title: RBANS embedded measures of suboptimal effort in dementia: effort scale has a lower failure rate than the effort index.
abstract: The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310-319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841-854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190-195). We explored failure rates on these effort measures in a non-litigating mixed dementia sample (N = 145). Failure rate on the EI was high (48%) and associated with dementia severity. In contrast, failure on the ES was 14% but differed based on type of dementia. ES failure was low (4%) when dementia was due to Alzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations.
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada S7N 5A5.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Burton
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada S7N 5A5.
authors.forename: Joe
authors.initials: J
authors.lastname: Enright
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada S7N 5A5 moconnel@uvic.ca.
authors.forename: Megan E
authors.initials: ME
authors.lastname: O'Connell
authors.affiliation: Department of Neuropsychology, Copeman Health Clinic, Vancouver, BC, Canada V6Z 2L4 School of Kinesiology, University of British Columbia, Vancouver, BC, Canada V6T 1Z1.
authors.forename: Shawnda
authors.initials: S
authors.lastname: Lanting
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, Saskatoon, SK, Canada S7N 5E5.
authors.forename: Debra
authors.initials: D
authors.lastname: Morgan
mesh_terms: D000544:Alzheimer Disease / Q000150:complications; D001288:Attention; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D003704:Dementia / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007802:Language; D007858:Learning; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D014796:Visual Perception
keywords: Dementia; Geriatrics; Malingering; RBANS; Sub-optimal effort; Validity indicators