RBANS Embedded Measures of Suboptimal Effort in Dementia: Effort Scale Has a Lower Failure Rate than the Effort Index

Abstract

The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310-319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841-854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190-195). We explored failure rates on these effort measures in a non-litigating mixed dementia sample (N = 145). Failure rate on the EI was high (48%) and associated with dementia severity. In contrast, failure on the ES was 14% but differed based on type of dementia. ES failure was low (4%) when dementia was due to Alzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations.

Effort Testing in Dementia Assessment: A Systematic Review

“…It is likely that some of the variation in performance seen across the different studies may be partially accounted for not just by dementia severity but by dementia subtype. Burton et al (2015) touched on this issue when they found that the Effort Scale had significantly higher specificity in their Alzheimer's sample (96%) compared to their non-Alzheimer sample (69%).…”

“…The paper scored poorly however on the CCAT (21/40) due to inadequate information given regarding data collection, inclusion and exclusion criteria and participant demographic information. Burton, Enright, O'Connell, Lanting & Morgan (2015) compared the ES in AD and non-AD dementias. They found an impressively high specificity level of 0.96 in their AD sample, however this fell to 0.69 in their non-AD sample.…”

Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults

“…Numerous research studies have been conducted regarding the ability of the measure to identify cognitive change in individuals with normal cognition (Andreotti & Hawkins, 2015; Cooley et al, 2015; Duff & Ramezani, 2015; Phillips et al, 2015; Thaler, Hill, Duff, Mold, & Scott, 2015), Mild Cognitive Impairment (MCI; Clark, Hobson, & O’Bryant, 2010; Duff, Hobson, Beglinger, & O’Bryant, 2010; Hobson, Hall, Humphreys-Clark, Schrimsher, & O’Bryant, 2010; Karantzoulis, Novitski, Gold, & Randolph, 2013; O’Mahar et al, 2012), and Alzheimer’s disease (AD; Burton, Enright, O’Connell, Lanting, & Morgan, 2015; Duff et al, 2008; Enright, O’Connell, MacKinnon, & Morgan, 2015; Heyanka, Scott, & Adams, 2015; McDermott & DeFilippis, 2010; Morgan, Linck, Scott, Adams, & Mold, 2010; Schmitt et al, 2010). Despite these efforts, however, there have been few studies examining the RBANS and its association with imaging biomarkers related to AD, such as decreased hippocampal volumes on magnetic resonance imaging (MRI; Choi et al, 2016; Jack et al, 2010), hypometabolism on fluoro-2-deoxyglucose (FDG) positron emission tomography (PET; Frings, Spehl, Hull, & Meyer, 2016; Jagust et al, 2010), and amyloid accumulations on amyloid PET (Beach, Thal, Zanette, Smith, & Buckley, 2016; L.…”

Predictors and Impact of Self-Reported Suboptimal Effort on Estimates of Prevalence of HIV-Associated Neurocognitive Disorders

“…That is, due to a one or a combination of several potential factors (e.g., fatigue, apathy, distraction, boredom, intoxication), participants' scores do not reflect their true ability. This is different from feigned effort , in which performance is intentionally deficient with the goal of appearing cognitively impaired, although suboptimal effort has previously been used synonymously with feigned effort 16-18 . Feigned effort is a well-documented phenomenon in several patient populations, generally in the context of forensic or disability evaluations in which there is potential for secondary gain 19-22 .…”