When assessing symptom validity in patients with dementia, traditional approaches may be inappropriate because neurological factors may cause altered performance. The Medical Symptom Validity Test has a Dementia Profile that explicitly recognizes this fact. We prospectively evaluated classification accuracy of the Dementia Profile for 52 referrals to a memory disorders clinic. The Dementia Profile correctly classified 36/52 patients. Sensitivity was 54.8%, specificity was 90.5%, positive predictive value was 89.5%, negative predictive value was 60.0%, and the likelihood ratio was 5.77. Of 31 patients with dementia, 11 did not fail symptom validity indices. When only considering patients who failed symptom validity indices, sensitivity of the Dementia Profile was 85%. Classification accuracy statistics are also provided for the Genuine Memory Impairment Profile.

We prospectively evaluated performance of 63 referrals to a memory disorders clinic who received the Medical Symptom Validity Test (MSVT) as part of their standard neuropsychological evaluation. The patients were grouped based on independent medical diagnoses and presence or absence of a potential financial incentive to under-perform. Twenty-seven patients (42.9%) scored below cutoffs on the MSVT symptom validity indices. Two individuals in the potential financial incentive group showed clear signs of invalid responding (18.2%). Twenty-two of the remaining 25 patients who failed the symptom validity indices corresponded to the dementia profile. Three individuals did not correspond to the dementia profile but are thought to have performed validly representing a 4.8% false positive rate. When considering all MSVT indices, the base rate of invalid responding in the potential financial incentive to under-perform group increased to 27.3%. Combining all groups our base rate of invalid responding was 4.8%. Specific performances are presented.

In the military and Veterans Administration systems, individuals with potential MTBI are presenting with symptoms in excess of what would be expected based on initial injury characteristics and/or at unexpected time periods based on current research findings. This article investigates factors that might account for the discrepancy between current research expectations and some occurrences in clinical practice. The physics of blast waves, as well as animal and human research, relevant to explosions are reviewed. Additional factors that occur within the military blast exposure milieu are also explored because the context in which an injury occurs can potentially impact symptom severity and course of recovery. Differential diagnoses, iatrogenic illness, diagnosis threat, and symptom embellishment are also considered.

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Severe traumatic brain injury (TBI) has been associated with increased mortality. This study characterizes long-term mortality, life expectancy, causes of death and risk factors for death among patients admitted within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS) who lack command following at the time of admission for inpatient TBI rehabilitation. Of the 8,084persons enrolled from 1988 and 2009, 387 from 20 centers met study criteria.Individuals with moderate to severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the U.S. general population of similar age, gender and race, with an average life expectancy (LE) reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation were 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the US general population matched for age, gender and race/ethnicity, these non-command following individuals were over 4 times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared to the US general population, and compared to all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate compared to the general population.