Mechanisms of Possible Neurocognitive Dysfunction

2017 ◽  
Author(s):  
Daniel L. Drane ◽  
Dona E. C. Locke
Keyword(s):  
Neuropsychological Testing ◽  
Psychological Theory ◽  
Future Research ◽  
Performance Validity ◽  
Post Traumatic Stress ◽  
Neurocognitive Dysfunction ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Performance Validity Measures ◽  
Validity Tests

This chapter covers what is known about the possible mechanisms of neurocognitive dysfunction in patients with psychogenic nonepileptic seizures (PNES). It begins with a review of all research examining possible cognitive deficits in this population. Cognitive research in PNES is often obscured by noise created by a host of comorbid conditions (e.g., depression, post-traumatic stress disorder, chronic pain) and associated issues (e.g., effects of medications and psychological processes that can compromise attention or broader cognition). More recent studies employing performance validity tests raise the possibility that studies finding broad cognitive problems in PNES may be highlighting a more transient phenomenon secondary to these comorbid or secondary factors. Such dysfunction would likely improve with successful management of PNES symptomatology, yet the effects of even transient variability likely compromises daily function until these issues are resolved. Future research must combine the use of neuropsychological testing, performance validity measures, psychological theory, neuroimaging analysis, and a thorough understanding of brain–behavior relationships to address whether there is a focal neuropathological syndrome associated with PNES.

Performance Validity Testing in Multiple Sclerosis

2020 ◽  
Vol 26 (10) ◽  
pp. 1028-1035 ◽  
Author(s):  
Rachel Galioto ◽  
Kaltra Dhima ◽  
Ophira Berenholz ◽  
Robyn Busch
Keyword(s):  
Multiple Sclerosis ◽  
Psychological Symptoms ◽  
Neuropsychological Testing ◽  
Intractable Epilepsy ◽  
Neuropsychological Evaluation ◽  
Performance Validity ◽  
Retrospective Data Analysis ◽  
Disability Status ◽  
Validity Tests ◽  
Item Scores

AbstractObjective:Performance validity tests (PVTs) are designed to detect nonvalid responding on neuropsychological testing, but their associations with disease-specific and other factors are not well understood in multiple sclerosis (MS). We examined PVT performance among MS patients and associations with clinical characteristics, cognition, mood, and disability status.Method:Retrospective data analysis was conducted on a sample of patients with definite MS (n = 102) who were seen for a clinical neuropsychological evaluation. Comparison samples included patients with intractable epilepsy seen for presurgical workup (n = 102) and patients with nonacute mild traumatic brain injury (mTBI; n = 50). Patients completed the Victoria Symptom Validity Test (VSVT) and validity cutoffs were defined as <16/24 and <18/24 on the hard items.Results:In this MS cohort, 14.4% of patients scored <16 on the VSVT hard items and 21.2% scored <18. VSVT hard item scores were associated with disability status and depression, but not with neuropsychological scores, T2 lesion burden, atrophy, disease duration, or MS subtype. Patients applying for disability benefits were 6.75 times more likely to score <18 relative to those who were not seeking disability. Rates of nonvalid scores were similar to the mTBI group and greater than the epilepsy group.Conclusions:This study demonstrates that nonvalid VSVT scores are relatively common among MS patients seen for clinical neuropsychological evaluation. VSVT performance in this group relates primarily to disability status and psychological symptoms and does not reflect factors specific to MS (i.e., cognitive impairment, disease severity). Recommendations for future clinical and research practices are provided.

scholarly journals Development and Application of Novel Performance Validity Metrics for Computerized Neurocognitive Batteries

2021 ◽  
Author(s):  
J. Cobb Scott ◽  
Tyler M. Moore ◽  
David R Roalf ◽  
Theodore D. Satterthwaite ◽  
Daniel H. Wolf ◽  
...  
Keyword(s):  
Simulated Data ◽  
Real Data ◽  
Response Patterns ◽  
Performance Validity ◽  
Neurocognitive Tests ◽  
Validity Measures ◽  
Novel Method ◽  
Performance Validity Measures ◽  
Validity Tests ◽  
Performance Validity Tests

Objective: Data from neurocognitive assessments may not be accurate in the context of factors impacting validity, such as disengagement, unmotivated responding, or intentional underperformance. Performance validity tests (PVTs) were developed to address these phenomena and assess underperformance on neurocognitive tests. However, PVTs can be burdensome, rely on cutoff scores that reduce information, do not examine potential variations in task engagement across a battery, and are typically not well-suited to acquisition of large cognitive datasets. Here we describe the development of novel performance validity measures that could address some of these limitations by leveraging psychometric modeling from data embedded within the Penn Computerized Neurocognitive Battery (PennCNB). Method: We first developed these validity measures using simulations of invalid response patterns with parameters drawn from real data. Next, we examined their application in two large, independent samples: 1) children and adolescents from the Philadelphia Neurodevelopmental Cohort (n=9,498); and 2) adult servicemembers from the Marine Resiliency Study-II (n=1,444). Results: Our performance validity metrics detected patterns of invalid responding in simulated data, even at subtle levels. Furthermore, a combination of these metrics significantly predicted previously established validity rules for these tests in both developmental and adult datasets. Moreover, most clinical diagnostic groups did not show reduced validity estimates. Conclusion: These results provide proof-of-concept evidence for multivariate, data-driven performance validity metrics. These metrics offer a novel method for determining the performance validity for individual neurocognitive tests that is scalable, applicable across different tests, less burdensome, and dimensional. However, more research is needed into their application.

Practical and Diagnostic Challenges for the Neuropsychologist

2017 ◽  
Author(s):  
Kim Willment ◽  
David Loring
Keyword(s):  
Decision Making ◽  
Psychological Distress ◽  
Neuropsychological Evaluation ◽  
Performance Validity ◽  
Cognitive Profiles ◽  
Therapeutic Goals ◽  
Psychogenic Nonepileptic Seizures ◽  
Clinical Environments ◽  
Nonepileptic Seizures ◽  
Neuropsychological Findings

The objective of this chapter is to outline practical and diagnostic challenges in the clinical neuropsychological evaluation of patients with psychogenic nonepileptic seizures (PNES) and to aid neuropsychologists in developing a consistent decision-making protocol. Challenges outlined include responding to performance validity test (PVT) failures, testing in different clinical environments, medications effects, acute psychological distress, and length of evaluations. Diagnostic challenges related to the neuropsychological evaluation in PNES, including the lack of specificity of cognitive profiles and psychopathological heterogeneity, are discussed. The final focus of the chapter is therapeutic goals of the neuropsychological evaluation, particularly the integration of the neuropsychological findings during the delivery of the PNES diagnosis and promoting cognitive self-efficacy.

Digit Span Forward as a Performance Validity Test in Dementia Evaluations: Specificity in Mild Cognitive Impairment, Mild Dementia, and Moderate Dementia

2019 ◽  
Vol 34 (6) ◽  
pp. 837-837
Author(s):  
H Clark ◽  
P Martin ◽  
R Schroeder
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Digit Span ◽  
Future Research ◽  
Performance Validity ◽  
Mild Dementia ◽  
Dementia Patients ◽  
Moderate Dementia ◽  
Neuropsychological Evaluations ◽  
Validity Tests

Abstract Objective Traditional performance validity tests (PVTs) often yield high false positive rates in dementia evaluations. The current study examined the frequency of extremely low scores (≤ 2 percentile) on WAIS-IV Digit Span Forward (DSF) in older adults with Mild Cognitive Impairment (MCI) or dementia to evaluate its possible utility as a PVT in these populations. Method Archival data from outpatient neuropsychological evaluations were analyzed. Individuals who were not diagnosed with a neurocognitive disorder, had missing data, or were believed to be invalidly performing were excluded. Participants (n = 195; mean age = 72.8; mean education = 13.2 years) were classified according to their evaluation diagnosis of MCI (n = 72; mean RBANS Total Score = 86.8) or dementia. Dementia patients were further divided by MoCA score into groups of mild dementia (n = 90; MoCA≥15; mean RBANS Total Score = 71.0) or moderate dementia (n = 33; MoCA < 15; mean RBANS Total Score = 55.9). Frequencies of scaled scores were analyzed to calculate specificity values for each group. Results A WAIS-IV DSF scaled score of ≤4 (≤ 2 percentile) resulted in specificity values of 0.99 and 0.94 in MCI and mild dementia, respectively. Conversely, in moderate dementia, ≥0.90 specificity was achieved only when using a more conservative cutoff of ≤2. Conclusions Low DSF scaled scores occurred infrequently in MCI and mild dementia, indicating strong specificity and potential utility as a PVT in these populations. However, in moderate dementia, low DSF scores were more common, requiring use of a more stringent cutoff. Future research should examine DSF sensitivity to invalid performance, as well as DSF specificity according to specific etiologies of MCI and dementia.

scholarly journals A-207 Applying the Hartford Consistency Index to the Brief Visuospatial Memory Test—Revised for Assessing Performance Validity in an Outpatient Sample: A Pilot Study

2020 ◽  
Vol 35 (6) ◽  
pp. 1002-1002
Author(s):  
Sheikh K ◽  
Peck C
Keyword(s):  
Digit Span ◽  
Area Under The Curve ◽  
Memory Test ◽  
Consistency Index ◽  
Visuospatial Memory ◽  
Performance Validity ◽  
Performance Validity Measures ◽  
Validity Tests ◽  
External Incentives ◽  
Performance Validity Tests

Abstract Objective Prior studies have examined indices within the Brief Visuospatial Memory Test—Revised (BVMT-R) as potential embedded performance validity tests (PVT). Findings from these studies, however, are limited and with mixed results. Therefore, the purpose of the current study was to compare the classification accuracy of the Hartford Consistency Index (HCI) with published BVMT-R performance validity measures in an outpatient sample. Method A total of 115 archival files met study inclusion criteria: a) ≥ 18 years-old; b) administered &gt; 2 PVTs (Reliable Digit Span, Dot Counting Test, and Test of Memory Malingering); and c) no diagnoses of intellectual disability or dementia. Utilizing standard cutoffs, participants were classified as ‘Valid’ (n = 94) or ‘Invalid’ (n = 21). ‘Valid’ profiles passed all PVTs and were free of known external incentives while ‘Invalid’ profiles failed ≥2 PVTs. Results An HCI cutoff of &lt; 1 yielded 90% specificity, 48% sensitivity, and the area under the curve (AUC = .70) was adequate. Applying published cutoffs for Recognition Hits (≤4) and Percent Retention (≤58%) to our sample produced &gt; 90% specificity, but sensitivity rates were &lt; 40% and AUCs were consistently &lt; .70. Similarly, the Recognition Discrimination (≤4) cutoff revealed inadequate specificity (84%), but acceptable sensitivity (63%), and AUC (.73). Conclussions Results from our study support the use of the HCI as an embedded PVT within the BVMT-R for non-demented outpatient samples. Furthermore, the HCI outperformed other embedded PVTs examined. Limitations of our study and future directions are discussed.

Prevalence of poor effort and malingered neurocognitive dysfunction in litigating patients in Switzerland

2017 ◽  
Vol 28 (2) ◽  
pp. 97-116
Author(s):  
Andrea M. Plohmann ◽  
Max Hurter
Keyword(s):  
Depressive Disorders ◽  
Psychiatric Patients ◽  
Binary Logistic Regression ◽  
Cognitive Test ◽  
Performance Validity ◽  
Neurocognitive Dysfunction ◽  
Education Levels ◽  
Slick Criteria ◽  
First Generation Migrants ◽  
Validity Tests

Abstract. To determine the prevalence of inauthentic cognitive test results, the data of 455 examinees who had finished at least two performance validity tests (PVTs) were analyzed retrospectively. The PVTs administered were the WMT, MSVT, NV-MSVT, ASTM, BSV, RMT, and RDS. Classification as “definite” or “probable” malingering was done according to the Slick criteria. Sociodemographic variables and diagnoses were described using binary logistic regression. Poor effort in at least two PVTs correlated significantly with education levels, immigration, and origin. Irrespective of education level, the highest risk of definite malingering was found in first-generation migrants. Cervical spine dysfunction, normal cerebral imaging, PTSD, somatoform, and/or depressive disorders also correlated with negative response bias. The probability that psychiatric patients fulfill criteria of probable malingering was higher than in patients with isolated organic mental disorders.

scholarly journals RBANS Validity Measures and the TOMM in Veterans Undergoing Seizure Monitoring

2020 ◽  
Author(s):  
Laurence Binder ◽  
Martin C Salinsky ◽  
Daniel Storzbach ◽  
Sandy K Tadrous-Furnanz
Keyword(s):  
Positive Likelihood Ratio ◽  
Epileptic Seizures ◽  
Cutoff Score ◽  
Performance Validity ◽  
Test Of Memory Malingering ◽  
Psychogenic Nonepileptic Seizures ◽  
Neuropsychological Status ◽  
Embedded Measures ◽  
Validity Measures ◽  
Nonepileptic Seizures

Abstract Objective To assess the validity of embedded measures of performance validity, the effort index (EI) and effort scale (ES) of the repeatable battery for the assessment of neuropsychological status (RBANS), in Veterans with seizures; to compare the frequency of failure on the test of memory malingering (TOMM) in patients with epileptic versus psychogenic nonepileptic seizures (PNES). Methods Seizure diagnosis was established for 309 participants in epilepsy monitoring units using conventional diagnostic criteria who completed both the TOMM and RBANS. The criterion for performance invalidity was failure on any trial of the TOMM. We examined multiple EI and ES cutoffs to establish optimal sensitivity and specificity. Results An RBANS EI cutoff score of greater than three was optimal with specificity of .98, sensitivity of.19, and positive Likelihood Ratio of 10 but was not useful when below this cutoff. Confidence intervals indicate the need for confirmation of a failed EI with another performance validity test (PVT). No ES cutoff had sufficient specificity for clinical use. Invalid TOMM performance but not invalid RBANS performance was significantly more common in persons with PNES than in persons with epileptic seizures. Conclusions In Veterans undergoing seizure monitoring, the RBANS EI was useful as a screen when positive that requires confirmation with another PVT. The RBANS ES was not useful. Invalid performance on the TOMM was more common in persons with PNES than in persons with epileptic seizures.

scholarly journals Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria

2020 ◽  
Vol 35 (6) ◽  
pp. 735-764 ◽  
Author(s):  
Elisabeth M S Sherman ◽  
Daniel J Slick ◽  
Grant L Iverson
Keyword(s):  
Neuropsychological Assessment ◽  
Psychiatric Symptoms ◽  
Detection Methods ◽  
Performance Validity ◽  
Neurocognitive Dysfunction ◽  
Neuropsychological Dysfunction ◽  
Malingered Neurocognitive Dysfunction ◽  
Validity Tests ◽  
External Incentives

Abstract Objectives Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field’s operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545–561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field. Method The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms. Results The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment. Conclusions The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.

Eye movement desensitization and reprocessing treatment in functional neurological symptom disorder with psychogenic nonepileptic seizures: A study of two cases

2021 ◽  
pp. 135910452110372
Author(s):  
Onur O Demirci ◽  
Eser Sagaltici
Keyword(s):  
Psychiatric Disorders ◽  
Eye Movement ◽  
Neurological Symptom ◽  
Term Treatment ◽  
Post Traumatic Stress ◽  
Psychogenic Nonepileptic Seizures ◽  
Long Term Treatment ◽  
Scale Scores ◽  
Nonepileptic Seizures ◽  
Functional Neurological Symptom Disorder

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients’ cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.

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