TY - JOUR
T1 - The RBANS effort index
T2 - Base rates in geriatric samples
AU - Duff, Kevin
AU - Spering, Cynthia C.
AU - O'Bryant, Sid E.
AU - Beglinger, Leigh J.
AU - Moser, David J.
AU - Bayless, John D.
AU - Culp, Kennith R.
AU - Mold, James W.
AU - Adams, Russell L.
AU - Scott, James G.
N1 - Funding Information:
The project described was supported by research grants (K23 AG028417-01A2) from the National Institutes on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.
PY - 2011/1
Y1 - 2011/1
N2 - The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.
AB - The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.
KW - RBANS
KW - geriatric assessment
KW - symptom validity testing
UR - http://www.scopus.com/inward/record.url?scp=79952587210&partnerID=8YFLogxK
U2 - 10.1080/09084282.2010.523354
DO - 10.1080/09084282.2010.523354
M3 - Article
C2 - 21390895
AN - SCOPUS:79952587210
SN - 0908-4282
VL - 18
SP - 11
EP - 17
JO - Applied Neuropsychology
JF - Applied Neuropsychology
IS - 1
ER -