CVLT-II short form forced choice recognition in a clinical dementia sample: Cautions for performance validity assessment

Abstract

Performance validity tests are susceptible to false positives from genuine cognitive impairment (e.g., dementia); this has not been explored with the short form of the California Verbal Learning Test II (CVLT-II-SF). In a memory clinic sample, we examined whether CVLT-II-SF Forced Choice Recognition (FCR) scores differed across diagnostic groups, and how the severity of impairment [Clinical Dementia Rating Sum of Boxes (CDR-SOB) or Mini-Mental State Examination (MMSE)] modulated test performance. Three diagnostic groups were identified: subjective cognitive impairment (SCI; n = 85), amnestic mild cognitive impairment (a-MCI; n = 17), and dementia due to Alzheimer’s Disease (AD; n = 50). Significant group differences in FCR were observed using one-way ANOVA; post-hoc analysis indicated the AD group performed significantly worse than the other groups. Using multiple regression, FCR performance was modeled as a function of the diagnostic group, severity (MMSE or CDR-SOB), and their interaction. Results yielded significant main effects for MMSE and diagnostic group, with a significant interaction. CDR-SOB analyses were non-significant. Increases in impairment disproportionately impacted FCR performance for persons with AD, adding caution to research-based cutoffs for performance validity in dementia. Caution is warranted when assessing performance validity in dementia populations. Future research should examine whether CVLT-II-SF-FCR is appropriately specific for best-practice testing batteries for dementia.