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Arch Clin Neuropsychol. 2018 Aug 1;33(5):606-618. doi: 10.1093/arclin/acx098.

Performance Validity, Neurocognitive Disorder, and Post-concussion Symptom Reporting in Service Members with a History of Mild Traumatic Brain Injury.

Lippa SM1,2, Lange RT1,2,3, French LM1,2,4,5, Iverson GL1,6,7,8.

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Defense and Veterans Brain Injury Center, Bethesda, MD, USA.
National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.
Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.
Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA.



To examine the influence of different performance validity test (PVT) cutoffs on neuropsychological performance, post-concussion symptoms, and rates of neurocognitive disorder and postconcussional syndrome following mild traumatic brain injury (MTBI) in active duty service members.


Participants were 164 service members (Age: M = 28.1 years [SD = 7.3]) evaluated on average 4.1 months (SD = 5.0) following injury. Participants were divided into three mutually exclusive groups using original and alternative cutoff scores on the Test of Memory Malingering (TOMM) and the Effort Index (EI) from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): (a) PVT-Pass, n = 85; (b) Alternative PVT-Fail, n = 53; and (c) Original PVT-Fail, n = 26. Participants also completed the Neurobehavioral Symptom Inventory.


The PVT-Pass group performed better on cognitive testing and reported fewer symptoms than the two PVT-Fail groups. The Original PVT-Fail group performed more poorly on cognitive testing and reported more symptoms than the Alternative PVT-Fail group. Both PVT-Fail groups were more likely to meet DSM-5 Category A criteria for mild and major neurocognitive disorder and symptom reporting criteria for postconcussional syndrome than the PVT-Pass group. When alternative PVT cutoffs were used instead of original PVT cutoffs, the number of participants with valid data meeting cognitive testing criteria for neurocognitive disorder or postconcussional syndrome decreased dramatically.


PVT performance is significantly and meaningfully related to overall neuropsychological outcome. By using only original cutoffs, clinicians and researchers may miss people with invalid performances.


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