Performance and Symptom Validity Assessment in Patients with Apathy and Cognitive Impairment

AbstractObjective:Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with validity test performance and may thus lead to an incorrect (i.e., false-positive) classification of the patient’s scores as non-credible. The study aimed at examining the false-positive rate of three validity tests in patients with cognitive impairment and apathy.Methods:A cross-sectional, comparative study was performed in 56 patients with dementia, 41 patients with mild cognitive impairment, and 41 patients with Parkinson’s disease. Two PVTs – the Test of Memory Malingering (TOMM) and the Dot Counting Test (DCT) – and one SVT – the Structured Inventory of Malingered Symptomatology (SIMS) – were administered. Apathy was measured with the Apathy Evaluation Scale, and severity of cognitive impairment with the Mini Mental State Examination.Results:The failure rate was 13.7% for the TOMM, 23.8% for the DCT, and 12.5% for the SIMS. Of the patients with data on all three tests (n = 105), 13.5% failed one test, 2.9% failed two tests, and none failed all three. Failing the PVTs was associated with cognitive impairment, but not with apathy. Failing the SVT was related to apathy, but not to cognitive impairment.Conclusions:In patients with cognitive impairment or apathy, failing one validity test is not uncommon. Validity tests are differentially sensitive to cognitive impairment and apathy. However, the rule that at least two validity tests should be failed to identify non-credibility seemed to ensure a high percentage of correct classification of credibility.

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Preliminary Results of MyCog, a Brief Assessment for the Detection of Cognitive Impairment in Primary Care

Innovation in Aging ◽

10.1093/geroni/igaa057.833 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 259-260

Author(s):

Laura Curtis ◽

Lauren Opsasnick ◽

Julia Yoshino Benavente ◽

Cindy Nowinski ◽

Rachel O’Conor ◽

...

Keyword(s):

Primary Care ◽

Cognitive Impairment ◽

Cognitive Aging ◽

False Positive ◽

False Positive Rate ◽

False Negative ◽

False Negative Rate ◽

Self Report ◽

Card Sorting ◽

Primary Care Settings

Abstract Early detection of Cognitive impairment (CI) is imperative to identify potentially treatable underlying conditions or provide supportive services when due to progressive conditions such as Alzheimer’s Disease. While primary care settings are ideal for identifying CI, it frequently goes undetected. We developed ‘MyCog’, a brief technology-enabled, 2-step assessment to detect CI and dementia in primary care settings. We piloted MyCog in 80 participants 65 and older recruited from an ongoing cognitive aging study. Cases were identified either by a documented diagnosis of dementia or mild cognitive impairment (MCI) or based on a comprehensive cognitive battery. Administered via an iPad, Step 1 consists of a single self-report item indicating concern about memory or other thinking problems and Step 2 includes two cognitive assessments from the NIH Toolbox: Picture Sequence Memory (PSM) and Dimensional Change Card Sorting (DCCS). 39%(31/80) participants were considered cognitively impaired. Those who expressed concern in Step 1 (n=52, 66%) resulted in a 37% false positive and 3% false negative rate. With the addition of the PSM and DCCS assessments in Step 2, the paradigm demonstrated 91% sensitivity, 75% specificity and an area under the ROC curve (AUC)=0.82. Steps 1 and 2 had an average administration time of <7 minutes. We continue to optimize MyCog by 1) examining additional items for Step 1 to reduce the false positive rate and 2) creating a self-administered version to optimize use in clinical settings. With further validation, MyCog offers a practical, scalable paradigm for the routine detection of cognitive impairment and dementia.

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False-Positive Rates Associated with the Use of Multiple Performance and Symptom Validity Tests

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acu019 ◽

2014 ◽

Vol 29 (4) ◽

pp. 364-373 ◽

Cited By ~ 93

Author(s):

G. J. Larrabee

Keyword(s):

False Positive ◽

Symptom Validity ◽

Symptom Validity Tests ◽

Validity Tests

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Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽

10.1161/str.51.suppl_1.88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinav J Appukutty ◽

Lesli E Skolarus ◽

Mellanie V Springer ◽

William J Meurer ◽

James F Burke

Keyword(s):

Older Adults ◽

False Positive ◽

Age Groups ◽

Vascular Risk Factor ◽

The United States ◽

Cross Sectional ◽

Stroke Incidence ◽

Ed Visits ◽

Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

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The range and clinical impact of cognitive impairment in French patients with ALS: A cross-sectional study of neuropsychological test performance

Amyotrophic Lateral Sclerosis ◽

10.3109/17482968.2011.580847 ◽

2011 ◽

Vol 12 (5) ◽

pp. 372-378 ◽

Cited By ~ 29

Author(s):

Paul H. Gordon ◽

Daniel Delgadillo ◽

Ambre Piquard ◽

Gaelle Bruneteau ◽

Pierre-François Pradat ◽

...

Keyword(s):

Cognitive Impairment ◽

Test Performance ◽

Neuropsychological Test ◽

Cross Sectional Study ◽

Clinical Impact ◽

Sectional Study ◽

Cross Sectional

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False Positive Rates and Associated Risk Factors on the VOMS and mBESS in U.S. Military Personnel

Journal of Athletic Training ◽

10.4085/1062-6050-0094.21 ◽

2021 ◽

Author(s):

Anthony P. Kontos ◽

MAJ Katrina Monti ◽

Shawn R. Eagle ◽

MAJ Eliot Thomasma ◽

Cyndi L. Holland ◽

...

Keyword(s):

Risk Factors ◽

Motion Sickness ◽

Military Personnel ◽

False Positive ◽

False Positive Rate ◽

Cross Sectional Study ◽

False Positives ◽

Chi Square ◽

Cross Sectional ◽

History Of

ABSTRACT Context: In 2018, the U.S. military developed the Military Acute Concussion Evaluation-2 (MACE-2) to inform acute evaluation of mTBI. However, researchers have yet to investigate false positive rates for components of the MACE-2 including the Vestibular-Ocular Motor Screen (VOMS) and modified Balance Error Scoring System (mBESS) in military personnel. Objective: To examine factors associated with false positives in VOMS and mBESS in U.S. Army Special Operations Command (USASOC) personnel. Design: Cross-sectional study. Setting: Military medical clinic. Participants: 416 healthy USASOC personnel completed medical history, VOMS, and mBESS evaluations. Main Outcome Measures: False positive rates for the VOMS (2+ on VOMS symptom item, ≥ 5 cm for near point of convergence [NPC] distance) and mBESS (total score >4) were determined using chi-square analyses and independent samples t-tests. Multivariable logistic regressions (LR) with adjusted odds ratios (aOR) were performed to identify risk factors for false positives on VOMS and mBESS. VOMS items false positive rates ranged from 10.6% (smooth pursuits) to 17.5% (NPC). mBESS total score false positive rate was 36.5%. Results: The multivariable LR model supported three significant predictors of VOMS false positives including age (OR= 1.07, 95% CI= 1.02–1.12, p=0.007), migraine (OR=2.49, 95% CI= 1.29–4.81, p=0.007), and motion sickness history (OR=2.46, 95% CI= 1.34–4.50, p=0.004). Results of the multivariable LR model supported only motion sickness history as a significant predictor (OR=2.34, 95% CI= 1.34–4.05, p=0.002) of mBESS false positives. Conclusions: There were low false positive rates across VOMS items, which were associated with age, history of mTBI, migraine, and motion sickness. False positives for the mBESS total score were higher (36.5%) and were only associated with a history of motion sickness. These risk factors for false positives should be considered when administering and interpreting VOMS and mBESS components of the MACE-2 in this population.

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Mild cognitive impairment: historical development and summary of research

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2004.6.4/jgolomb ◽

2004 ◽

Vol 6 (4) ◽

pp. 351-367

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Test Performance ◽

Historical Development ◽

Molecular Genetic ◽

Treatment Strategies ◽

The Elderly ◽

Global Scale ◽

Cognitive Test ◽

Cross Sectional

This review article broadly traces the historical development, diagnostic criteria, clinical and neuropathological characteristics, and treatment strategies related to mild cognitive impairment (MCI), The concept of MCI is considered in the context of other terms that have been developed to characterize the elderly with varying degrees of cognitive impairment Criteria based on clinical global scale ratings, cognitive test performance, and performance on other domains of functioning are discussed. Approaches employing clinical, neuropsychological, neuroimaging, biological, and molecular genetic methodology used in the validation of MCI are considered, including results from cross-sectional, longitudinal, and postmortem investigations. Results of recent drug treatment studies of MCI and related methodological issues are also addressed.

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