1. The current interpretation guidelines of the Test of Memory Malingering may result in the inaccurate identification of malingering tendencies in Spanish speaking subjects
Lorna Myers, PhD and Marcela Bonafina, Ph.D.
Northeast Regional Epilepsy Group, NY, NJ, and CT, USA.
Methods
At the neuropsychology division of the Northeast Regional Epilepsy Group, the Test of Memory Malingering was administered as part of our standard Spanish speaking psychometric battery.
A total of 44 patients consecutive patients with confirmed diagnoses of dementia (mild to severe---n=16), epilepsy (n=24), Parkinson’s (n=2), hydrocephalus (n=1) and stroke (n=1) were administered the complete battery. Three additional patients were excluded because the reason for referral was traumatic brain injury and potential litigation was unclear. One other patient was excluded because she was actively involved in litigation. In two cases, a second assessment was performed as a follow up one year later; only the first assessment was utilized for the present analysis.
Twenty-nine were females and mean age was 56 years (SD=16.8). The mean education for the sample was 10.2 years (SD 4.16). None of the patients were involved in litigation nor had any apparent secondary gain that would lead to purposeful exaggeration of cognitive impairment.
Conclusions
Introduction
The Test of Memory Malingering (TOMM, Tombaugh T, 1996) was designed to help neuropsychologists discriminate between malingered and true memory impairments. Standardization of the measure was performed on 70 cognitively intact individuals recruited from the community ranging from years, mean education 12.7 years. No mention of ethnicity, race or language preference is made in the manual. The mean scores for this sample were 47.8 on Trial 1 and 49.9 on Trial 2. The percent of cognitively intact adults who correctly identified 45 or more items on Trial 1 was 90% and was at 100% at a score of 47 or higher on Trial 2.
According to the TOMM manual, suggested interpretation of the test is that 1) scoring lower than chance on any trial indicates the possibility of malingering and 2) any score lower than 45 on Trial 2 indicates the possibility of malingering.
Results
Our sample earned a mean score of 41.8 (SD=8.14) on Trial 1. Fifty percent (22/44) of the Spanish speaking group scored less than 45 on Trial 1 and 21% (9/44) of our sample “failed” Trial 2 in that they scored below 45/50. In addition, two of those nine earned a “less than chance score” on Trial 1 and 2 (<25).
Of the patients who “failed” the second trial of the TOMM, 5 were diagnosed with epilepsy, 1 had mild dementia, 2 had moderate to severe dementia and 1 had hydrocephalus.
Patients with a confirmed diagnosis of epilepsy were among the two who earned a ‘less than chance score” on both trials.
Results indicate that according to the TOMM manual interpretation guidelines, two of our epileptic subjects would have fulfilled both criteria suggesting “possibility of malingering.” In addition, 9 out of our 44 patients would fulfill criteria 2 from the manual.
The possibility of malingering carries much weight in litigation.
This report is intended to open up a discussion whether modifications in interpretation of scores and suggested cutoffs with Spanish speaking clients may be in order to improve sensitivity and specificity of this measure.
Some suggested future directions:
* Standardization studies of the TOMM that include (racially, ethnically, linguistically) representative samples.
Analysis of the 50 line drawings to assure cultural universality.