Spanish normative studies in a young adult population (NEURONORMA young adults project): Guidelines for the span verbal, span visuo-spatial, Letter-Number Sequencing, Trail Making Test and Symbol Digit Modalities Test

A pilot study on the adequacy of the TOMM in detecting invalid performance in patients with substance use disorders

Objective: The validity of neuropsychological test performance has scarcely been studied in patients with substance use disorders (SUD), despite the possibility that some SUD individuals may distort their performance for compensation seeking (e.g., work leave, permanent or total disability, or the designation of services such as sheltered housing). Thus, the aim of the present study is to determine: (i) the possible utility of the Test of Memory Malingering (TOMM) in detecting invalid test results among SUD patients, and (ii) the percentage of individuals that underperform the TOMM among SUD patients seeking compensation.Method: Seventy-seven patients (59 men and 18 women) with SUD in outpatient treatment with an age range between 20 and 59 years were divided into two groups: SUD patients without compensation seeking (n = 41), and SUD patients with compensation seeking (n = 36). Participants performed a neuropsychological assessment with measures of processing speed, working memory, inhibition, verbal memory, cognitive flexibility, and decision-making, that also included the TOMM.Results: Our results demonstrate that there were no significant differences on TOMM performance between the two groups. Only one participant underperformed the TOMM (1.3% of the sample). Results showed cognitive impairment in the sample, but no differences between the groups on the different neuropsychological measures.Conclusions: This constitutes the first study to explore the capacity of a forced-choice test to detect invalid test results in an SUD population. There was a high performance on the TOMM among the SUD participants of our study despite their cognitive impairment, indicating adequate effort in their neuropsychological test performance. Further, these findings suggest that the probability of showing invalid neuropsychological performance among SUD compensation seeking patients is much lower than what has been found in other populations, such as in mild brain injury patients.

Demographically adjusted norms for the Trail Making Test in native Spanish speakers: Results from the neuropsychological norms for the US-Mexico border region in Spanish (NP-NUMBRS) project

OBJECTIVE

Despite the wide use of the Trail Making Test (TMT), there is a lack of normative data for Spanish speakers living in the USA. Here we describe the development of regional norms for the TMT for native Spanish speakers residing in the Southwest Mexico-Border Region of the USA.

METHOD

Participants were 252 healthy native Spanish speakers, 58% women, from ages 19 to 60, and ranging in education from 0 to 20 years, recruited in San Diego, CA and Tucson, AZ. All completed the TMT in Spanish along with a comprehensive neuropsychological test battery as part of their participation in the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project. Univariable and interactive effects of demographics on test performance were examined. T-scores were calculated using fractional polynomial equations to account for linear and any non-linear effects of age, education, and sex.

RESULTS

Older age and lower education were associated with worse scores on both TMT A and B. No sex differences were found. The newly derived T-scores showed no association with demographic variables and displayed the expected 16% rates of impairment using a -1 SD cut point based on a normal distribution. By comparison, published norms for English-speaking non-Hispanic Whites applied to the current data yielded significantly higher impairment for both TMT A and B with more comparable rates using non-Hispanic African Americans norms.

CONCLUSIONS

Population-specific, demographically adjusted regional norms improve the utility and diagnostic accuracy of the TMT for use with native Spanish speakers in the US-Mexico Border region.