The development of ACE-III performance validity tests for dementia screening

Area of Science:

• Neuropsychology
• Cognitive Science
• Gerontology

Background:

• Performance validity tests (PVTs) are crucial in neuropsychological evaluations.
• A need exists for brief, validated PVTs compatible with dementia screening tools.
• The Addenbrooke's Cognitive Examination-III (ACE-III) is a common cognitive screening assessment.

Purpose of the Study:

• To develop and evaluate brief PVTs integrated into the ACE-III.
• To assess the utility of these PVTs in a dementia clinic setting.
• To identify reliable measures for detecting invalid cognitive performance during screening.

Main Methods:

• A diagnostic accuracy study compared individuals with Alzheimer's disease dementia and healthy older adults simulating dementia.
• Participants completed the ACE-III, Test of Memory Malingering (TOMM), and five novel ACE-III-based PVTs.
• The novel PVTs included Object Recognition Test, Word Recognition Test, Dot Counting, ACE-III Digit Span, and Coin in the Box test.

Main Results:

• The TOMM Trial 2 showed high accuracy (AUC=0.92) but was difficult for individuals with moderate dementia to complete.
• The Combined Object Recognition Test (AUC=0.89) and ACE-III Digit Span (AUC=0.85) demonstrated high diagnostic accuracy.
• These ACE-III PVTs effectively differentiated genuine cognitive impairment from simulated impairment.

Conclusions:

• The Object Recognition Test and ACE-III Digit Span are potential candidates for integration into the ACE-III.
• Further research with known-group designs is needed before clinical recommendation.
• Consideration must be given to the administration of PVTs by non-neuropsychologists in screening contexts.