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Advanced Neurology PVT in Indonesian neurological patients

In fact, nearly half of the ND group had completed only Our study has several limitations. Most of the
the lower level of secondary school (9 years of education) participants in our ND group had not received a formal
or less, which is common among older adults in Indonesia. diagnosis based on a comprehensive diagnostic workup
Second, the results of our correlational analyses suggest by a neurologist. Our sample included participants from
that lower educational levels are associated with lower nursing homes and a halfway house for elderly transgender
PVT scores. Despite this demographic difference, our people. Furthermore, in Indonesia, many older people
study demonstrates that the specificity of the PVTs for use with severe cognitive impairment do not consult medical
in Indonesia (a developing lower-middle-income country) professionals, resulting in a lack of formal diagnoses for
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and in clinical samples with low to moderate levels of those with probable dementia or ND. Despite this,
education is adequate. we consider the participants in our ND group to be
cognitively impaired, based on their low MMSE scores
Only two participants with ND (Participants 32 and
87) failed at least two PVTs, even though their MMSE and the everyday cognitive problems observed by nursing
home staff and the head of the halfway house. In addition,
scores were not very low (25 and 26), and no participant the distinction between mild and major ND was based on
with major ND failed at least two PVTs. One participant MMSE scores (i.e., ≤26 and ≤21, respectively). Although
from the PS group failed the TMJPI and the NV-MSVT. the MMSE has faced criticism from a psychometric
This participant complained that the tests were “long and perspective, it is extensively used for cognitive screening
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monotonous.” We also observed that this patient appeared in Indonesia. Future research in neurological samples
tired during these two tests, which were administered at the using PVTs should incorporate more comprehensive
end of the session. Based on these observations, we argue neuropsychological assessments. Another limitation of
that this participant should be classified as a true positive. our study is the lack of information on dementia subtypes,
Finally, one participant from the mixed-etiology group which is likely to explain variation in PVT scores. 64
failed both the RDS and the TMJPI. This participant’s
primary diagnosis was brain tumor-related epilepsy (focal The mixed-etiology group in this study consisted
onset with impaired awareness), with PS as a comorbidity. of participants with heterogeneous diagnoses, some
This woman was cooperative and enthusiastic and seemed of whom had comorbid disorders. Given that each
to exert her best effort in completing the tests. We suspect neurological disorder or disease results in different
that her failure on the PVTs was due to her severe clinical cognitive symptoms, 18,55,65 this could ultimately affect the
condition, which likely reflects a false-positive outcome. PVT cut-off scores as well. 13,55 Future should replicate our
findings in prospective research using Indonesian samples
The intercorrelation between the RDS, LDF-1, and with formal diagnoses (e.g., based on the Diagnostic and
LDF-2 was high, which is not surprising, given that these Statistical Manual of Mental Disorders, Fifth Edition,
tests were derived from a single test, the DS. Similarly, the Text Revision criteria). Finally, this study examined the
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A1 and A2 criteria of the NV-MSVT were highly correlated, specificity of multiple PVTs only in a mixed neurological
as the calculation of both criteria incorporates DR, CNS, sample of participants who were assumed to be making
DRA, and DRV. Furthermore, the other intercorrelations their best effort. While lowering the PVT cut-off scores
between PVTs were modest, indicating no redundancy compared to those from our previous study improved the
between tests. The modest intercorrelation between PVTs specificity, it inevitably impacted the sensitivity of the tests
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found in our study thus supports their convergent validity. for detecting invalid performance. Therefore, it is crucial
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The MMSE scores in our study were most strongly to investigate the sensitivity of our adjusted cut-off scores
associated with PVT scores compared to the demographic in future research.
variables. This finding supports the evidence that more
severe cognitive impairment is associated with lower PVT 5. Conclusion
scores. 21,52 It is also important to note that in our sample, This study validated several PVTs, specifically their
age and level of education were modestly associated with specificity rates, within an Indonesian mixed neurological
PVT scores. These findings suggest that clinicians should sample. The cut-off scores from the previous simulation
exercise caution when administering PVTs to older study resulted in unacceptably low specificity rates in
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patients with severe cognitive impairment (e.g., ND or our clinical sample. As a result, the cut-off scores were
dementia) and low levels of education, as they are more adjusted. In general, more adjustments were required for
likely to be classified as false positives. Therefore, low the groups with the most severe cognitive impairment
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PVT scores from individuals with this demographic and (i.e., the ND group). For individuals with severe cognitive
clinical background should not be immediately interpreted impairment, using the LDF-1 or LDF-2 as embedded
as invalid performance. validity measures of the DS was preferred over the RDS,

Volume 4 Issue 2 (2025) 95 doi: 10.36922/an.5661