Early cutoff criteria for strong performance on the test of memory malingering

Abstract

Objective: The Test of Memory Malingering (TOMM) is widely used to assess performance validity. To improve efficiency, we investigated whether abbreviated administration (i.e., only the first 25 items of Trial 1 [T1]) is possible when effort is very strong (.49/50 on T1 or T2). Method: We collected TOMM scores of 501 consecutive adult patients ranging in cognitive status who underwent standard neuropsychological evaluation at Mayo Clinic, Rochester, MN. Results: Receiver Operating Characteristic (ROC) analysis showed excellent area under the curve (AUC) (0.94; CI95%[0.92, 0.97]) and a cutoff of 25/25 had 100% specificity for identifying strong performance. Of the 224 patients who obtained a perfect score on the first 25 items, 197 (88%) obtained .49 on T1 and the remaining patients (n = 27) obtained ≥49 on T2. Conclusion: A perfect score on the first 25 items of the TOMM predicted overall strong performance 100% of the time, supporting abbreviated administration in select cases in a general outpatient clinical setting.