Limitations of performance validity tests in dementia evaluations: The role of base rates.
Limitations of performance validity tests in dementia evaluations: The role of base rates.
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DOI：
10.1037/pas0001166
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发表时间：
2022-11
影响因子：
3.6
通讯作者：
Correia, Stephen
中科院分区：
文献类型：
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作者：
Gaudet, Charles E;Castelluccio, Brian;Gold, Dov;McLaughlin, Nicole C R;Correia, Stephen
表现有效性测试 (PVT) 经常用于检测认知测试中的无效表现。无论感兴趣的条件如何，将 PVT 纳入认知测试组中都是很常见的。然而，不同临床人群的无效表现的基本率有所不同。对不同临床人群中无效表现基本率和 PVT 分类准确率的研究通常没有进行综合。为了解决这一差距，本研究检查了用于进行痴呆症评估的老年人的特定 PVT 的临床效用。我们根据之前发表的研究，使用估计的 5% 无效表现基本率，计算了所选 PVT 无效表现的后验概率。在 PVT 中，基于 PVT 失败（即无效性能被识别为无效）的无效性能的后验概率在 7.3% 到 60.3% 之间；假阳性（即有效表现被识别为无效）的后验概率范围为 39.7% 至 92.7%。相反，真阴性（即有效表现被识别为有效）的后验概率在 95.7% 到 99.3% 之间；假阴性（即无效表现被识别为有效）的后验概率范围为 0.7% 至 4.3%。结果对 PVT 在痴呆症评估中的效用提出了质疑。因此，在痴呆症评估中使用 PVT 可能会错误地将有效测试数据识别为无效（即假阳性错误），其频率超过估计的无效表现的 5% 基本率。进一步研究检查老年人无效表现的相关性将澄清基本率估计并有可能提高 PVT 的效用。
Performance validity tests (PVTs) are frequently used to detect invalid performance on cognitive testing. The inclusion of PVTs in cognitive test batteries is commonplace irrespective of the condition of interest. However, base rates of invalid performance vary across clinical populations. Research accounting for base rates of invalid performance in varying clinical populations and PVT classification accuracy rates are not commonly synthesized. To address this gap, the present study examined the clinical utility of select PVTs used with older adults presenting for dementia evaluations. We computed posterior probabilities of invalid performance for the select PVTs using an estimated 5% base rate of invalid performance based on prior published studies. Posterior probabilities of invalid performance based on a PVT failure (i.e., invalid performance identified as invalid) ranged from 7.3% to 60.3% across PVTs; posterior probabilities of a false positive (i.e., valid performance identified as invalid) ranged from 39.7% to 92.7%. Conversely, posterior probabilities of a true negative (i.e., valid performance identified as valid) ranged from 95.7% to 99.3%; posterior probabilities of a false negative (i.e., invalid performance identified as valid) ranged from 0.7% to 4.3%. Results call into question the utility of PVTs in dementia evaluations. Consequently, the use of PVTs in dementia evaluations is likely to erroneously identify valid test data as invalid (i.e., false-positive error) at a frequency that exceeds the estimated 5% base rate of invalid performance. Further research examining correlates of invalid performance among older adults will clarify base rate estimates and potentially enhance the utility of PVTs.