Cross-validation of the Trail Making Test as a non-memory-based embedded performance validity test among veterans...

Area of Science:

• Neuropsychology
• Cognitive Assessment
• Performance Validity Testing

Background:

• Neuropsychological evaluations are crucial for diagnosing cognitive impairments.
• Performance Validity Tests (PVTs) are essential to ensure the accuracy of assessment results.
• The Trail Making Test (TMT) Parts A and B are commonly used in cognitive assessments.

Purpose of the Study:

• To cross-validate TMT Parts A and B scores as embedded PVTs.
• To detect invalid neuropsychological performance in veterans with and without cognitive impairment.
• To assess the utility of TMT-derived PVTs in diverse veteran populations.

Main Methods:

• 100 veterans undergoing outpatient neuropsychological evaluation were studied.
• TMT Parts A and B were administered alongside four criterion PVTs.
• Veterans were classified into valid (n=75) and invalid (n=25) performance groups.

Main Results:

• TMT-derived PVTs significantly differentiated validity groups in the overall sample (AUCs=.72-.78).
• TMT scores showed high accuracy (AUCs=.80-.88) for veterans without cognitive impairment.
• TMT embedded PVTs demonstrated poor accuracy and low sensitivity in veterans with cognitive impairment.

Conclusions:

• TMT Parts A and B serve as effective embedded PVTs for veterans without cognitive impairment.
• Demographically corrected TMT scores were more robust than raw scores.
• TMT embedded PVTs have limited utility for detecting invalid performance in veterans with cognitive dysfunction.