Computerized neurocognitive assessments and detection of the malingering athlete.

Background: Healthcare professionals are concerned that athletes have the capability to intentionally underperform on baseline computerized neurocognitive assessments in an effort to expedite their return to the field of play following a concussion. The purpose of this study was to determine if the use of overlapping validity measures will provide better sensitivity for detecting malingering athletes on a baseline computerized neurocognitive assessment.
Methods: Twenty male, collegiate rugby players (mean age 23±4 years) participated in this study. Subjects completed 2 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assessments within a 7-day interval. The initial test, non-malingering baseline (NM), was performed adhering to ImPACT's normal sequence of instructions. Immediately prior to the second assessment, the malingering attempt (MA), each participant was instructed to "underperform on the test" in such a way that it was not obvious they were trying to score poorly.
Results: ImPACT detected 70% (N.=14) of the malingerers using internal validation measures, whereas the trained physician identified 80% of the malingerers (N.=16) including all of the malingerers detected by ImPACT. The Schatz Word Memory Check identified 100% of malingering tests.
Conclusions: These data indicate that the combination of a trained physician review and ImPACT test measures are more successful at recognizing possible malingers than use of the ImPACT validity measures alone. The Schatz Word Memory Check was highly effective at identifying invalid baseline tests and should be considered a valid test measure for future clinical reviews.