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Evaluating Suboptimal Performance in Compensation-Seeking Patients: Methodologies and Mood Impact

This study investigates suboptimal performance in compensation-seeking patients using the California Verbal Learning Test (CVLT) and Word Memory Test (WMT). Key questions explore whether these tests identify the same individuals as exerting suboptimal effort, and how groups differ on neurocognitive abilities and self-reported memory. Additionally, a second study correlates depressive symptoms with cognitive scores in optimally performing patients, aiming to understand the effect of mood on memory complaints. Findings reveal significant differences in identified patients based on test methodology and the influence of mood on cognitive performance.

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Evaluating Suboptimal Performance in Compensation-Seeking Patients: Methodologies and Mood Impact

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  1. Suboptimal Performance:When Do Methods & Mood Matter? Martin L. Rohling, Ph.D. University of South Alabama

  2. Definition of “Education” “Education is the process of going from cocksure ignorance to thoughtful uncertainty” (Source Unknown)

  3. Study 1: Reference Rohling, M. L., Green, P., Allen, L. M., & Williamson, D. J. (2000). Comparisons between a Logistic Regression Formula for the CVLT and the Word Memory Test as Indicators of Suboptimal Performance in a Sample of Litigants. Poster presented at the 20th annual convention of NAN in Orlando, FL.

  4. California Verbal Learning Test • Original version of verbal learning and memory task (Delis et al., 1987) • 16-item list learning task • dependent measures used • immediate FR • 20 min. DFR • recognition memory • Sensitive to neurological disease (e.g., Delis et al., 1991, Deweer et al., 1994), age (Kausler, 1994), and gender (Wiens et al., 1994)

  5. Study 1: Specific Questions • Within a compensation-seeking sample • Do the WMT and the CVLT-Logit Formula of Millis (1999) identify the same patients as exerting suboptimal effort? • If not, how do the identified groups differ on • Tests of neurocognitive abilities • Self-report of memory functioning • Other tests that have been cross-validated and found to be sensitive to suboptimal effort

  6. Study 1: Participants • 794 patients referred for evaluation for compensation-related purposes • All diagnostic groups included • 53% Head injury referral • 27% Medical referrals • 12% Psychiatric referrals • 8% Other neurological • Age = 42 (11); Education = 12 (4); Sex = 63% males; Non-Native English = 14%; Handedness = 9% Left

  7. Study 1: Effort Groups • WMT: Invalid if any of the 3 criteria violated • IR < 82.5% • DR < 82.5% • CON1 < 75% • CVLT-Logit Formula: Invalid if the Logistic equation, (e^g) / [1 + (e^g)], is less than .50 • the constant g is defined as follows: g = 8.41 + (SDFR * .56) - (LDFR * .52) - (RG Hits * .72)

  8. 523 (66%) 59 (7%) 112 (14%) 100 (13%) Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating OVERALL SAMPLE CVLT Genuine Exaggerating WMT 582 (73%) Genuine Exaggerating 212 (27%) 635 (80%) 159 (20%)

  9. Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating • Relative to the WMT: • CVLT identified 25% fewer exaggerators • CVLT identified 9% more genuine patients • 79% overall agreement • However, for patients identified by one or the other method (n = 271) • methods agreed just 37% of the time

  10. Study 1: Patients Identified as Exaggerating Differed by Method Demographic Differences Relative to WMT-poor effort group: • CVLT-Logit group was older • CVLT-Logit group less educated • CVLT-Logit group had more patients whose 1st language was not English

  11. Graphic’s Abbreviations G-W Genuine WMT - ABOVE cut score G-C Genuine CVLT - ABOVE cut score E-W Exaggerated WMT - BELOW cut score E-C Exaggerated CVLT - BELOW cut score Composite Summary Scores MCI Memory Complaints Inventory NPT Neuropsychological Tests EPT Emotional & Personality Tests

  12. Differences on Summary Measures

  13. Examples on Specific NPTs

  14. Gervais’ & Green’s SamplesSummary Measure Similarities

  15. Green’s & Gervais’ Samples

  16. Study 1: Conclusions • Measures identified different patients • Findings replicated in independent sample • Compared to the CVLT, the WMT groups had larger differences on • Measures sensitive to symptom exaggeration (i.e., RCFT, Warr-F) • Other validated SVTs (e.g., CARB) • Self-reports of memory & emotional functioning (i.e., MCI & MMPI-2)

  17. Study 1: Why Did Results Differ? • WMT less confounded by Age & Education • CVLT sensitive to cognitive impairment • works against it as a SVT • However, • CVLT congruence with WMT (79%) • CT algorithms (64% to 73%)

  18. Study 2: Reference Rohling, M. L., Green, P., Allen, L. M., & Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17, 205-222.

  19. Study 2: Specific Questions • Within an optimally performing compensation-seeking sample • Memory Complaints correlate with mood • Depressed mood impairs cognition • Memory Complaints unrelated to cognition

  20. Study 2: Depression Measures 3 measures of mood • Beck Depression Inventory • MMPI-2 Depression scale • r = .70 with BDI • SCL-90-R Depression scale • r = .74 with BDI • r = .63 MMPI-De

  21. Study 2: Mood Group Assignment • Patients classified into 2 subgroups • From entire sample, 420 passed all SVTs • Sample split based on BDI • Low-Depressed 25%ile on BDI (< 10) • n = 178, M = 6 (3) • High-Depressed 75%ile on BDI (> 25) • n = 187, M = 31 (6)

  22. Study 2: Participants • All 365 patients referred for evaluation for compensation-related purposes • All diagnostic groups included • 53% Head injury referrals • 22% Medical referrals • 14% Psychiatric referrals • 11% Other neurological • Age = 42 (11); Education = 13 (3); Sex = 64% males; Non-Native English = 18%; Handedness = 9% Left

  23. Study 2: ResultsMood & Validity Status SVT Status Genuine Exaggerating Mood BDI 175 (48%) Depress 75%ile 186 (52%) Non-Dep 25%ile 266 (74%) 95 (26%)

  24. EPT MCI OTBM EPT MCI OTBM EPT MCI OTBM 1.3 1.3 1.1 1.1 Low-Dep Low-Dep Low-Dep .9 .9 .7 .7 .5 .5 .3 .3 .1 .1 Z-scores -.1 -.1 -.3 -.3 -.5 -.5 -.7 -.7 -.9 -.9 -1.1 -1.1 High-Dep High-Dep High-Dep -1.3 -1.3 -1.5 -1.5 Total Sample Genuine Pts Exaggerating Pts Study 2: ResultsSample Split by Validity Status

  25. Study 2: Results Effect of Mood Depends on Effort • Exaggerating patients accounted for • 39% of High-Dep group • 14% of Low-Dep group • Mood & Effort used as IVs and Cognition DV • effect for Effort, no effect for Mood • However, when Memory Complaints DV • effects for both Effort and Mood • Also, when other Emotion/Personality DV • effects for both Effort and Mood

  26. Study 2: Answers to Specific Questions When both mood groups were included in regression analysis, as predicted • Memory ratings related to mood • (r = .60; p < .0001) • Mood not correlated with cognition • (r = .10; p > .10) • Memory ratings not related to cognition • (r = .13, p = .06)

  27. Study 2: Mood Replication Gervais’ pain sample findings (n = 177) • Exaggerating patients accounted for • 55% of High-Dep; 33% of Low-Dep group • Memory ratings related to mood (r = .55) • Mood not correlated with cognition (r = .06) • Memory ratings related to cognition (r = .15) • Group means correlated with Green’s .94 • all patient (High-D, Low-D, Gen, & Exag).

  28. Study 2: Conclusions • Memory complaints not synonymous with impairment in compensation seeking sample • Findings replicated • Effort accounts for more variance in self-ratings of cognition and objective performance than mood • Findings replicated

  29. Study 1 & 2: Summary • Ability test algorithms less effective for the assessment of effort than tests designed for this purpose • In a compensation-seeking sample • Mood not related to cognitive impairment • Mood is related to memory complaints • More variance accounted for by Effort than by Mood

  30. Genuine (n = 412) Exaggerating (n = 149) Dependent Domain Normal (n = 311) Neuro (n=101) Normal (n = 144) Neuro (n = 5) Neuropsychological Tests .33 (.62) .19 (.64) -.60a, b (.80) -.79a, b (.65) Symptom Validity Tests .51 (.38) .50 (.30) -1.25a, b (.94) -.50a, b, c (.52) Memory Complaints Inv. .14 (.93) .41a (.92) -.62a, b (.93) .49c (.54) Psychiatric Symptoms .10 (.95) .46a (.96) -.39a, b (.85) .19 (.99)

  31. Gen (n=412) Ex (n=149) ES Cognitive Domain M SD M SD t p (d) Neuropsych Ability .34 .75 -.86 1.01 15.3 .0001 1.43 Attention/Work Mem .29 .76 -.74 1.13 12.0 .0001 1.16 Visual Mem Learn .28 .85 -.72 .99 11.8 .0001 1.12 Perceptual Organ .27 .79 -.68 1.15 11.1 .0001 1.05 Auditory Mem Learn .23 .88 -.60 1.04 9.5 .0001 .89 Executive Function .23 .88 -.60 1.04 9.5 .0001 .89 Verbal Comprehen .18 .92 -.45 1.06 7.0 .0001 .65 Psychomotor Speed .17 .80 -.41 1.29 6.1 .0001 .60

  32. .5 .3 .1 -.1 Gen-Norm -.3 Gen-Neuro Cell Mean -.5 Exag-Norm Exag-Neuro -.7 -.9 -1.1 -1.3 -1.5 Neuropsych Ability Symptom Validity

  33. .5 .3 .1 -.1 Gen-Norm -.3 Gen-Neuro Cell Mean Exag-Norm -.5 Exag-Neuro -.7 -.9 -1.1 -1.3 -1.5 Memory Complaints Psychiatric Symptoms

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