Embedded PVTs, as their name suggests, are “built-into” existing neuropsychological tests (e.g., Reliable Digit Span from the Wechsler Adult Intelligence Scale) on which e-values tend to demonstrate a psychometric floor performance. The distinction can be made using either embedded or stand-alone Performance Validity Tests (PVTs), which detect inconsistent or invalid response patterns. For these reasons, there is an urgent need to distinguish between real and simulated cognitive deficits. Dementia simulation has many consequences, draining limited Social Security resources and inappropriately depriving resources from those who really need them ( Yeh et al., 2019). Other reasons for simulating cognitive deficits akin to dementia include acquiring attributions and/or a higher value for early retirement subsidies. Due to the long wait times and difficulties in accessing these specialized structures, individuals may simulate cognitive deficits or claim incapacity to obtain a diagnosis that facilitates entry. In addition, with the demographic rise of older populations and the progressive increment of older adult dependency, institutionalization in Residential Care Structures is increasing ( Toth et al., 2022). In fact, in Portugal, 18,725 people benefited from early retirement in 2010, a number that rose to over 150,000 in 2016 and in 2019 (161,530 and 152,369, respectively Instituto Nacional de Estatística, 2021). In response to the increase in dementia prevalence and difficulties in working beyond retirement age, early retirement requests have risen. An additional concern is the expected increase in neurodegenerative diseases, considering age is the biggest risk factor for dementia ( Alzheimer’s Society, 2016).ĭementia is a progressive pathology associated with aging in which one or more cognitive functions decline from a previous level of functioning beyond what is expected for their age and education ( American Psychiatric Association, 2013), compromising autonomy in Activities of Daily Living. Several critical implications have emerged from this “longevity revolution.” Among them, there is a growing concern for adjusting national social policies related to retirement age, as has happened in Portugal in recent years ( Decreto-Lei n.º 119/2018 de 27 de Dezembro do Ministério do Trabalho, Solidariedade e Segurança Social, 2018). By 2050, it is estimated that 1 in every six individuals will be older than 65, a stark increase from the 2019 estimate of 1 in 11 ( United Nations, 2019). We are currently witnessing the progressive aging of the world population. These results present important implications for clinical practice and the daily life of patients, as the use of incorrect cut-off points could impede patients from getting the resources they need. Additionally, the Rey-15 Item Memory Test did not demonstrate sufficient discriminating capacity for dementia. The results showed that (1) all measures, except for the Coin in Hand- Extended version (CIH-EV), were sensitive to one or more sociodemographic and/or cognitive variables, and (2) it was necessary to adjust cut-off points for all measures. Further, we examined the potential need for adjusting cut-off scores for three stand-alone (Test of Memory Malingering, Rey-15 Item Memory Test, and Coin in Hand-Extended Version) and one embedded (Reliable Digit Span) PVT for Portuguese older adults with dementia. Here, we analyzed the sensitivity of PVTs in discriminating between dementia and simulation using receiver operating characteristic (ROC) curve analyses. Previous research demonstrates that PVTs may be sensitive to dementia, thus inaccurately classifying real memory impairment as simulation. Performance Validity Tests (PVTs) are specifically designed to assess a lack of effort and the possible simulation of cognitive impairment. In order to ensure the proper allocation of care and resources to this clinical group, it is necessary to correctly distinguish between simulated versus bona-fide cognitive deficits typical of dementia. The rising demographic of older adults worldwide has led to an increase in dementia cases. 4Psychology Department, Campus Duques de Soria, University of Valladolid, Valladolid, Spain.
3Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal.2CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.1Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.Sandra Fernandes 1,2 * †, Inês Ferreira 1 †, Luís Querido 1,3 and Julia C.
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