Moving the Goalposts: Examination of the Rey 15-Item Test in Older Adults Rachel L. Fazio, Psy.D., Allison N. Faris, Psy.D., Karim Z. Yamout, Psy.D., & James M. McGovern, Psy.D. Carter Psychology Center, Bradenton, Florida, & Neuropsychological Associates, Santa Rosa, CA Send correspondence to: rlfazio@gmail.com ABSTRACT RESULTS Table 1. Regression Values for Age & Diagnosis. Objective: To determine the validity of the Rey Fifteen Item Test (RFIT) as a freestanding performance validity test in an elderly population with varying cognitive diagnoses. Method: Participants were patients referred for outpatient neuro-psychological assessment, primarily for memory complaints. Those with medicolegal issues were removed leaving 83 who were given the RFIT. Average age was 70; mean education was 14 years. Participants were diagnosed with no cognitive diagnosis (14.5%), Mild Cognitive Impairment (43.4%), Major Neurocognitive Disorder (30.1%), or another diagnosis (12%; mostly ADHD). The RFIT combination score was calculated (Boone et al., 2002). Results: There was a correlation of -.56 between age and combination score (p < .01). Over 57% of those > 50 years old failed the RFIT. Greater cognitive impairment led to higher failure rates (MND = 88%, MCI = 44%, no/other diagnosis = 23%). In individuals over 50 with no cognitive diagnosis, 22% produced a failing score. Multiple regression was performed to clarify these relationships. One model indicated significant contributions of both age and diagnosis (R2 = .417). Additional variables were also evaluated in exploratory models. Conclusions: RFIT score was affected by diagnosis and age. Results suggest the RFIT has poor specificity for detecting underperformance on cognitive testing in a clinical population over age 50. While a passing score on the RFIT with an older evaluee is an indicator of good effort, a “failing” score has little clinical value. Processing speed demonstrated a significant relationship with combination score as did scores on a test of visual memory. Crosstabulation: Over 57% of those over age 50 produced a failing score on the RFIT; 60% of those over age 60 did so; 71% of those over 70 failed the RFIT. Diagnosis also appeared to have an effect as 88% of those with MND produced a failing score, vs. 44% with MCI; 23% of those with no/other diagnosis (combined group) produced a failing score. Even when only those without any cognitive diagnosis were considered, 22% of individuals over age 50 still produced a failing score. Correlation: Age was significantly (p < .01) negatively correlated with RFIT combination score (rs = -.56). Multiple Regression: Hierarchical multiple regression demonstrated a significant contribution for both age and diagnosis (R2 = .417). When measures of processing speed were also included, the proportion of variance explained increased significantly whether WAIS-IV Symbol Search (R2 = .614) or Trail Making Test A (TMTA) was used (R2 = .491). See Tables 1-3 for regression values. Similarly, there appeared to be a contribution of short-term visual memory, with the Rey Complex Figure Test’s 3-minute recall trial making a significant contribution (R2 = .519), although there were fewer cases available for this analysis. B SE β t p Age -.188 .051 -.351 -3.665 <.001 Diagnosis -3.48 .818 -.407 -4.254 Note. Constant = 38.08. N = 83. Diagnoses were collapsed as 0 = No diagnosis; 1 = LD/Other; 2 = MCI; 3 = MND. Table 2. Regression Values for Age, Diagnosis, and Symbol Search. B SE β t p Age -.203 .046 -.378 -4.372 <.001 Diagnosis -2.15 .774 -.252 -2.779 .007 Symbol 1.15 .201 .467 5.752 Note. Constant = 26.26. N = 69. Diagnoses were collapsed as 0 = No diagnosis; 1 = LD/Other; 2 = MCI; 3 = MND. Table 3. Regression Values for Age, Diagnosis, and TMTA. B SE β t p Age -.258 -.051 -.534 -.332 -.251 Diagnosis -4.41 -1.043 -.565 -.358 -.273 TMTA -.115 -.027 -.523 -.356 -.272 CONCLUSIONS METHOD An RFIT combination score of < 20 has an unacceptably high false positive rate in individuals over the age of 50. This may be due to processing speed slowing with age given the very brief exposure time for the RFIT stimuli. Exploratory analyses also demonstrated a contribution of visual memory abilities. The RFIT is not suggested for use in adults over age 50 due to very poor specificity values. In order to achieve approximately 90% specificity (which in this case would simply remove the lowest scoring 10%), the following values would need to be used: Combination score > 6 Recall > 3 True positives > 3 False positives < 5 Future research may want to explore using additional variables, such as intrusions, repetitions, or atypical recognition errors to improve specificity in older populations. Alternately, longer exposure time or multiple presentations may also improve specificity. Participants: All participants were individuals who presented to an outpatient clinic for neuropsychological assessment. Medicolegal cases were not included in these analyses. Eighty-three had been administered a RFIT. Average age was 70 (± 16), average education 14 years (± 2.8). The sample was 49.4% female. Almost a third of the sample was assigned a clinical diagnosis of dementia (30.1%); 43.4% Mild Cognitive Impairment (MCI); 12% a historical or new diagnosis related to a learning disorder/ADHD; 14.5% had no diagnosis. Measures: RFIT and clinical testing; due to the clinical nature of the testing, not all participants received all other tests used in regressions. (A RFIT combination score of < 20 was considered “failing.”) Data Analysis: Crosstabulation of % failing the RFIT in various age brackets was calculated. Spearman correlations were run between age and combination score. Finally, multiple regression was performed. Note. Constant = 31.68. N = 75. Diagnoses were collapsed as 0 = No diagnosis; 1 = LD/Other; 2 = MCI; 3 = MND. REFERENCES Boone, K. B., Salazar, X., Lu, P., Warner-Chacon, K., & Razani, J. (2002). The Rey 15-item recognition trial: A technique to enhance sensitivity of the Rey 15-item memorization test. Journal of clinical and Experimental Neuropsychology, 24(5), 561-573. Rey, A. (1964). L’examen clinique en psychologic. Paris: Presses Universitaires de France.