Performance validity test failure rates among neuropsychological outpatients clinically referred for persistent Long COVID cognitive symptoms following mild SARS-CoV-2 disease severity.

Abstract

Objective: Persisting cognitive symptoms following SARS-CoV-2 infection (Long COVID) has become an increasingly common referral for neuropsychological evaluation. This study examined performance validity test (PVT) failure rates among adults referred for evaluation due to Long COVID cognitive complaints after mild SARS-CoV-2 disease severity.

Method: Data from 57 demographically diverse outpatients (72% female; M_age = 44.23; M_education = 15.39 years) consecutively referred for a focused neuropsychological evaluation due to Long COVID cognitive symptoms were analyzed. The neuropsychological test battery included one freestanding (Test of Memory Malingering-Trial 1) and four embedded PVTs (Reliable Digit Span; California Verbal Learning Test-Brief Form Forced Choice; Brief Visuospatial Memory Test-Revised Recognition Discriminability; Stroop Color and Word Test-Word Reading T-Score), as well as a 11 neuropsychological test scores assessing the major domains of cognition, which were used to compute an overall neuropsychological test battery mean composite score.

Results: Individual PVT failure rates ranged from 4% to 18%. Overall, 67% passed all PVTs, 24% failed one PVT, and 9% failed ≥ 2 PVTs. Patients failing two or more PVTs had an overall neuropsychological test battery mean performance that was significantly lower than the group failing one or zero PVTs and 1.0 standard deviations below the population mean. Patients with zero PVT failures also outperformed those with one PVT failure by 0.5 standard deviations. Nonsignificant differences in COVID disease characteristics emerged between groups.

Conclusions: The majority of patients (67%) passed all PVTs, with 24% of patients failing one PVT and 9% failing ≥ 2 PVTs. Future research is warranted to understand implications of a single freestanding PVT failure in this population, and to establish base rates of invalidity in Long COVID and among those with more severe initial COVID infection necessitating hospitalization and/or medical intervention. Such practices ensure accurate diagnosis, guide treatment, and improve the reliability of research on the cognitive sequelae of COVID-19.