Wait, There's a Baby in this Bath Water! Update on Quantitative and Qualitative Cut-Offs for Rey 15-Item Recall and Recognition

• Published in: Archives of clinical neuropsychology Vol. 34; no. 8; pp. 1367 - 1380
• Main Authors: Poynter, Kellie, Boone, Kyle Brauer, Ermshar, Annette, Miora, Deborah, Cottingham, Maria, Victor, Tara L, Ziegler, Elizabeth, Zeller, Michelle A, Wright, Matthew
• Format: Journal Article
• Language: English
• Published: United States 27.11.2019
• Subjects: Adolescent; Adult; Age Factors; Aged; False Positive Reactions; Female; Humans; Male; Malingering - diagnosis; Malingering - psychology; Mental Recall; Middle Aged; Neuropsychological Tests - statistics & numerical data; Psychomotor Performance; Recognition, Psychology; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Young Adult; Rey 15-item plus recognition; Performance validity; Malingering
• ISSN: 1873-5843; 1873-5843
• DOI: 10.1093/arclin/acy087

Evaluate the effectiveness of Rey 15-item plus recognition data in a large neuropsychological sample. Rey 15-item plus recognition scores were compared in credible (n = 138) and noncredible (n = 353) neuropsychology referrals. Noncredible patients scored significantly worse than credible patients on all Rey 15-item plus recognition scores. When cut-offs were selected to maintain at least 89.9% specificity, cut-offs could be made more stringent, with the highest sensitivity found for recognition correct (cut-off ≤11; 62.6% sensitivity) and the combination score (recall + recognition - false positives; cut-off ≤22; 60.6% sensitivity), followed by recall correct (cut-off ≤11; 49.3% sensitivity), and recognition false positive errors (≥3; 17.9% sensitivity). A cut-off of ≥4 applied to a summed qualitative error score for the recall trial resulted in 19.4% sensitivity. Approximately 10% of credible subjects failed either recall correct or recognition correct, whereas two-thirds of noncredible patients (67.7%) showed this pattern. Thirteen percent of credible patients failed either recall correct, recognition correct, or the recall qualitative error score, whereas nearly 70% of noncredible patients failed at least one of the three. Some individual qualitative recognition errors had low false positive rates (<2%) indicating that their presence was virtually pathognomonic for noncredible performance. Older age (>50) and IQ < 80 were associated with increased false positive rates in credible patients. Data on a larger sample than that available in the 2002 validation study show that Rey 15-item plus recognition cut-offs can be made more stringent, and thereby detect up to 70% of noncredible test takers, but the test should be used cautiously in older individuals and in individuals with lowered IQ.