Abstracts from the 19th Annual Meeting
743
provide some rationale and support for the use of symptom validity tests employing trivial memory tasks in compensation-related evaluations involving chronic pain complaints.
Allen, L. M. III, Green, P., & Elmer, B. N.
The Effect of Pain on Neurocognitive Measures in Patients Demonstrating Good Effort, Part
II." Data on Measures of Psychopathology and Commonly Used Neuropsychological Tests.
High levels of reported pain are frequently found in patients undergoing neuropsychological evaluation. The effect of concurrently self-reported pain on neurocognitive function in patients demonstrating good effort has not been well-studied. Parallel work has
shown that measures of verbal learning and memory are unrelated to self-reported pain
symptoms. We hypothesized that higher acute pain levels would be associated with high
levels of psychological distress and decreased performance on selected neuropsychological measures. From a pool of 658 patients referred for compensation-related neuropsychological evaluations, 409 patients (62%) who passed CARB and the WMT effort tests
comprised our initial population of genuine patients. "Current" pain was assessed at
testing using a 0-5 scale, with zero signifying "totally absent" and five signifying "worst
imaginable pain." The no current pain (NP) group contained 103 patients who rated
their pain as 0, while the high current pain (HP) group contained 62 patients who rated
their pain as 4 or 5 during testing. Another two chronic pain groups were independently
drawn from this population using Multidimensional Pain Inventory Pain Severity Index
(MPI-PSI) T scores. Forty patients scoring in the lowest quartile constituted the low
chronic pain group (LCP), and 43 patients who scored in the highest quartile made up
the high chronic pain group (HCP). Preliminary analyses found some population differences related to each method of defining pain, and the differentiating variables were
subsequently employed as covariates. CARB and WMT exaggeration measures were
completely unrelated to any independent, dependent or population variables. A
MANOVA was run to compare the LP and HP groups on WCST total categories and
perseveration errors, Category Test errors, Rey Complex Figure score, and digits forward and backwards. This model failed to reach significance (p = .68). Nonsignificant
results were also obtained for these variables in a MANOVA comparing LCP and HCP
groups (p = .54). In contrast, MANOVA comparisons of the NP and HP groups on the
MMPI-2 and the SCL-90 were both significant (p < .001 for each). A MANOVA that
compared the LCP and HCP groups on the MMPI-2 did not reach overall significance,
although a MANOVA comparing the chronic pain groups on the SCL-90 was significant
(p < .001), with 5 out of 12 scales elevated in the HCP group. High reported pain levels
are clearly associated with marked reported psychological distress. However, neither
method of quantifying high pain levels was found to impact cognitive ability. Similar
negative results were reported elsewhere for the same pain groups on several measures
of verbal learning and memory. Although we statistically controlled for pre-existing
population differences, these results suggest that pain does not significantly impact measures of cognitive ability when the effects of symptom exaggeration are removed.
Green, P., Allen, L. M. III, & lverson, G. L.
Utility of the Memory Complaints Inventory for Identifying Symptom Exaggeration in
Mild to Moderate Traumatic Brain Injury.
The Memory Complaints Inventory (MCI) is a 58-item self-administered computerized
questionnaire designed to quantify self-reported difficulties with memory. The MCI has
nine scales designed to measure different aspects of perceived memory problems (a total
score is also compared). Participants were 153 patients undergoing compensation-related
neuropsychological evaluation with mild to moderate traumatic brain injury (TBI). The
744
Abstracts from the 19th Annual Meeting
sample was 75% male, had an average age of 40.4 years (SD = 12.8), 11.8 years of education (SD = 2.96), and 95% were right handed. The sample incidence of positive CT or
M R I findings was 39%, average Glasgow Coma Score (GCS) was 14.6 (SD = 1.2), average duration of loss of consciousness (LOC) was 2.1 hours (SD = 15.2), and average
other-verified duration of post traumatic amnesia (PTA) was 10.2 hours (SD = 47.18).
Median values for GCS, LOC, and P T A indicated that the sample was predominantly
composed of patients with mild TBI. Two subgroups were studied. The Genuine group
was composed of 84 TBI patients who passed both the Computerized Assessment of Response Bias (CARB) and the exaggeration measures of the Word Memory Test (WMT),
two well-validated symptom validity tests in which patients with severe TBI and neurological disorders routinely obtain near perfect scores. The Exaggerating group was comprised of 69 TBI patients who failed either C A R B or the WMT. The two groups did not
differ in gender, handedness, years of education, or the incidence of English as a second
language, but Genuine patients were slightly younger than the Exaggerating patients
(38.3 versus 43.1 years; p = .02). There were no significant differences between the
groups on any of the injury severity variables (p > .14 for all). A M A N O V A with age as
a covariate was conducted to compare Genuine patients with Exaggerators on all nine
MCI Scales. A significant overall model was produced, Hotellings T(1,150), F = 4.50,
p < .001, with a small associated overall effect size (g = .22). Univariate comparisons
(i.e., t tests) with Bonferonni corrections revealed that all MCI scales were significantly
elevated in the Exaggerating group (p < .008 for all). The MCI provides a comprehensive review of reported memory difficulties and, in the present study, scores were differentially elevated in litigants who were suspected of biased responding.
Gontkovsky, S. T., & Souheaver, G. T.
Malingering: When Are Brain Damaged Patients Inappropriately Labeled Using the 21
Item Test and the WMS-R Logical Memory Forced-Choice Recognition Test?
Clinical neuropsychologists are often confronted with evaluating patients in disability,
forensic, or competency proceedings. Under such conditions, patients' presentations
may be prejudiced by the prospect of beneficial gain and/or avoidance of adverse consequences. It is therefore necessary to include in the test battery, objective measures that
are useful in judging whether a deliberate exaggeration of deficiencies by the patient has
occurred. Recently developed tests for such purposes include the 21 Item Test (Iverson,
1998) and the Forced-Choice Recognition Test for WMS-R Logical Memory (FCT-LM)
(Denney, 1999). The 21 Item Test requires the subject to freely recall as many words as
possible from a 21-item list prior to exposure to a forced-choice condition in which he or
she is provided a list of 21 word pairs. Each pair is comprised of one word from the original list and one foil. Interpretation may be based on binomial probabilities, inconsistencies in performance, or rare levels of performance. Similar to the 21 Item Test, the FCTLM is based upon the symptom validity paradigm and adds a forced-choice component
to the WMS-R Logical Memory task. Again, the subject is required to choose between
the correct response from the story and a foil. In both cases, determination of biased responding is based upon established guidelines. The present study examined the performance of individuals with documented and suspected cerebral dysfunction on these
measures and compared the relationship between the two tests in classifying biased responding/malingering in these populations. Subjects (n = 40) were selected from patients at a large V A medical center who were seen for neuropsychological evaluation.
Eighteen patients (mean age = 55.22 years, SD = 14.76; mean education = 11.22 years,
SD = 2.69) were classified as brain-damaged based on independent neurological and/or
neuroradiological examination. The remaining 22 (mean age = 53 years, SD = 14.05;