Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine -Wichita, Wichita, KS, USA.
University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
Clin Neuropsychol. 2020 Jan;34(1):88-119. doi: 10.1080/13854046.2019.1637027. Epub 2019 Jul 30.
The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention. Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models. For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59-0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96-0.98) and moderately sensitive (0.46-0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59-0.70) while maintaining adequate specificity (0.91-0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia. The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.
本研究遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，是对记忆测验 (TOMM) 的首次系统评价和荟萃分析，旨在检查传统和替代的截断值，包括试验 1、试验 2 和保留。搜索标准确定了 1997 年至 2017 年期间发表的 539 篇文章。在应用选择标准后，有 60 篇文章被保留进行荟萃分析。使用固定效应和随机效应模型计算分类准确性统计数据。对于试验 1，当保持特异性≥0.90 时，发现截断值<42 可获得最高的敏感性值（0.59-0.70）。考虑到所有可用的研究和仅通过已知组设计分类的神经认知/精神病样本，传统的试验 2 和保留的截断值具有高度特异性（0.96-0.98）和中度敏感性（0.46-0.56）。对于两个试验，当考虑到所有可用的研究和仅通过已知组设计分类的神经认知/精神病样本时，修改后的截断值<49 可以提高敏感性（0.59-0.70），同时保持足够的特异性（0.91-0.97）。补充审查显示，对于大多数不以英语为主要语言的受检者，传统的 TOMM 截断值具有>0.90 的特异性，但在痴呆患者中则远低于可接受的水平。当按照传统的截断值解释时，TOMM 具有高度的特异性。在未被怀疑有明显损伤的个体中，研究结果表明，对于那些与较高的无效性发生率相关的环境，不太保守的 TOMM 试验 2 或保留的截断值<49 可以被解释为无效，尤其是在与较高的阳性预测值相关的环境中。在大多数情况下，TOMM 试验 1 的截断值<42 也可以被解释为无效。
