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Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients
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Differentiating malingering from genuine cognitive dysfunction using the Trail Making Test-ratio and Stroop

Jens Egeland1, Tone Langfjaeran

  • 1Department of Research, Vestfold Mental Health Care Trust, Tønsberg, Norway. jens.egeland@piv.no

Applied Neuropsychology
|May 26, 2007
PubMed
Summary

Neuropsychological test performance can help identify malingering versus true impairment. A low Trail Making Test B:A ratio and inverted Stroop effect suggest malingering, while high ratios and specific Stroop interference indicate brain disease.

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Area of Science:

  • Neuropsychology
  • Forensic Psychology
  • Clinical Neuroscience

Background:

  • Differentiating malingering from genuine cognitive impairment is crucial in legal contexts.
  • Neuropsychological tests are often employed, but performance patterns can be ambiguous in low-scoring individuals.

Purpose of the Study:

  • To investigate the utility of the Trail Making Test B:A ratio and Stroop Interference in distinguishing between malingering and genuine impairment in litigants.
  • To assess the sensitivity and specificity of these measures for identifying malingering.

Main Methods:

  • Comparison of possible malingerers (n=41), impaired litigants (n=30), and cognitively normal litigants (n=17).
  • Analysis of Trail Making Test B:A ratio scores and Stroop Interference patterns.

Main Results:

  • A majority of suspected malingerers exhibited a low Trail Making Test B:A ratio (<2.5) and an inverted Stroop effect.
  • Impaired subjects predominantly showed a high Trail Making Test B:A ratio and specific Stroop interference.
  • Individual measure sensitivity ranged from 61-68% and specificity from 57-59%, deemed insufficient for individual classification.

Conclusions:

  • The combination of Trail Making Test B:A ratio and Stroop Interference enhances predictability in differentiating malingering.
  • Clinicians should seek corroborating evidence for malingering when a low Trail Making Test B:A ratio and inverted Stroop effect are observed simultaneously.
  • Patients with a high Trail Making Test B:A ratio and Stroop interference warrant thorough examination for potential brain disease.