The Impact of Increasing Material-Specific Verbal and Visual Memory Impairment Severity on Embedded Performance Validity Tests in the Rey Auditory Verbal Learning Test and Brief Visuospatial Memory Test-Revised

Performance on some freestanding performance validity tests (PVTs) is adversely affected by specific cognitive processes/abilities, notably genuine memory impairment; however, this has not been well-researched in the context of memory-based embedded PVTs. This cross-sectional study evaluated the Rey Auditory Verbal Learning Test (RAVLT) Effort Score (ES) and Brief Visuospatial Memory Test-Revised (BVMT-R) Recognition Discrimination (RD) for classifying validity status across three levels of visual and verbal learning and memory performance (i.e., no, mild, and severe impairment). Data for this known-groups study were gathered from 292 mixed clinical neuropsychiatric patients who completed a comprehensive evaluation and classified into valid (n = 235) or invalid (n = 57) groups by four independent criterion PVTs. Overall, ES had 33% sensitivity/89% specificity and RD had 37% sensitivity/95% specificity at optimal cutoffs. ES had good classification accuracy, with 60-74% sensitivity/88-89% specificity for patients with normal performance and 30-33% sensitivity/ >= 89% specificity for those with mildly impaired verbal learning/memory performance. However, ES was unable to accurately differentiate those with severely impaired material-specific verbal learning/memory performance. RD had excellent classification accuracy, with 61% sensitivity/ >= 95% specificity for those with normal visual learning/memory performance and 37% sensitivity/ >= 93% specificity for those with mildly impaired performance. Contrasting ES, RD remained able to accurately differentiate invalidly performing patients from those with severely impaired visual learning/memory performance, with 26% sensitivity/84-87% specificity. Both RAVLT ES and BVMT-R RD were useful PVTs, even among patients with material-specific verbal and visual memory deficits. That said, ES did not accurately differentiate invalid performance from valid-impaired performance with severely impaired verbal learning/memory performance.