scholarly journals Examining the Clinical Utility of Selected Memory-Based Embedded Performance Validity Tests in Neuropsychological Assessment of Patients with Multiple Sclerosis

2021 ◽  
Vol 13 (4) ◽  
pp. 477-486
Author(s):  
John W. Lace ◽  
Zachary C. Merz ◽  
Rachel Galioto
Keyword(s):  
Multiple Sclerosis ◽  
Neuropsychological Assessment ◽  
Clinical Utility ◽  
Medical Center ◽  
Clinical Care ◽  
Verbal Learning ◽  
Academic Medical Center ◽  
Performance Validity ◽  
Validity Tests ◽  
Performance Validity Tests

Within the neuropsychological assessment, clinicians are responsible for ensuring the validity of obtained cognitive data. As such, increased attention is being paid to performance validity in patients with multiple sclerosis (pwMS). Experts have proposed batteries of neuropsychological tests for use in this population, though none contain recommendations for standalone performance validity tests (PVTs). The California Verbal Learning Test, Second Edition (CVLT-II) and Brief Visuospatial Memory Test, Revised (BVMT-R)—both of which are included in the aforementioned recommended neuropsychological batteries—include previously validated embedded PVTs (which offer some advantages, including expedience and reduced costs), with no prior work exploring their utility in pwMS. The purpose of the present study was to determine the potential clinical utility of embedded PVTs to detect the signal of non-credibility as operationally defined by below criterion standalone PVT performance. One hundred thirty-three (133) patients (M age = 48.28; 76.7% women; 85.0% White) with MS were referred for neuropsychological assessment at a large, Midwestern academic medical center. Patients were placed into “credible” (n = 100) or “noncredible” (n = 33) groups based on a standalone PVT criterion. Classification statistics for four CVLT-II and BVMT-R PVTs of interest in isolation were poor (AUCs = 0.58–0.62). Several arithmetic and logistic regression-derived multivariate formulas were calculated, all of which similarly demonstrated poor discriminability (AUCs = 0.61–0.64). Although embedded PVTs may arguably maximize efficiency and minimize test burden in pwMS, common ones in the CVLT-II and BVMT-R may not be psychometrically appropriate, sufficiently sensitive, nor substitutable for standalone PVTs in this population. Clinical neuropsychologists who evaluate such patients are encouraged to include standalone PVTs in their assessment batteries to ensure that clinical care conclusions drawn from neuropsychological data are valid.

scholarly journals Are Established Embedded Performance Validity Test Cut-Offs Generalizable to Patients With Multiple Sclerosis?

2020 ◽  
Vol 35 (5) ◽  
pp. 511-516
Author(s):  
Christopher H Domen ◽  
Michael R Greher ◽  
Patrick W Hosokawa ◽  
Sierra L Barnes ◽  
Brian D Hoyt ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Retrospective Study ◽  
Initial Data ◽  
False Positive ◽  
Large Scale ◽  
Advanced Disease ◽  
Performance Validity ◽  
Relapsing Remitting ◽  
Validity Tests ◽  
Performance Validity Tests

Abstract Objective Data for the use of embedded performance validity tests (ePVTs) with multiple sclerosis (MS) patients are limited. The purpose of the current study was to determine whether ePVTs previously validated in other neurological samples perform similarly in an MS sample. Methods In this retrospective study, the prevalence of below-criterion responding at different cut-off scores was calculated for each ePVT of interest among patients with MS who passed a stand-alone PVT. Results Previously established PVT cut-offs generally demonstrated acceptable specificity when applied to our sample. However, the overall cognitive burden of the sample was limited relative to that observed in prior large-scale MS studies. Conclusion The current study provides initial data regarding the performance of select ePVTs among an MS sample. Results indicate most previously validated cut-offs avoid excessive false positive errors in a predominantly relapsing remitting MS sample. Further validation among MS patients with more advanced disease is warranted.

A Bayesian Approach to Mixed Group Validation of Performance Validity Tests

2014 ◽  
Author(s):  
Douglas Mossman ◽  
William Miller ◽  
Elliot Lee ◽  
Roger Gervais ◽  
Kathleen Hart ◽  
...  
Keyword(s):  
Bayesian Approach ◽  
Performance Validity ◽  
Mixed Group ◽  
Validity Tests ◽  
Performance Validity Tests

scholarly journals Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study

2021 ◽  
Vol 11 (6) ◽  
pp. 800
Author(s):  
Harriet A. Ball ◽  
Marta Swirski ◽  
Margaret Newson ◽  
Elizabeth J. Coulthard ◽  
Catherine M. Pennington
Keyword(s):  
Cognitive Abilities ◽  
Minnesota Multiphasic Personality Inventory ◽  
Verbal Learning ◽  
Cognitive Disorder ◽  
Control Group ◽  
Performance Validity ◽  
Immediate Recall ◽  
Trail Making ◽  
Learning Test ◽  
Validity Tests

Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology.

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

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