RBANS Validity Measures and the TOMM in Veterans Undergoing Seizure Monitoring

Area of Science:

• Neuropsychology
• Clinical Neurology
• Psychiatry

Background:

• Assessing performance validity is crucial in neuropsychological evaluations, especially in clinical populations like Veterans with seizures.
• The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) includes embedded measures, the effort index (EI) and effort scale (ES), to assess performance validity.
• The Test of Memory Malingering (TOMM) is a common tool for detecting invalid performance.

Purpose of the Study:

• To evaluate the validity of the RBANS EI and ES as measures of performance validity in Veterans with seizures.
• To compare the rates of invalid performance on the TOMM between patients with epileptic seizures and psychogenic nonepileptic seizures (PNES).

Main Methods:

• 309 participants in epilepsy monitoring units with diagnosed seizures completed both the TOMM and RBANS.
• Performance invalidity was defined by failure on any trial of the TOMM.
• Various cutoffs for the RBANS EI and ES were analyzed to determine optimal sensitivity and specificity.

Main Results:

• An RBANS EI cutoff score greater than three demonstrated high specificity (.98) but low sensitivity (.19), suggesting its utility as a positive screen requiring confirmation.
• No specific cutoff for the RBANS ES demonstrated sufficient specificity for clinical application.
• Invalid performance on the TOMM was significantly more prevalent in individuals with PNES compared to those with epileptic seizures.

Conclusions:

• The RBANS EI can serve as a useful initial screen for performance invalidity in Veterans undergoing seizure monitoring, provided positive results are confirmed with another performance validity test (PVT).
• The RBANS ES was found to be not clinically useful due to insufficient specificity.
• Higher rates of invalid performance on the TOMM were observed in patients with PNES compared to those with epileptic seizures.