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Who is Exaggerating Cognitive Impairment and Who is Not?

Published online by Cambridge University Press:  07 November 2014

Martin L. Rohling ,
Lyle M. Allen III  and
Paul Green
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Abstract

This chart review examined the effects of effort on neuropsychological assessment and test performance patterns among genuine and exaggerating patients, with and without neurological findings, as aids to diagnosing symptom exaggeration. The sample consisted of 561 consecutive patients involved in compensation claims. With a flexible neuropsychological test (NPT) battery, the claims were assessed over 2 days. The sample included 303 patients evaluated for traumatic brain injury, 55 patients with neurological disease, and 203 patients assessed for other conditions (eg, depression or chronic pain). An average of 38 ability measures per patient were used to generate an overall NPT domain score. Composite scores were also computed for symptom validity tests, self-report measures of psychiatric symptoms, and memory complaint inventory. Seven NPT cognitive subdomain scores were multiply regressed onto the symptom validity test composite, accounting for 45% of its total variance. Patients were also assigned to Genuine or Exaggerator groups based on symptom validity test performance. The NPT for Exaggerating patients averaged 1.43 standard deviations below that of Genuine patients, suggesting that NPT scores for most Exaggerating patients are underestimates of their true ability. Factor analysis results differed between these groups. As a result, clinicians might avoid falsely identifying genuine patients as exaggerating by incorporating their self-reports of psychiatric symptoms and memory complaints into the diagnostic process.

Type
Original Research
Information
CNS Spectrums , Volume 7 , Issue 5 , May 2002 , pp. 387 - 395
Copyright
Copyright © Cambridge University Press 2002

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References

REFERENCES

1.Iverson, GL, Binder, LM. Detecting exaggeration and malingering in neuropsychological assessment. J Head Trauma Rehab. 2000;15:829–858.CrossRefGoogle ScholarPubMed
2.Faust, D, Hart, K, Guilmette, TJ, et al.Neuropsychologists' capacity to detect adolescent malingering. Prof Psychol Res Practice. 1988;19:508–515.CrossRefGoogle Scholar
3.Sweet, JJ. Malingering: differential diagnosis. In: Sweet, JJ, ed. Forensic Neuropsychology Fundamentals and Practice. Lisse, Switzerland: Swets and Zeitlinger; 1999.Google Scholar
4.Rohling, ML, Langhinrichsen-Rohling, J, Miller, LS. Actuarial assessment of malinger: The RIM Process. In: Franklin, R, ed. Prediction in Forensic and Neuropsychology. Mahwah, NJ: Lawrence Erlbaum Associates; 2002.Google Scholar
5.Binder, LM. Assessment of malingering after mild head trauma with the Portland Digit Recognition Test. J Clin Exp Neuropsych. 1993;15:170–182.CrossRefGoogle ScholarPubMed
6.Larrabee, GJ. Neuropsychology in personal injury litigation. J Clin Exp Neuropsych. 2000;22:702–707.CrossRefGoogle Scholar
7.Mittenberg, W, Patton, C, Canyock, EM, et al.A national survey of symptom exaggeration and malingering base rates. J Int Neuropsych Soc. 2002;8.Google Scholar
8.Schmand, B, Lindeboom, J, Schagen, S. et al.Cognitive complaints in patients with whiplash injury: the impact of malingering. J Neurol Neurosurg Psychiatry. 1998;64:339–343.CrossRefGoogle ScholarPubMed
9.Van der Werf, SP, Prins, JB, Jongen, PJ. et al.Abnormal neuropsychological findings are not necessarily a sign of cerebral impairment: A matched comparison between chronic fatigue syndrome and multiple sclerosis. Neuropsychiatry Neuropsychol Beh Neurol. 2000;13:199–203.Google Scholar
10.Gervais, R, Russell, AS, Green, P. et al.Effort testing in patients with fibromyalgia and disability Incentives. J Rheum. 2000;28:1892–1899.Google Scholar
11.Allen, LM, Green, P, Eimer, BM. The effect of pain on neurocognitive measures in patients demonstrating good effort. Part I: Data on objective and self-reported assessments of memory ability. Arch Clin Neuropsych. 1999;15:742–743.CrossRefGoogle Scholar
12.Green, P, Rohling, ML, Lees-Haley, PR, et al.Effort has a greater effect on test scores than severe brain injury in compensation claimants. Brain Injury, 2001;15:1045–1060.CrossRefGoogle Scholar
13.Miller, LS, Rohling, ML. A statistical interpretative method for neuropsychological test data. Neuropsych Rev. 2001;11:143–169.CrossRefGoogle ScholarPubMed
14.Heaton, RK, Gladsjo, JA, Palmer, BW, et al.Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry, 2001;58:24–32.CrossRefGoogle ScholarPubMed
15.Green, P, Allen, LM, Astner, K. The Word Memory Test: A User's Guide to the Oral and Computer-Administered Forms. US Version 1.1. Durham, NC: CogniSyst; 1996.Google Scholar
16.Allen, LM, Green, P. Severe TBI Sample Performance on CARB and the WMT: Supplement to the CARB '97 and Word Memory Test Manuals. Durham, NC: CogniSyst; 1999.Google Scholar
17.Allen, LM, Conder, RL, Green, P, et al.CARB' 97 Manual for the Computer Assessment of Response Bias. Durham, NC: CogniSyst; 1997.Google Scholar
18.Green, P, Allen, LM. The Memory Complaints Inventory. Durham, NC: CogniSyst: 1995.Google Scholar
19.Allen, LM, Richards, PM, Green, P, et al.Performance patterns on the computerized assessment of response bias in 1752 compensation cases. Arch Clin Neuropsych. 1997;13:15–16.CrossRefGoogle Scholar