a Neurology Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.
b Department of Psychiatry , Baylor College of Medicine , Houston , TX , USA.
Clin Neuropsychol. 2018 Apr;32(3):468-478. doi: 10.1080/13854046.2017.1368715. Epub 2017 Aug 22.
Performance validity testing is an increasingly vital component of neuropsychological evaluation, though administration of stand-alone performance validity tests (PVTs) can be time-consuming. As the Test of Memory Malingering (TOMM) is among the most commonly used and researched PVTs, much work has focused on creating abbreviated versions while preserving diagnostic accuracy. A recent addition to this effort, errors on the first 10 items of Trial 1 (TOMMe10), was analyzed for its utility in predicting TOMM performance.
Subjects were 180 veterans seen on a long-term epilepsy monitoring unit. TOMM learning trials, Word Memory Test (WMT), and WAIS-IV Digit Span (for Reliable Digit Span; RDS) were administered as part of a larger battery. Performance invalidity was classified using established cut scores. Diagnostic classification statistics were calculated predicting TOMM, WMT, and RDS performance, including sensitivity, specificity, receiver operating characteristics (ROC), and positive and negative predictive values for multiple TOMMe10 cut scores.
A cut score of ≥2 errors on TOMMe10 yielded the highest sensitivity (.88) while maintaining ≥.90 specificity when predicting TOMM (also supported by ROC analysis). This cut score was also optimal when validated against combinations of PVTs (e.g. two of TOMM, WMT, and RDS; WMT and/or RDS).
TOMMe10 shows great promise in predicting future TOMM performance. In settings where time with patients is at a premium, ≥2 errors on TOMMe10 may be used as an early TOMM discontinue criteria, allowing examiners to use their limited time more effectively. The use of TOMMe10 in settings with varying TOMM failure base rates was discussed.
尽管单独进行表现性效度测验（PVT）可能会耗费大量时间，但表现性效度测验已成为神经心理评估中越来越重要的组成部分。由于记忆测验（TOMM）是最常用和研究最多的 PVT 之一，因此大量工作集中在创建缩短版的同时保持诊断准确性。最近在这方面的研究中，对测试 1 的前 10 项（TOMMe10）的错误进行了分析，以研究其在预测 TOMM 表现方面的效用。
180 名退伍军人在长期癫痫监测单元就诊，作为更大的测试组合的一部分，他们接受了 TOMM 学习测试、词汇记忆测试（WMT）和韦氏智力测验第四版数字广度（用于可靠数字广度；RDS）。使用既定的切割分数来分类表现无效。计算了预测 TOMM、WMT 和 RDS 表现的诊断分类统计数据，包括多个 TOMMe10 切割分数的灵敏度、特异性、接收者操作特征（ROC）以及阳性和阴性预测值。
当预测 TOMM 时，TOMMe10 的切割分数为≥2 个错误时，灵敏度最高（0.88），同时特异性保持≥0.90（ROC 分析也支持）。当根据 PVT 组合进行验证时（例如，TOMM、WMT 和 RDS 中的两个；WMT 和/或 RDS），该切割分数也是最佳的。
TOMMe10 显示出在预测未来 TOMM 表现方面的巨大潜力。在与患者相处时间紧张的情况下，TOMMe10 上的≥2 个错误可作为早期停止 TOMM 的标准，使检查者能够更有效地利用有限的时间。讨论了在 TOMM 失败基础率不同的情况下使用 TOMMe10 的问题。
