Identifying deliberate attempts to fake memory impairment through the combined use of reaction time and event-related potential measures

Distinguishing Between Genuine and Feigned Dementia Using Event-related Potentials

BACKGROUND

Individuals with probable Alzheimer disease (AD) may perform below cutoffs on traditional, memory-based performance validity tests. Previous studies have found success using event-related potentials (ERPs) to detect feigned neurocognitive impairment in younger populations.

OBJECTIVE

To evaluate the utility of an auditory oddball task in conjunction with the P3b peak amplitude to distinguish probable AD from simulated dementia.

METHOD

Twenty individuals with probable AD and 20 older healthy controls (HC) underwent an ERP auditory oddball protocol and the Test of Memory Malingering (TOMM). The HC were asked to perform honestly for one condition and to simulate dementia for the other. The individuals with probable AD were asked to perform honestly. The P3b peak amplitude and button press accuracy were collected from each participant and were analyzed to determine their effectiveness in detecting performance validity.

RESULTS

The P3b peak amplitude remained stable regardless of behavioral condition in the HC group. When combined with the TOMM Trial 2 score, the P3b peak amplitude further improved the ability to correctly differentiate individuals with probable AD from HC simulating dementia with 100% sensitivity and 90% specificity.

CONCLUSION

The P3b peak amplitude was found to be an effective physiologic measure of cognitive impairment in individuals with probable AD compared with HC simulating dementia. When combined with the TOMM Trial 2 score, the P3b peak amplitude served as a promising performance validity measure for differentiating individuals with probable AD from HC simulating dementia.

Performance validity assessment using response time on the Warrington Recognition Memory Test

OBJECTIVE

The present study tested the incremental utility of response time (RT) on the Warrington Recognition Memory Test - Words (RMT-W) in classifying bona fide versus feigned TBI.

METHOD

Participants were 173 adults: 55 with moderate to severe TBI, 69 healthy comparisons (HC) instructed to perform their best, and 49 healthy adults coached to simulate TBI (SIM). Participants completed a computerized version of the RMT-W in the context of a comprehensive neuropsychological battery. Groups were compared on RT indices including mean RT (overall, correct trials, incorrect trials) and variability, as well as the traditional RMT-W accuracy score.

RESULTS

Several RT indices differed significantly across groups, although RMT-W accuracy predicted group membership more strongly than any individual RT index. SIM showed longer average RT than both TBI and HC. RT variability and RT for incorrect trials distinguished SIM-HC but not SIM-TBI comparisons. In general, results for SIM-TBI comparisons were weaker than SIM-HC results. For SIM-HC comparisons, classification accuracy was excellent for all multivariable models incorporating RMT-W accuracy with one of the RT indices. For SIM-TBI comparisons, classification accuracies for multivariable models ranged from acceptable to excellent discriminability. In addition to mean RT and RT on correct trials, the ratio of RT on correct items to incorrect items showed incremental predictive value to accuracy.

CONCLUSION

Findings support the growing body of research supporting the value of combining RT with PVTs in discriminating between verified and feigned TBI. The diagnostic accuracy of the RMT-W can be improved by incorporating RT.

Response Time Measures as Supplementary Validity Indicators in Forced-Choice Recognition Memory Performance Validity Tests: A Systematic Review

Performance validity tests (PVTs) based on the forced-choice recognition memory (FCRM) paradigm are commonly used for the detection of noncredible performance. Examinees' response times (RTs) are affected by cognitive processes associated with deception and can also be gathered without lengthening the duration of the assessment. Consequently, interest in the utility of these measures as supplementary validity indicators in FCRM-PVTs has grown over the years. The current systematic review summarizes both clinical and simulation (i.e., healthy participants simulating cognitive impairment) studies of RTs in FCRM-PVTs. The findings of 25 peer-reviewed articles (n = 26 empirical studies) indicate that noncredible performance in FCRM-PVTs is associated with longer RTs. Additionally, there are indications that noncredible performance is associated with larger variability in RTs. RT measures, however, have lower discrimination capacity than conventional accuracy measures. Their utility may therefore lie in reaching decisions regarding cases with border zone accuracy scores, as well as aiding in the detection of more sophisticated examinees who are aware of the use of accuracy-based validity indicators in FCRM-PVTs. More research, however, is required before these measures are incorporated in daily practice and clinical decision-making processes.

Feigning memory impairment in a forced-choice task: Evidence from event-related potentials

Strategies of malingering detection have brought about a wealth of neuropsychological studies in the last decades. However, the investigation of physiological measures to reliably differentiate between authentic and manipulated symptom presentations is still in its infancy. The present study examined event-related potentials (ERP) to identify feigned memory impairment. We tested instructed malingerers (n = 25) and control participants (n = 22) with a recognition task similar to the Test of Memory Malingering. No differences between groups were found for P1 (70-110 ms) but for N1 (120-170 ms) and P300 components, with lower amplitudes for instructed malingerers. Behavioral data showed a typical pattern of unrealistically high errors in a forced-choice recognition task and less overall recalled stimuli in instructed malingerers. We also found study-phase repetition and old/new effects in the P300, but no interactions with groups (control vs. malingering). Post-hoc analyses revealed that the P300 effect is greater when participants reported an attention-based faking strategy, as opposed to response-based malingerers and controls. The employment of physiological measures can yield additional information on the validity of test data without the need to perform additional tests.

Distinguishing TBI Malingering and Fatigue Using Event-Related Potentials

Abstract. Poorer-than-expected performance on cognitive-behavioral tasks may indicate malingering, or it could be an outcome of fatigue, resulting in false positives when suboptimal task performance is used to flag individuals feigning or exaggerating symptoms of traumatic brain injury (TBI). The primary goal of this study was to examine the P3 event-related potentials (ERP) and behavioral outcomes associated with TBI malingering and fatigue, in order to distinguish between them. A secondary goal was to determine if history of TBI (hTBI) is associated with differences in fatigue, ERPs, or performance on a short-term memory task. Participants completed the Mental Fatigue and Related Symptoms (SR-MF) questionnaire and were interviewed to assess TBI history, then they completed a computerized “old/new” (match-mismatch) task while ERPs were recorded, under three conditions: Normal, Malinger, and Fatigue. Participants reported mild fatigue at the end of study, with no difference between individuals reporting a history of TBI ( n = 32) and healthy controls ( n = 47). Fatigue was associated with prolonged P3 latency but was otherwise indistinguishable from Normal. In contrast, Malinger was clearly distinguished from Normal by significantly lower accuracy, longer reaction times, reduced P3 amplitude on Match trials, and a smaller old/new ERP effect. Individuals with a history of TBI reported clinical levels of fatigue at baseline but did not differ significantly from healthy controls on any behavioral or ERP measure. The results support the use of behavioral and ERP measures to identify malingering, without concern over confounding effects of mild subjective fatigue, including mild fatigue induced by testing.

A Laboratory Word Memory Test Analogue Differentiates Intentional Feigning from True Responding Using the P300 Event-Related Potential

Symptom exaggeration and feigned cognitive impairment occur commonly in forensic and medicolegal evaluations. As a result, methods to detect feigned cognitive impairment are an indispensable component of neuropsychological assessments. This study reports the results of two neurophysiological experiments using a forced-choice recognition task built from the stimuli of the Word Memory Test and Medical Symptom Validity Test as well as a new linguistically informed stimulus set. Participant volunteers were instructed either to do their best or to feign cognitive impairment consistent with a mild traumatic brain injury while their brain activity was monitored using event-related potentials (ERP). Experiment 1 varied instructions across individuals, whereas Experiment 2 varied instructions within individuals. The target brain component was a positive deflection indicating stimulus recognition that occurs approximately 300 ms after exposure to a stimulus (i.e., the P300). Multimodal comparison (P300 amplitude to behavioral accuracy) allowed the detection of feigned cognitive impairment. Results indicate that, for correct responses, P300s were equivalent for the simulated malingering and good effort conditions. However, for incorrect responses, feigned impairment produced reliable but significantly reduced P300 amplitudes. Although the P300 is an automatic index of recognition—even when knowledge is hidden—its amplitude appears capable of modulation by feigning strategies. Implications of this finding are discussed for research and clinical applications.

Financial Incentive Does Not Affect P300 in the Complex Trial Protocol (CTP) Version of the Concealed Information Test (CIT) in Malingering Detection. II. Uninstructed Subjects

Well-known research showed that the skin conductance response (SCR) of the Autonomic Nervous System (ANS) in the Concealed Information Test (CIT) is usually augmented in participants who are financially and motivationally incentivized to beat the CIT. This is not what happens with Reaction Time (RT)-based CITs, P300 CITs based on the 3-stimulus protocol, nor on the P300-based complex trial protocol for detection of malingering (however these tests differ from forensic CITs). The present report follows up the Rosenfeld et al. (1, 2) study of motivated malingerers instructed how to beat the test, with uninstructed motivated (paid and unpaid) and unmotivated ("simple malingering") subjects, using episodic and semantic memory probes. The Test of Memory Malingering (TOMM) validated behavioral differences among groups. The "CIT effect" (probe-minus-irrelevant P300 differences) did not differ among incentive groups, although as previously, semantic memory-evoked P300s exceeded episodic memory evoked P300s. An effect of specific test-beating instructions was found to enhance the CIT effect for semantic information.

ERP correlates of malingered executive dysfunction

Assessment of malingering has become an integral part of many neuropsychological evaluations, particularly in forensic settings. However, traditional malingering measures are known to be vulnerable to both manipulation and coaching. Consequently, recent research has attempted to identify physiological indices of cognitive functioning that are less susceptible to overt manipulation. While prior studies have explored the validity of physiological assessment of memory deficits, this study evaluates the effectiveness of a physiological measure of executive functioning. This study used EEG recording in conjunction with a three-stimulus oddball design to compare neural responses in simulated malingerers feigning cognitive deficits associated with traumatic brain injury (TBI) and controls. Specifically, the study explored the efficacy of an event-related potential (ERP) known as P3a, which is believed to be an index of frontal lobe executive processes, specifically the attentional orienting response. The results of this study demonstrated that simulated malingerers did not produce a P3a response that was significantly different from control participants. Furthermore, the P3a in simulated malingerers did not demonstrate any of the properties reported in prior studies with TBI patients. Not only were malingerers unable to produce a significant change in their basic orienting response, but the very process of attempting to employ additional strategies to appear impaired produced other physiological markers of deception. Therefore, the P3a component appeared to be unaffected by an individual's motivation or overt performance, which suggests that it may have potential for development as a physiological measure for differentiating between malingerers and those with genuine TBI.

Impact of stimulus similarity between the probe and the irrelevant items during a card-playing deception detection task: the "irrelevants" are not irrelevant

Event-related brain potential paradigms for the detection of concealed information commonly involve presenting probes embedded within a series of irrelevant items. This study investigated the impact of similarity of the irrelevant items with the probe. For the task, a card was shown followed by the sequential presentation of six "test" cards, one of which was the same as the initial card (the probe) along with five "irrelevant" cards that varied in terms of similarity with the probe. Participants either identified or denied recognition of the probe. The results show that P300 amplitude is modulated by stimulus similarity and highlight the importance of the irrelevant items on deception detection rates.