1. Background/Objective
Clinical Utility of the Memory Complaints Inventory to Detect Medical Symptom Validity Test and Non-Verbal Medical Symptom Test Validity Performance
Patrick Armistead-Jehle, Ph.D., ABPP-CN1, Chad E. Grills, Ph.D2., ABPP-CN; Rachel K. Bieu, Ph.D.3,4; Joseph F. Kulas, PhD., ABPP-CN3,4
1Fort. Leavenworth, KS, 2Schofield Barracks, HI, 3VA Connecticut Health Care System, 4Yale School of Medicine, Department of Psychiatry
Background/Objective
Subjective memory complaints are frequently encountered by neuropsychologists; however, there is a limited relationship between such complaints and performances on standardized measures (Armistead-Jehle, Gervais, & Green, 2012a; 2012b). Explanations for this limited relationship include pain, psychological factors, insomnia, and somatization, as well as response bias and poor effort. The Memory Complaints Inventory (MCI) is a 58 item self-report instrument resulting in nine scales designed to measure credible and non-credible subjective memory symptoms. While the MCI could be useful in assessing the degree to which exaggeration influences subjective self report, few studies have evaluated how this measure compares to performance validity testing.
The primary aim of the current study was to examine the classification statistics of the MCI relative to two well established stand-alone measures of performance validity, the MSVT and NV-MSVT. It was hypothesized that the MCI would adequately classify PVT performances across a clinical sample, in terms of sensitivity, specificity, negative predictive power, and positive predictive power.
TABLE 1. MCI Scale Classification Statistics with MSVT as Criterion Variable (n=339)
MCI Scale
Total Score
Sensitivity
 Specificity
BR = .25
BR = .35
BR = .45
PPP
NPP
IRM
≥ 50%
.16
.98
.69
.78
.79
.68
.85
.59
≥ 40%
.29
.95
.64
.80
.74
.71
.81
.62
≥ 30%
.40
.84
.46
.58
.72
.63
≥ 20%
.38
.83
.50
.75
.60
.67
≥ 10%
.28
.90
.48
.70
.61
ACB
.13
.97
.77
.34
.91
.56
.76
.45
.47
.82
.65
.66
.37
.49
.87
.31
.89
.42
.52
AAB
.05
.53
.08
.57
.36
Mean MCI Scales
.23
.96
.51
.73
.86
.41
.33
.44
.55
1.0
.14
.39
TABLE 3. Comparison of MCI Scale Scores as a Function of MSVT and NV-MSVT Performance (n=339)
 MCI Scale
MSVT
NV-MSVT
Pass
Fail t p
IRM
16.5 (12.7)
27.7 (17.6)
6.2
<.001
17.6 (13.8)
27.7 (17.4)
4.6
ACB
17.2 (14.0)
29.7 (17.4)
6.5
18.4 (14.8)
29.2 (18.1)
AAB
7.64 (10.1)
13.9 (14.4)
4.3
8.2 (10.9)
14.1 (13.7)
3.4
=.001
Mean MCI
24.2 (13.9)
37.4 (14.3)
7.3
25.6 (14.6)
36.7 (14.0)
5.0
TABLE 4. Point Biserial Correlations Between MCI Scales and MSVT and NV-MSVT
MCI Scale
Performance Validity Test
MSVT
NV-MSVT
IRM
-.32 (p<.001)
-.24 (p<.001)
ACB
-.33 (p<.001)
AAB
-.28 (p<.001)
-.18 (p=.001)
Mean MCI
-.37 (p<.001)
-.26 (p<.001)
Results
The examined MCI Scales were negatively correlated with failure on the MSVT and NV-MSVT (all p values ≤ .001) – see Table 4.
Those who failed the MSVT and NV-MSVT had significantly higher scores on the examined MCI scales (all p values ≤ .001) – see Table 3.
The examined MCI scales demonstrated acceptable specificity in relation to PVT failure, but limited sensitivity and positive and negative predictive powers (see Tables 1 and 2).
TABLE 2. MCI Scale Classification Statistics with NV-MSVT as Criterion Variable (n=339)
MCI Scale
Total Score
Sensitivity
 Specificity
BR = .25
BR = .35
BR = .45
PPP
NPP
IRM
≥ 50%
.16
.97
.61
.78
.71
.68
.79
.58
≥ 40%
.24
.92
.49
.69
.70
.60
≥ 30%
.38
.82
.41
.80
.53
.63
.62
≥ 20%
.66
.84
.50
.76
≥ 10%
.34
.30
.87
.51
.72
ACB
.14
.96
.55
.77
.75
.26
.88
.59
.44
.39
.64
.35
.46
.47
.57
.65
.98
.33
.31
.93
.43
.89
AAB
.04
.06
.45
.67
.56
.12
.28
.81
Mean MCI Scales
.32
.74
.40
.52
.86
.83
1.00
.11
.37
.48
Conclusions
There is a clear association between PVT failure and elevations on the examined MCI scale scores. Given the high levels of specificity, when elevated (i.e., >50%), the examined MCI scales may serve to alert the clinician to the possibility of performance invalidity. However as the sensitivity, PPP, and NPP of these scales in relation to PVT failure is limited, MCI administration (absent of PVTs) as a means to gauge performance validity is not supported.
Methods
A retrospective review of cases administered the MCI, MSVT, and NV-MSVT was conducted. The sample consisted of 339 Active Duty Service Members with an average age and education of 34.8 years (SD = 7.7) and 15.0 years (SD = 2.4), respectively % were male.
Select MCI scales designed to assess non-credible memory complaints were examined. Impairment of Remote Memory [IRM], Amnesia for Complex Behavior [ACB], Amnesia for Antisocial Behavior [AAB], and the overall MCI subtest mean were compared to the MSVT and the NV-MSVT, with suboptimal effort defined by the respective manuals.
References
Armistead-Jehle, P., Gervais, R.O. & Green, P. (2012a). Memory complaints and symptom validity test performance in a clinical sample. Archives of Clinical Neuropsychology, 27,
Armistead-Jehle, P., Gervais, R.O. & Green, P. (2012b). Memory Complaints Inventory results as a function of symptom validity test performance. Archives of Clinical Neuropsychology, 27,
* The views, opinions, and/or findings contained in this research are those of the authors and should not be construed as official Department of the Army or Department of Veterans Affairs positions, policies, or decisions unless so designated by other official documentation