Page 93 - AN-4-2

Advanced Neurology PVT in Indonesian neurological patients

1. Introduction Parkinson’s disease, or epilepsy) range from 0% to 20%,
whereas failure rates in patients with severe cognitive
Performance validity testing (PVT) is essential in impairments (e.g., dementia) may approach 100%. These
16
neuropsychological assessment, enabling clinicians rates vary depending on the PVT used and the applied
to make accurate inferences about a patient’s current cut-off score. Moreover, PVT cut-off scores derived from
16
1-4
cognitive abilities and functioning. Initially referred to one clinical group may not only apply to other clinical
as “malingering,” performance invalidity was primarily groups. Therefore, in clinical practice, it is essential to
7,13
associated with medicolegal settings. PVTs have also use PVT diagnostic accuracy data obtained from patients
5
6
become important in general clinical settings, where with clinical characteristics similar to the patient group
external incentives may play a role in neuropsychological under evaluation. 13,18 Thus, research on PVT failure rates
assessments. When external incentives are present, in clinical populations and the refinement of cut-off scores’
7
performance invalidity has been found to increase up accuracy is essential for their validation.
to 40% compared to settings without such incentives.
8
Performance invalidity, however, is not solely attributable Clinical neuropsychologists have suggested that PVT
to external incentives. For instance, older individuals with validation studies should include individuals with severe
dementia may lack insight into their cognitive deficits, memory deficits (i.e., individuals with chance-level
making them unmotivated to undergo assessments, recognition memory performance), such as those with
19
thereby increasing the risk of invalid test outcomes. dementia due to Alzheimer’s disease. In these cases,
7
Therefore, administering PVTs is necessary for clinical prominent impairments in the memory domain are
20
assessments, regardless of the presence (or absence) of typically present. In fact, even individuals with Alzheimer’s
external incentives. 7,9,10 dementia rarely score at or below 50% correct on PVTs
based on a yes/no recognition paradigm. Therefore, the
21
Failure to establish performance validity can have PVT cut-off score obtained in individuals with dementia
serious consequences. First, patients exhibiting invalid may represent the lowest possible false-positive rate. If
performance may be classified as more cognitively patients with less severe cognitive impairment (e.g., mild
impaired than their actual cognitive functioning reflects. TBI) score below this cut-off, this could be considered
11
Second, and more importantly, falsely diagnosing patients evidence of non-credible performance. 9,21
with a neurodegenerative disease when they have no
22
cognitive impairment could lead to adverse psychological In a previous study, several PVTs, including the
outcomes. Third, misclassifying genuine patients as non-verbal medical symptom validity test (NV-MSVT),
7
individuals “feigning” their symptoms (i.e., false positives) the Tes Memori Jangka Pendek Indonesia (TMJPI), the
can have both emotional and financial consequences. In Reliable Digit Span (RDS), the Longest Digit Forward-1
1,12
each of these cases, patients may fail to receive accurate Trial (LDF-1), and the Longest Digit Forward-2 Trials
diagnoses, necessary treatments, appropriate care, or (LDF-2), were validated for use in Indonesia through a
essential recommendations (e.g., driving restrictions or the simulation study. However, this study involved only healthy
specific care or support they need). 5 participants, and therefore, the derived cut-off scores may
not be applicable to individuals with clinical conditions.
23
Consequently, incorporating PVTs into The current study aims to evaluate the specificity of
neuropsychological assessments is imperative for these PVTs in a mixed neurological sample in Indonesia,
obtaining accurate results. In clinical practice, it is essential including individuals with neurocognitive disorder (ND)
to avoid misclassifying patients with genuine cognitive due to possible neurodegenerative disease, post-stroke
impairments as having invalid performance. For this (PS) patients, and patients with other brain disorders (e.g.,
reason, the specificity of a PVT (i.e., its ability to classify epilepsy, TBI, or brain tumor). Specificity data on PVTs are
valid performers as passing the PVT) should be high essential for clinicians to interpret test results accurately.
(≥0.90). 13,14 In addition, clinicians should use multiple We hypothesize that the ND group will perform worse than
PVTs to assess performance validity, as this practice the other two groups on all PVTs, as previous studies have
enhances diagnostic accuracy by improving true-positive shown higher failure rates in individuals with conditions
rates while minimizing the likelihood of false positives. 9,15 similar to ND (e.g., dementia). In addition, we hypothesize
16
Although PVTs are not designed to measure that the recommended cut-off scores from the previous
cognitive abilities, some patients with “actual” cognitive study will result in unacceptably high false-positive rates
22
impairments may fail PVTs, particularly when standard, (i.e., poor specificity). Furthermore, we expect that the
often conservative cut-off scores are applied. 16,17 The failure specificity and cut-off scores of the PVTs in the present
rates of PVTs in patients with mild to moderate cognitive study will differ from those in validation studies conducted
impairments (e.g., traumatic brain injury [TBI], early-stage in Western, high-income countries, as data derived from

Volume 4 Issue 2 (2025) 87 doi: 10.36922/an.5661