Department of Psychiatry, University of Illinois College of Medicine , Chicago, IL, USA.
Department of Psychology, Rosalind Franklin University of Medicine and Science , North Chicago, IL, USA.
J Clin Exp Neuropsychol. 2020 Jul;42(5):473-484. doi: 10.1080/13803395.2020.1758635. Epub 2020 Jun 4.
Validity indicators embedded within standard neuropsychological tests have received increasing attention as more efficient measures for sampling performance validity throughout an evaluation. This cross-sectional study examined multiple performance validity tests (PVTs) embedded in the Wechsler Adult Intelligence Scale-IV (WAIS-IV) Working Memory (WMI) and Processing Speed (PSI) Indices for detecting invalid test performance.
This cross-sectional study examined data from a mixed clinical neuropsychiatric sample of 110 patients referred for outpatient evaluation. The sample was composed of 85 patients with valid neuropsychological performance and 25 with invalid performance based on multiple independent criterion PVTs. Among the patients with valid performance, 54% were cognitively impaired, whereas 46% were cognitively unimpaired.
Among the overall sample, performance on WMI, PSI, and 3/4 constituent subtests (i.e., Digit Span, Symbol Search, Coding) was significantly worse among the invalid group compared to the valid group (.06-.16) with areas under the curve (AUCs) of.67-.76 and 24-32% sensitivity (≥88% specificity) for identifying invalid performance at cut-scores that maximized accuracy. When the sample was subdivided by cognitive impairment status, AUCs of.68-.87 and 36-56% sensitivity (≥87% specificity) for detecting invalidity at cut-scores that maximized accuracy were found among those without cognitive impairment. In contrast, for patients with cognitive impairment, Digit Span, Arithmetic, WMI, and Coding were nonsignificant, and AUCs of.66-.67. Further, notably reduced sensitivities of 16-28% (≥91% specificity) were found for the remaining significant indices.
Overall, results indicated that embedded WAIS-IV WMI and PSI are useful embedded PVTs in conditions in which cognitive impairment is not expected; however, these embedded PVTs demonstrated questionable utility among patients with cognitive impairment due to poor sensitivity, if adequate specificity is maintained, suggesting limited efficacy among patients with cognitive impairment due to risk of false-positive classification.
随着在评估过程中更有效地采样表现有效性，嵌入在标准神经心理学测试中的有效性指标受到越来越多的关注。这项横断面研究检查了韦氏成人智力量表-IV（WAIS-IV）工作记忆（WMI）和处理速度（PSI）指数中嵌入的多个表现有效性测试（PVT），以检测无效的测试表现。
这项横断面研究检查了来自混合临床神经精神病学样本的 110 名门诊评估患者的数据。该样本由 85 名表现有效和 25 名表现无效的患者组成，这是基于多个独立的独立 PVT 确定的。在表现有效的患者中，54%的患者存在认知障碍，而 46%的患者不存在认知障碍。
在总体样本中，与表现有效的组相比，无效组的 WMI、PSI 和 3/4 个组成分测验（即数字跨度、符号搜索、编码）的表现明显更差（.06-.16），曲线下面积（AUC）为.67-.76，在最佳准确性的切割分数下，识别无效表现的敏感性为 24-32%（特异性≥88%）。当按认知障碍状态细分样本时，在最佳准确性的切割分数下，发现无认知障碍患者的 AUC 为.68-.87 和 36-56%的敏感性（特异性≥87%）。相比之下，对于有认知障碍的患者，数字跨度、算术、WMI 和编码则不显著，AUC 为.66-.67。此外，对于其余显著指数，发现敏感性显著降低，为 16-28%（特异性≥91%）。
总体而言，结果表明，嵌入的 WAIS-IV WMI 和 PSI 在预期没有认知障碍的情况下是有用的嵌入式 PVT；然而，由于敏感性差，对于有认知障碍的患者，这些嵌入式 PVT 的实用性存在问题，如果保持足够的特异性，则表明由于错误分类的风险，对于有认知障碍的患者，疗效有限。
