Evaluation of performance validity tests in a community sample: Rates of invalid performance for English and Spanish...

Objective: To evaluate rates of below cutoff performance (fail rates) for the Test of Memory Malingering Trial 1 (TOMM-1) and Reliable Digit Span (RDS) in a culturally and linguistically diverse community-based cognitive aging cohort. Methods: Cognitively and functionally normal adults from the Health and Aging Brain Study-Health Disparities (HABS-HD) cohort in the Dallas-Fort Worth area, free of major neurological, psychiatric, or cardiovascular conditions, were included. Fail rates were examined for TOMM-1 (≤41, ≤40) and RDS (≤6, ≤5) cutoffs, including combined thresholds, across demographic subgroups. Relative importance of sociodemographic variables was tested via regression. Results: In the normative sample, overall fail rates were higher for RDS (3.1-11.6%) than TOMM-1 (2.1-2.9%), with combined cutoffs yielding <1%. Higher fail rates occurred primarily among less educated (<12 years) and Spanish-speaking participants, with the highest among Spanish speakers on RDS (46.7%). Acceptable false-positive rates for the TOMM-1 (≤5.9%) and combined (≤3.2%) TOMM-1 and RDS were demonstrated across all evaluated groups. Language and education explained most variance in RDS scores (14.9%, 10.3%, respectively), while education and age explained most variance in TOMM-1 scores (2.3%, 1.4%, respectively). Demographic effects were more influential on RDS than on TOMM-1. Conclusions: Performance validity outcomes vary across community adults without external incentives, influenced by education and language.