title: False-Positive Error Rates for Reliable Digit Span and Auditory Verbal Learning Test Performance Validity Measures in Amnestic Mild Cognitive Impairment and Early Alzheimer Disease.
abstract: OBJECTIVE
  The objective is to examine failure on three embedded performance validity tests [Reliable Digit Span (RDS), Auditory Verbal Learning Test (AVLT) logistic regression, and AVLT recognition memory] in early Alzheimer disease (AD; n = 178), amnestic mild cognitive impairment (MCI; n = 365), and cognitively intact age-matched controls (n = 206).
  
  
  METHODS
  Neuropsychological tests scores were obtained from subjects participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI).
  
  
  RESULTS
  RDS failure using a ≤7 RDS threshold was 60/178 (34%) for early AD, 52/365 (14%) for MCI, and 17/206 (8%) for controls. A ≤6 RDS criterion reduced this rate to 24/178 (13%) for early AD, 15/365 (4%) for MCI, and 7/206 (3%) for controls. AVLT logistic regression probability of ≥.76 yielded unacceptably high false-positive rates in both clinical groups [early AD = 149/178 (79%); MCI = 159/365 (44%)] but not cognitively intact controls (13/206, 6%). AVLT recognition criterion of ≤9/15 classified 125/178 (70%) of early AD, 155/365 (42%) of MCI, and 18/206 (9%) of control scores as invalid, which decreased to 66/178 (37%) for early AD, 46/365 (13%) for MCI, and 10/206 (5%) for controls when applying a ≤5/15 criterion. Despite high false-positive rates across individual measures and thresholds, combining RDS ≤ 6 and AVLT recognition ≤9/15 classified only 9/178 (5%) of early AD and 4/365 (1%) of MCI patients as invalid performers.
  
  
  CONCLUSIONS
  Embedded validity cutoffs derived from mixed clinical groups produce unacceptably high false-positive rates in MCI and early AD. Combining embedded PVT indicators lowers the false-positive rate.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA dloring@emory.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Loring
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Goldstein
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Chuqing
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Drane
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Lah
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Liping
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Independent Practice, Sarasota, FL, USA.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Larrabee
mesh_terms: D000161:Acoustic Stimulation; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D060825:Cognitive Dysfunction / Q000150:complications* / Q000175:diagnosis; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014706:Verbal Learning / Q000502:physiology*
keywords: AVLT; False-positive rate; Performance validity test; Reliable Digit Span; Test specificity