No abstract

The DCT demonstrated good classification accuracy and sensitivity/specificity for identifying noncredible performance in this mixed clinical veteran sample, suggesting utility as a non-memory-based PVT with this population. Moreover, cognitive impairment significantly contributed to slower completion times, but not reduced accuracy.

Current standards of practice in neuropsychology advocate for including validity tests (PVTs). Abbreviating PVTs, such as the Test of Memory Malingering (TOMM), may help reduce overall evaluation time while maintaining diagnostic accuracy. TOMM Trial 1 performance (T1), as well as the number of errors within the first 10 items of Trial 1 (TOMMe10), have shown initial promise as abbreviated PVTs but require additional external cross-validation. This study sought to replicate findings from other mixed, diverse, clinical samples and provide further validation of abbreviated administrations of the TOMM. Data included 120 veterans who completed the TOMM and 3 criterion PVTs during clinical evaluation. In total, performance from 68% of the sample was classified as valid (52% met criteria for cognitive impairment), and performance from 32% of the sample was invalid. Group differences, diagnostic accuracy statistics, and receiver operating characteristic (ROC) curves were analyzed for relevant TOMM indices. There were large (ηp2 = .45–.66), significant differences between validity groups (p < .001) on TOMM T1 and TOMMe10, with lower TOMM T1 and higher TOMMe10 scores for participants with invalid performance. Using established cut-scores, sensitivities/specificities were: TOMMe10 ≥1 error: .84/.66; ≥2 errors: .74/.93; TOMM T1 ≤40: .82/.93. ROC curve analysis yielded significant areas under the curve for both TOMMe10 and T1 with respective optimal cut-scores of ≥2 errors (.74 sensitivity/.93 specificity) and ≤41 (.84 sensitivity/.91 specificity). TOMMe10 and T1 performances are minimally impacted by cognitive impairment. Although both evidenced robust psychometric properties, TOMM T1 continued to show greater accuracy than TOMMe10.

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.

Confrontation naming test performance is related to cognitive processing speed, although the magnitude of this effect varies by the demands of each naming test (i.e., largest for RPN; smallest for VNT). Thus, results argue that processing speed is important to consider for accurate clinical interpretation of naming tests, especially in the context of cognitive impairment.