impact PVT classification accuracy statistics., Method: To analyze this, the authors used three different criterion grouping approaches to examine how classification accuracy statistics of a PVT (Word Choice Test; WCT) would differ. The three criterion grouping approaches included: (1) failure of 2+ PVTs versus failure of 0 PVTs, (2) failure of 2+ PVTs versus failure of 0-1 PVT, and (3) failure of a stand-alone PVT versus passing of a stand-alone PVT (Test of Memory Malingering)., Results: When setting specificity at ≥.90, WCT cutoff scores ranged from 41 to 44 and associated sensitivity values ranged from .64 to .88, depending on the criterion grouping approach that was utilized., Conclusions: When using a stand-alone PVT to define criterion group status, classification accuracy rates of the WCT were higher than expected, likely due to strong correlations between the reference PVT and the WCT. This held true even when considering evidence that this grouping approach results in higher rates of criterion group misclassification. Conversely, when using criterion grouping approaches that utilized failure of 2+ PVTs, accuracy rates were more consistent with expectations. These findings demonstrate that criterion grouping approaches can impact PVT classification accuracy rates and resultant cutoff scores. Strengths, weaknesses, and practical implications of each of the criterion grouping approaches are discussed.

Neuropsychologists provide detailed assessments of cognitive and emotional functioning that often cannot be obtained through other diagnostic means. They use standardized assessment tools and integrate the findings with other data to determine whether cognitive decline has occurred, to differentiate neurologic from psychiatric conditions, to identify neurocognitive etiologies, and to determine the relationship between neurologic factors and difficulties in daily functioning. Family physicians should consider referring patients when there are questions about diagnostic decision making or planning of individualized management strategies for patients with mild cognitive impairment, dementia, traumatic brain injury, and other clinical conditions that affect cognitive functioning. Neuropsychological testing can differentiate Alzheimer dementia from nondementia with nearly 90% accuracy. The addition of neuropsychological testing to injury severity variables (e.g., posttraumatic amnesia) increases predicted accuracy in functional outcomes. A neuropsychological evaluation can be helpful in addressing concerns about functional capacities (e.g., ability to drive or live independently) and in determining a patient's capacity to make decisions about health care or finances. Most patients who underwent neuropsychological evaluation and their significant others reported that they found the evaluation helpful in understanding and coping with cognitive problems.

Objectives: To examine neuropsychological test performance among individuals clinically diagnosed with Parkinson's disease (PD) without evidence of dopaminergic deficiency on [123]I-CIT single photon emission computed tomography imaging., Methods: Data were obtained from the Parkinson's Progression Marker Initiative. The sample included 59 participants with scans without evidence of dopaminergic deficiency (SWEDD), 412 with PD, and 114 healthy controls (HC). Tests included Judgment of Line Orientation, Letter-Number Sequencing, Symbol Digit Modalities, Hopkins Verbal Learning Test-Revised, and Letter and Category Fluency. Multivariate analysis of variance was used to compare standardized scores between the groups., Results: There was a statistically significant difference in performances between the groups, F(14,1155)=5.04; p<.001; partial η2=.058. Pairwise comparisons revealed significant differences in Category Fluency between SWEDD (M=0.22; SD=1.08) and HC (M=0.86; SD=1.15) and in Symbol Digit Modalities Test performance between SWEDD (M=45.09; SD=11.54) and HC (M=51.75; SD=9.79). No significant differences between SWEDD and PD were found. Using established criteria, approximately one in four participants in the SWEDD and PD groups met criteria for mild cognitive impairment (MCI)., Conclusions: Individuals with SWEDD demonstrate significantly worse mental processing speed and semantic fluency than HC. The neuropsychological test performances and rates of MCI were similar between the SWEDD group and PD groups, which may reflect a common pathology outside of the nigrostriatal pathway. (JINS, 2018, 24, 646-651).

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer's dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.

Background: Neuropsychiatric symptoms are common features of dementia, and these occur in three fourths of patients on psychogeriatric inpatient units. These symptoms have traditionally been treated with pharmacological agents, but many medications are as likely to harm patients with dementia as to help them. As a result, nonpharmacological interventions are increasingly being investigated as ways to reduce these symptoms. Objective: The current study evaluated the impact of an individualized music-based intervention on agitation, negative mood, positive mood, compliance with care, need for one-on-one nursing staff intervention, and need for PRN medication. Method: Participants in this study were older adults who were admitted to a geriatric behavioral inpatient unit for acute agitation or behavioral disturbance. Twenty patients were in a treatment as usual group and 21 were in the individualized music group. Results: Agitation, negative mood, and positive mood all benefited from the music-based intervention, with resulting large effect sizes. Resisting care level also significantly benefited from the intervention, with a resulting medium effect size. Conclusion: These findings indicate that an easily implemented and reproducible music-based intervention, which is well tolerated and without adverse side effects, can be an effective way to reduce neuropsychiatric symptoms associated with dementia on a hospital unit., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Normative sample composition can vary notably as a function of exclusionary criteria in older adult samples given that typical medical conditions of exclusion become more prevalent with age. Older adult norms may consist of typically aging or healthy aging individuals according to the stringency of the exclusion criteria, a difference illustrated when comparing two normative samples for the RBANS: the original standardization sample and the Oklahoma sample., Methods: The current study examined the clinical impact of norm selection in older adults by analyzing impairment classification rates for 105 older adult behavioral health inpatients. Rates of impaired performance (scaled score ≤4 or its normalized equivalent) were compared across RBANS subtests using standardization sample vs. Oklahoma sample normative data in patients aged 70-79 (n = 57) and 80-89 (n = 48)., Results: Across most RBANS subtests, utilization of the original standardization sample vs. Oklahoma sample norms resulted in a greater proportion of individuals classified as impaired. These findings occurred across both age groups and persevered when holding constant the sample normalization process. Overall, use of the standardization sample vs. Oklahoma sample normative data were 1-11 times more likely to indicate impairment, with one of the more notable differences seen on the Coding subtest in the 80-89 sample (65% vs. 8% labeled as impaired)., Conclusions: Sample composition and exclusionary criteria require consideration when selecting an appropriate normative sample against which to compare older adult test performance. Salient differences between typically aging vs. healthy aging older adult norms are discussed.

Objective: Excessive Decline from Premorbid Functioning (EDPF) is presented as a construct and defined as a discrepancy between predicted premorbid ability and current test performance that is so atypical of individuals with true neurocognitive impairment that it is likely the product of performance invalidity. New embedded PVTs (EDPF-FSIQ, EDPF-VW, and EDPF-PP) were derived by comparing scores from the WAIS-IV to TOPF demographically predicted premorbid estimates and then examined for classification accuracy., Participants and Methods: After excluding for dementia, intellectual disability, and left-sided stroke, participants (n = 230) were grouped according to number of PVTs failed. ROC analyses were conducted to determine the accuracy of EDPF indices in classifying patients as failing 0 or ≥2 PVTs within both a mixed neuropsychological outpatient sample and according to specific diagnostic criterion groups., Results: Significant group differences emerged for all EDPF indices (p < .001). EDPF-FSIQ resulted in an AUC of .837, classifying patients with 56% sensitivity at ≥90% specificity, and EDPF-VW resulted in an AUC of .850, classifying patients with 61% sensitivity at ≥90% specificity. Accuracy remained high across diagnostic groups (i.e. neurocognitive, moderate/severe TBI, and psychiatric) for EDPF-VW and EDPF-FSIQ, whereas specificity declined for EDPF-PP in patients with mixed neurocognitive disorders. Overall, classification accuracy rates exceeded those of Reliable Digit Span., Conclusions: Both EDPF-FSIQ and EDPF-VW demonstrated excellent discrimination between patients providing valid versus invalid test performance. Unique advantages of EDPF validity measures include incorporation of demographic estimates of premorbid ability and examination of performances on multiple tests spanning different cognitive domains.

Objective and Background: More than 10% of patients clinically diagnosed with Parkinson disease demonstrate normal dopamine uptake on dopamine transporter single-photon emission computed tomography (DaTscan), but little is known about how cognitive function differs between patients with dopamine deficiency on DaTscan and patients with scans without evidence of dopaminergic deficit (SWEDD). We compared the cognitive function of these two groups of patients over 2 years., Methods: We retrospectively analyzed data obtained from the Parkinson's Progression Markers Initiative on 309 participants clinically diagnosed with idiopathic Parkinson disease who had scored in the normal range on the Montreal Cognitive Assessment at baseline and had completed 1- and 2-year follow-up visits. We compared the Montreal Cognitive Assessment scores at 1 and 2 years between the 42 participants with SWEDD and the 267 with dopamine deficiency., Results: Mean cognitive scores did not differ significantly between groups at 1 year, but at 2 years the participants with SWEDD performed more poorly. At 2 years, 31% of the participants with SWEDD versus 15% of those with dopamine deficiency had statistically reliable cognitive impairment., Conclusions: This study provides evidence that some individuals clinically diagnosed with idiopathic Parkinson disease but with SWEDD demonstrate early cognitive decline. The results also suggest that recently diagnosed patients with SWEDD may be at even greater risk for cognitive decline than patients with DaTscan-confirmed early-stage Parkinson disease. While patients with SWEDD likely represent a heterogeneous group of etiologies, our results highlight the need to monitor these patients' cognitive function over time.

Objective: The current study investigated expert beliefs and practices as they relate to neuropsychological validity testing., Methods: North American neuropsychologists with expertise in neuropsychological validity testing (n = 24) were surveyed on numerous items related to validity testing. Results were analyzed and compared to findings from a prior expert survey and a recent survey of a general sample of neuropsychological practitioners., Results: Responses varied among experts on some items, indicating that experts have differences of opinion and practice regarding certain validity testing topics. However, expert opinion converged on a number of topics central to validity testing, particularly those highlighting the need for and importance of validity testing in neuropsychological assessment. Notably, expert responses on these topics often agreed with responses obtained from a prior expert sample and a general sample of neuropsychological practitioners., Conclusions: The results allow practitioners to see the range of validity testing beliefs and practices among current experts. Especially in those areas where consensus emerged, the results provide a way for practitioners to determine if their practices are consistent with those of their expert colleagues.

Wernicke-Korsakoff syndrome is caused by thiamine (vitamin B1) deficiency, typically resulting from malnutrition secondary to chronic alcohol abuse. Less often, other conditions can lead to malnutrition and Wernicke-Korsakoff syndrome. We describe a 35-year-old man who developed Wernicke-Korsakoff syndrome with a typical neurologic and neuropsychological presentation after somatic delusions led him to refuse to eat. Cases like his serve to heighten awareness of the interplay between psychiatric and neurologic conditions, their sometimes atypical pathogenesis, and the value to primary care providers of consulting with psychiatrists, neurologists, and neuropsychologists when managing patients with possible Wernicke-Korsakoff syndrome.

Previous research has demonstrated RBS and FBS-r to identify non-credible reporters of cognitive symptoms, but the extent that these scales might be influenced by true neurocognitive dysfunction has not been previously studied. The present study examined the relationship between these cognitive validity scales and neurocognitive performance across seven domains of cognitive functioning, both before and after controlling for PVT status in 120 individuals referred for neuropsychological evaluations. Variance in RBS, but not FBS-r, was significantly accounted for by neurocognitive test performance across most cognitive domains. After controlling for PVT status, however, relationships between neurocognitive test performance and validity scales were no longer significant for RBS, and remained non-significant for FBS-r. Additionally, PVT failure accounted for a significant proportion of the variance in both RBS and FBS-r. Results support both the convergent and discriminant validity of RBS and FBS-r. As neither scale was impacted by true neurocognitive dysfunction, these findings provide further support for the use of RBS and FBS-r in neuropsychological evaluations., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The current study investigated changes in neuropsychologists' validity testing beliefs and practices since publication of the last North American survey targeting these issues in 2007 and explored emerging issues in validity testing that had not been previously addressed in the professional survey literature., Methods: Licensed North American neuropsychologists (n = 316), who primarily evaluate adults, were surveyed in regard to the following topics: (1) comparison of objective validity testing, qualitative data, and clinical judgment; (2) approaches to validity test administration; (3) formal communication in cases of suspected malingering; (4) reporting of validity test results; (5) suspected causes of invalidity; (6) integration of stand-alone, embedded, and symptom-report validity measures; (7) multiple performance validity test interpretation; (8) research practices; and (9) popularity of specific validity instruments., Results: Overall, findings from the current survey indicated that all but a small minority of respondents routinely utilize validity testing in their examinations. Furthermore, nearly all neuropsychologists surveyed believed formal validity testing to be mandatory in forensic evaluations and at least desirable in clinical evaluations. While results indicated general agreement among neuropsychologists across many aspects of validity testing, responses regarding some facets of validity test implementation, interpretation, and reporting were more variable. Validity testing utilization generally did not differ according to level of forensic involvement but did vary in respect to respondent literature consumption., Conclusions: Study findings differ significantly from past professional surveys and indicate an increased utilization of validity testing, suggesting a pronounced paradigm shift in neuropsychology validity testing beliefs and practices.

The Designs subtest allows for accumulation of raw score points by chance alone, creating the potential for artificially inflated performances, especially in older patients. A random number generator was used to simulate the random selection and placement of cards by 100 test naive participants, resulting in a mean raw score of 36.26 (SD = 3.86). This resulted in relatively high-scaled scores in the 45-54, 55-64, and 65-69 age groups on Designs II. In the latter age group, in particular, the mean simulated performance resulted in a scaled score of 7, with scores 1 SD below and above the performance mean translating to scaled scores of 5 and 8, respectively. The findings indicate that clinicians should use caution when interpreting Designs II performance in these age groups, as our simulations demonstrated that low average to average range scores occur frequently when patients are relying solely on chance performance., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Test of Memory Malingering (TOMM) is the most used performance validity test in neuropsychology, but does not measure response consistency, which is central in the measurement of credible presentation. Gunner, Miele, Lynch, and McCaffrey (2012) developed the Albany Consistency Index (ACI) to address this need. The ACI consistency measurement, however, may penalize examinees, resulting in suboptimal accuracy. The Invalid Forgetting Frequency Index (IFFI), created for the present study, utilizes an algorithm to identify and differentiate learning and inconsistent response patterns across TOMM trials. The purpose of this study was to assess the diagnostic accuracy of the ACI and IFFI against a reference test (Malingered Neurocognitive Dysfunction criteria), and to compare both to the standard TOMM indexes. This retrospective case-control study used 59 forensic cases from an outpatient clinic in Southern Kansas. Results indicated that sensitivity, negative predictive value, and overall accuracy of the IFFI were superior to both the TOMM indexes and ACI. Logistic regression odds ratios were similar for TOMM Trial 2, Retention, and IFFI (1.25, 1.24, 1.25, respectively), with the ACI somewhat lower (1.18). The IFFI had the highest rate of group membership predictions (79.7%). Implications and limitations of the present study are discussed.

Frontotemporal dementia is a cause of behavioral disturbance that usually appears in individuals between 45 and 65 years of age. The authors present the case of a 65-year-old patient that illustrates how frontotemporal dementia can be misdiagnosed based on a behavioral pattern that suggests the presence of a primary mood disorder. Early accurate diagnosis of frontotemporal dementia and subsequent supportive measures can allow patients and families to make important decisions about business and legal affairs and how to spend remaining leisure time in the most meaningful and enjoyable way possible.

The Test of Memory Malingering is one of the most popular and heavily researched validity tests available for use in neuropsychological evaluations. Recent research has suggested, however, that the original indices and cutoffs may require modifications to increase sensitivity rates. Some of these modifications lack cross-validation and no study has examined all indices in a single sample. This study compares Trial 1, Trial 2, the Retention Trial, and the newly created Albany Consistency Index in a criterion group forensic neuropsychological sample. Findings lend support for the newly created indices and cutoff scores. Implications and cautionary statements are provided and discussed.

This study examined differences in raw scores on the Symptom Validity Scale and Response Bias Scale (RBS) from the Minnesota Multiphasic Personality Inventory-2 in three criterion groups: (i) valid traumatic brain injured, (ii) invalid traumatic brain injured, and (iii) psychogenic non-epileptic seizure disorders. Results indicate that a >30 raw score cutoff for the Symptom Validity Scale accurately identified 50% of the invalid traumatic brain injured group, while misclassifying none of the valid traumatic brain injured group and 6% of the psychogenic non-epileptic seizure disorder group. Using a >15 RBS raw cutoff score accurately classified 50% of the invalid traumatic brain injured group and misclassified fewer than 10% of the valid traumatic brain injured and psychogenic non-epileptic seizure disorder groups. These cutoff scores used conjunctively did not misclassify any members of the psychogenic non-epileptic seizure disorder or valid traumatic brain injured groups, while accurately classifying 44% of the invalid traumatic brain injured individuals. Findings from this preliminary study suggest that the conjunctive use of the Symptom Validity Scale and the RBS from the Minnesota Multiphasic Personality Inventory-2 may be useful in differentiating probable malingering from individuals with brain injuries and conversion disorders.

Background: The Coin-in-the-Hand Test was developed to help clinicians distinguish patients who are neurocognitively impaired from patients who are exaggerating or feigning memory complaints. Previous findings have shown that participants asked to feign memory problems and patients suspected of malingering performed worse on the test than patients with genuine neurocognitive dysfunction., Objective: We reviewed the literature on the Coin-in-the-Hand Test and evaluated test performance by 45 hospitalized patients who had dementia with moderately to severely impaired cognition., Methods: We analyzed Coin-in-the-Hand Test scores, neuropsychological findings, and other data to determine whether demographic or neurocognitive variables affected Coin-in-the-Hand Test scores. We also calculated base rates of these scores and provided cutoff ranges for clinical use., Results: Coin-in-the-Hand Test scores were independent of neurocognitive functioning, age, education level, and type of dementia. Base rates of scores suggest that a low cutoff can help differentiate between patients with true neurocognitive impairments and those exaggerating or feigning memory complaints., Conclusions: Both the literature and our findings show the Coin-in-the-Hand Test to have potential as a quick and easy screening tool to detect neurocognitive symptom exaggeration. This test could effectively supplement commonly used neurocognitive screens such as the Mini-Mental State Examination, the Saint Louis University Mental Status Examination, and the Montreal Cognitive Assessment.

Reliable Digit Span (RDS) is a heavily researched symptom validity test with a recent literature review yielding more than 20 studies ranging in dates from 1994 to 2011. Unfortunately, limitations within some of the research minimize clinical generalizability. This systematic review and cross-validation study was conducted to address these limitations, thus increasing the measure's clinical utility. Sensitivity and specificity rates were calculated for the ≤6 and ≤7 cutoffs when data were globally combined and divided by clinical groups. The cross-validation of specific diagnostic groups was consistent with the data reported in the literature. Overall, caution should be used when utilizing the ≤7 cutoff in all clinical groups and when utilizing the ≤6 cutoff in the following groups: cerebrovascular accident, severe memory disorders, mental retardation, borderline intellectual functioning, and English as a second language. Additional limitations and cautions are provided.

This study utilized multiple criterion group neuropsychological samples to evaluate the "over-reporting" and "under-reporting" MMPI-2-RF validity scales. The five criterion groups included in this study were (1) litigating traumatic brain injury patients who failed Slick et al. criteria for probable malingering, (2) litigating traumatic brain injury patients who passed Slick et al. criteria, (3) mixed neuropsychological outpatients who passed SVTs and were diagnosed with primary neurological conditions, (4) mixed neuropsychological outpatients who passed SVTs and were diagnosed with primary psychiatric conditions, and (5) epileptic seizure disorder inpatients who were diagnosed via video-EEG. Using the data from these groups, cumulative percentages for all possible T-scores and sensitivity and specificity rates for optimal cutoff scores were determined. When specificity rates were set at 90% across all non-malingering neurological condition groups, sensitivity rates ranged from 48% (FBS-r) to 10% (K-r).

Although it is recognized that significant cognitive deficits are inherent in many psychiatric disorders, there is minimal research on whether the deficits can cause a failing score on symptom validity tests (SVTs). The performances of 104 and 178 patients with psychotic disorders and non-psychotic psychiatric disorders, respectively, on seven SVTs were examined. Analyses indicate that most of these SVTs have specificity rates of 90% or better for both clinical groups. Further, only 7% of patients in the psychotic group and 5% of patients in the non-psychotic psychiatric group produced false-positive classifications based on malingering criteria similar to those suggested by Slick et al. (i.e., failure of two or more SVTs or failure of one SVT at statistically significantly worse than chance rates). Consequently this research indicates that psychiatric disorders typically do not adversely affect SVT performance.

It has been suggested that the Sentence Repetition Test (SRT) could serve as an adequate embedded symptom validity measure identifying suspect effort during neuropsychological testing. However, very little research has examined sensitivity and specificity rates when using this measure in a variety of clinical settings. The SRT was administered to 1031 patients referred for neuropsychological assessment in outpatient, inpatient, and independent medical evaluation settings. These patients were diagnosed with a wide range of psychiatric, developmental, and neurological disorders. The results of this study reveal that the SRT is a valid measure of suspect effort for the vast majority of these patients (sensitivity = 56.8% and specificity = 95.8% in combined clinical settings). However, analyses also indicate that the SRT is not a valid effort measure for individuals with mental retardation or dementia due to specificity rates falling well below 90% for both groups. Furthermore, the validity of the SRT as an effort measure is questionable for individuals with English as a second language, with a verbal learning disability, with a left cerebrovascular accident, or with an expressive-receptive language disorder due to small sample sizes or borderline specificity rates. Sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy rates are provided for varying cutoff scores in inpatient, outpatient, and IME settings. The results of this extensive study confirm that the SRT can be a useful measure in detecting suspect effort in neuropsychological testing while also providing valuable clinical information.