a California School of Forensic Studies, Alliant International University , Los Angeles , CA , USA.
b Mental Health Care Line, Veterans Administration Tennessee Valley Healthcare System , Nashville , TN , USA.
Clin Neuropsychol. 2018 Aug;32(6):1054-1067. doi: 10.1080/13854046.2018.1425481. Epub 2018 Jan 18.
To cross-validate the Dot Counting Test in a large neuropsychological sample.
Dot Counting Test scores were compared in credible (n = 142) and non-credible (n = 335) neuropsychology referrals.
Non-credible patients scored significantly higher than credible patients on all Dot Counting Test scores. While the original E-score cut-off of ≥17 achieved excellent specificity (96.5%), it was associated with mediocre sensitivity (52.8%). However, the cut-off could be substantially lowered to ≥13.80, while still maintaining adequate specificity (≥90%), and raising sensitivity to 70.0%. Examination of non-credible subgroups revealed that Dot Counting Test sensitivity in feigned mild traumatic brain injury (mTBI) was 55.8%, whereas sensitivity was 90.6% in patients with non-credible cognitive dysfunction in the context of claimed psychosis, and 81.0% in patients with non-credible cognitive performance in depression or severe TBI. Thus, the Dot Counting Test may have a particular role in detection of non-credible cognitive symptoms in claimed psychiatric disorders. Alternative to use of the E-score, failure on ≥1 cut-offs applied to individual Dot Counting Test scores (≥6.0″ for mean grouped dot counting time, ≥10.0″ for mean ungrouped dot counting time, and ≥4 errors), occurred in 11.3% of the credible sample, while nearly two-thirds (63.6%) of the non-credible sample failed one of more of these cut-offs.
An E-score cut-off of 13.80, or failure on ≥1 individual score cut-offs, resulted in few false positive identifications in credible patients, and achieved high sensitivity (64.0-70.0%), and therefore appear appropriate for use in identifying neurocognitive performance invalidity.
在大型神经心理学样本中对点数计数测试进行交叉验证。
比较可信（n=142）和不可信（n=335）神经心理学转诊患者的点数计数测试得分。
不可信患者在所有点数计数测试得分上的得分均显著高于可信患者。虽然原始 E 分数截断值≥17 具有出色的特异性（96.5%），但它的敏感性仅为 52.8%。然而，截断值可大幅降低至≥13.80，同时仍保持足够的特异性（≥90%），并将敏感性提高至 70.0%。对不可信亚组的检查表明，点数计数测试在伪装的轻度创伤性脑损伤（mTBI）中的敏感性为 55.8%，而在声称患有精神病的患者中认知功能障碍不可信的情况下，敏感性为 90.6%，在抑郁症或严重 TBI 中认知表现不可信的患者中，敏感性为 81.0%。因此，点数计数测试可能在检测声称的精神障碍中不可信的认知症状方面具有特殊作用。替代使用 E 分数，在个体点数计数测试得分上达到≥1 个截止值（平均分组点数计数时间≥6.0″，平均未分组点数计数时间≥10.0″，以及≥4 个错误），在可信样本中占 11.3%，而近三分之二（63.6%）的不可信样本未能达到这些截止值中的一个或多个。
E 分数截断值为 13.80，或在≥1 个个体得分截止值上失败，在可信患者中导致很少的假阳性识别，并且具有高敏感性（64.0-70.0%），因此适用于识别神经认知表现无效性。
