Assessment of Feigned Cognitive Impairment: A Neuropsychological Perspective

In the book Assessment of Feigned Cognitive Impairment, edited by Kyle Brauer Boone, the authors examine the array of assessment instruments that are used to determine feigned cognitive impairment. Part 1 of the book provides historical and literary examples of malingering to convey its universal nature. The contributors relate how feigned cognitive impairment has developed into an issue of prime significance in mental health and disability evaluations. They also provide a comprehensive overview of current functional neuroimaging studies of deception and malingering.

Part 2 of the book addresses techniques and strategies in cognitive effort assessments. The editor postulates that these forms of deception occur on a continuum and that forms of malingering overlap with somatoform disorders—contrary to the current DSM-IV classification system that differentiates malingering and somatoform disorders as mutually exclusive. There is an expansive discussion of forced-choice effort tests and the utility of these tests in helping to determine the likelihood of malingering. Non-forced-choice measures are also discussed, including the Rey-15 Test of Memory and the Rey Word Recognition Test.

The book lists an overview of estimated malingering base rates for a variety of medical and neurocognitive conditions. Also discussed are intelligence tests as a measure of effort in assessing cognitive impairment. The authors discuss the utility of intelligence testing in delineating poor effort as a sign of neurocognitive impairment and malingering. They also provide an assessment of the use of standardized memory tests to determine effort that is suspect. Reviewed tests include the Warrington Recognition Memory Test and the Wechsler Memory Scale. The authors compare predictive values of standardized memory tests, concluding that these tests of effort are useful in determining suspect efforts only if they are relied on with other forms of neuropsychological evaluations.

Executive functioning measures, motor and sensory tests, and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) are assessed for their usefulness and limitations in a determination of malingering. Included in the discussion of executive function measures is an in-depth review of the Wisconsin Card Sorting Test. The authors provide extensive evidence that the MMPI-2 is highly valuable in determining feigned cognitive impairment, noting that the MMPI-2 has high predictive value, sensitivity, and specificity.

Part 3 of the book reviews neuropsychological testing for feigned cognitive impairment in cases of mild traumatic brain injury, pain- and fatigue-related medical disorders, mental retardation, attention-deficit hyperactivity disorder, and toxin exposures. This part of the book also discusses the challenges of cognitive testing with non-English-speaking and forensic populations. Part 3 concludes with an assessment of the state of cognitive testing instruments and predictions about the future of these tests.

This book provides an encompassing review of the various assessments for malingering cognitive impairment. The critique offered on the utility of these assessments is based on a comprehensive review of published research in the field. This book is technically advanced and is most appropriate as a reference for psychiatrists and psychologists who wish to develop expertise in assessing feigned cognitive impairment.