The Visual Association Test-Extended: a cross-sectional study of the performance validity measures

Objective: Given the hazards of knowledge about performance validity tests (PVTs) being proliferated among the general public, there is a continuous need to develop new PVTs. The purpose of these studies was to validate the newly developed Visual Association Test-Extended (VAT-E). Method: The VAT-E consists of 24 pairs of line drawings; it is partly based on Green's Word Memory Test (WMT) paradigm. In study 1, we compared VAT-E total scores of healthy controls (n=226), patients with mild cognitive impairment (MCI) (n=76), patients with Alzheimer's disease (AD) (n=26), and persons instructed to feign memory deficit (n=29). In study 2, we compared litigating patients classified by Slick's criteria as Malingering of Neurocognitive Dysfunction (MND) (n=26) or non-MND (n=67). In addition, we compared the VAT-E to the Test of Memory Malingering (TOMM) (study 1) and the WMT (study 2). Results: Results showed that the VAT-E differentiated patients with MCI (specificity 93-100%) or patients with AD (specificity 92-100%) from persons instructed to feign (sensitivity 86-100%). The VAT-E also differentiated MND from non-MND (sensitivity 54%, specificity 97%). The VAT-E was in perfect agreement with the TOMM in classifying healthy controls and persons instructed to feign, and it was in moderate agreement with the WMT in classifying non-MND and MND. Conclusion: Preliminary evidence shows that the VAT-E may be a useful PVT based on the ability to differentiate between those with genuine memory impairment, persons instructed to feign memory impairment, and a group suspected of malingering cognitive deficits.