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Advanced Neurology PVT in Indonesian neurological patients

Our results for the LDF-1 and LDF-2 also indicated the about the applicability of the TMJPI for individuals with
need to lower the cut-off scores derived from the previous severe cognitive impairment. A previous study reported a
simulation study. The ND group required lower adjusted specificity rate of 0.10 on the ASTM for participants with
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cut-off scores than the other two groups. Again, our cut- Alzheimer’s disease using a cut-off score of <84 or <85. In
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off scores were lower than those used in previous studies a more recent study, 68% of patients with severe memory
(≤4 for LDF-1 and ≤3 for LDF-2), which found adequate impairment due to Korsakoff’s syndrome performed below
specificity (≥0.90) in mixed psychiatric and neurological the already lowered cut-off score of 82 on the ASTM.
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samples and a slight specificity decrease in a probable Other studies have reported a significant correlation
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Alzheimer’s disease sample (0.83 for LDF-1 and 0.87 for between the ASTM and working memory (as measured
LDF-2). We argue that the need to lower the cut-off scores by the digit backward trial), which is severely impaired in
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for the embedded validity measures of the DS may be due people with ND or dementia. Research has also shown
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to the lower educational attainment of our samples, which that working memory significantly predicts reading
we discuss in more detail later. comprehension in older adults. Impairment in working
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We hypothesized that the LDF-2 would be more memory among the major ND participants might hinder
appropriate as an embedded PVT than the RDS for their ability to comprehend the TMJPI stimuli. However,
participants with ND. First, the original cut-off score on the suggested cut-off score of <62 for the major ND and
the LDF-2 resulted in a higher specificity than that of the ND groups in our study is likely not practical for detecting
RDS (0.53 vs. 0.35). Second, the LDF-2 required only minor invalid performance, as this cut-off score is very low.
adjustments when applied to the mild ND group (from ≤3 For the NV-MSVT, previous studies have found that
to ≤2). A similar finding has been documented previously, the original cut-off score for the NV-MSVT suggests
where the LDF-2 also performed better than the RDS perfect specificity in people with dementia while achieving
and maintained adequate specificity in participants with a specificity of 0.98 in neurological participants without
moderate Alzheimer’s disease. One possible explanation dementia. 19,46 These results were not replicated in our study
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is that the RDS includes a backward trial that measures sample. To improve specificity, we first adjusted Criterion
working memory, which may be more sensitive to severe A1, followed by adjustments to the B criteria, with different
memory impairment. 33,56 However, further research is modifications applied to each clinical group. Criterion A1
needed to support this hypothesis. required adjustment, but Criterion A2 did not, as Criterion
The TMJPI cut-off score derived from the previous A1 includes the PA subtest, which is considered more
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simulation study (<89) resulted in extremely low specificity difficult for clinical patients. Surprisingly, only a minor
rates across all clinical groups. This was not surprising, as adjustment was needed for the B criteria in the major ND
the original ASTM on which the TMJPI is based suggests group (adjusting Criterion B3 from ≥12 to ≥13), while
a cut-off score of <85 or <86. The cut-off score obtained most adjustments were required in the mixed-etiology
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from the mixed-etiology group (i.e., <84) was comparable group. This finding supports Green’s concept of the
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to those reported in studies involving MS patients, where “genuine memory impairment profile,” which is specific
cut-off scores around <85 or <83 were observed. 11,57 to individuals with severe cognitive impairment. We
Furthermore, we did not expect that the PS group (<78) suspect that the need for more adjustments to the B criteria
would require a slightly lower cut-off score than the mild in the mixed-etiology group was due to the heterogeneity
ND group (<79), as the mean MMSE score suggested that of the clinical diagnoses in this group.
the mild ND group was more cognitively impaired than In general, except for the TMJPI in the major ND and
the PS group. However, seven PS participants (16.7%) total ND groups, the PVTs examined in our study can be
scored between 18 and 27 on the MMSE and below 83 in validly applied within our clinical groups, provided that
TMJPI, indicating that some patients with PS may have had the cut-off scores are adjusted. However, our cut-off scores
mild-to-moderate cognitive impairment. Given the high were lower than those reported in previous studies from
language demands of the TMJPI, we hypothesize that the United States, the United Kingdom, the Netherlands,
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these participants with PS may have had residual language and Germany. In addition to the severity of cognitive
deficits. Unfortunately, we lack more detailed diagnostic impairment, we suspect that these differences may be due
information on other cognitive domains. Therefore, this to educational and/or cross-cultural factors. First, most
hypothesis deserves further investigation. previous studies included clinical participants with an
The TMJPI resulted in very low specificity for the average of 12 years of education, 9,11,12,18,21,46,51,52,57,60 which is
major ND group, which ultimately affected the specificity equivalent to secondary education or higher. In contrast,
of the ND group as a whole. This finding raises concerns most of our participants had secondary education or less.

Volume 4 Issue 2 (2025) 94 doi: 10.36922/an.5661