Medical Symptom Validity Test

The MSVT for Windows was first displayed in public at the NAN meeting, Tampa, Fl., October 2005, after extensive validation in Canada, the USA, Britain, Germany & Brazil in English, German, Portuguese & French studies. The MSVT is only available from Green’s Publishing.

The MSVT consists of a 94-page test manual and a CD with MSVT Windows program for patient testing, scoring and reporting of results. More than just a short form of the WMT, the MSVT is extremely cost effective and fast as a verbal memory screen with built-in effort measures.

Whereas the WMT has 20 word pairs, the MSVT has 10 pairs, cutting the test in half. The WMT has 6 subtests and a 30 minute delay between IR and DR subtests but the MSVT contains only 4 subtests and a 10 minute delay. Hence, the MSVT takes much less time than the WMT. Administration and scoring are automated.

The patient works on the MSVT for roughly 5 minutes. Your time administering the test is even less than that because it is computerized. The MSVT closely approximates the WMT in sensitivity. It has even higher specificity because it has been shown that MSVT subtests are objectively easier than WMT subtests in several groups (e.g. early and advanced dementia).

In a large Brazilian study (Courtney), the test was 99% accurate in differentiating between good effort versus simulated memory impairment. Of the simulators, 68 out of 70 cases failed the MSVT and all of them had an implausible profile. None of the simulators had a profile which would be consistent with dementia.

Two papers reporting completely independent research by Howe et al (2007, 2008) emphasize the importance of examining not only pass or fail on easy subtests but analyzing the profile of scores.

Whereas none of the simulators in the Brazilian study produced a “dementia profile”, 95% of the dementia cases studied by Howe et al either passed or they produced a dementia profile (i.e. 97% sensitivity to poor effort and 95% specificity in dementia).

Howe, L. L. S., Anderson, A. M., Kaufman, D. A. S., Sachs, B. C., & Loring, D. W. (2007). Characterization of the Medical Symptom Validity Test in evaluation of clinically referred memory disorders clinic patients. Archives of Clinical Neuropsychology, 22 (6), 753-761<

Howe, L.L.S. and Loring, D.W. (2008, in press) Classification Accuracy and Predictive Ability of The Medical Symptom Validity Test’s Dementia Profile and General Memory Impairment Profile. The Clinical Neuropsychologist

Non-French speaking children, when tested with the MSVT in French, scored the same as adults or children who are fluent in French (Gervais). Now, how does that happen?

The MSVT also has the Stealth option. The Stealth MSVT looks similar to the standard MSVT but the subtests have very different psychometric properties, the purpose being to deter coaching and render it ineffective.

Comparing MSVT & TOMM given to 292 adult outpatients with compensation incentives

Pass MSVT
Fail MSVT
Pass TOMM
211
44
Fail TOMM
9
28

MSVT pass and fail rates were compared in two groups; those who had passed both WMT & TOMM (n=96) versus those who had failed both WMT and TOMM (n=17) in testing of outpatients involved in compensation claims by Dr. Gervais. Using only the simple pass-fail distinction based on IR, DR & CNS scores, the MSVT was found to have 88% sensitivity; 91% specificity; 90% PPP and 89% NPP (assuming 50% base rate).

The MSVT and the MCI Windows programs may both be administered in English, French, Spanish, Dutch, German or Portuguese. The WMT Windows (Green, 2003) is in 10 languages (plus several more in the oral format). The nonverbal MSVT may be administered in any language. It is important to note that the primary purpose for the MSVT (& WMT) is to determine whether effort is sufficient to produce reliable and valid test scores on neuropsychological tests.

The nonverbal NV-MSVT is the latest addition to this series of tests, which measure both effort and memory. It may be used with people of any language because the patient sees no words at all on the screen. However, it incorporates several new principles not previously seen in any effort test.

Many people will pass TOMM but fail the NV-MSVT and we can prove that these are not false positives for the NV-MSVT.  DISCUSSIONS/RECENT_PAPERS_2010/TOMM_vs_NV-MSVT_abstract only.doc

Scores on CVLT SD Free Recall by pass/fail MSVT or TOMM

N
Mean CVLT
Free Recall
Std.
Dev.
Mean CVLT
Recog. Hits
Std.
Dev.
Pass TOMM
& MSVT
132
10.8
3.3
15
1.6
Fail only TOMM
5
8.8
2.5
13
1.9
Fail only MSVT
30
8.6
2.9
13
2.5
Fail both
14
7.1
2.8
13
2.8
P<0.001
P<0.001

The MSVT literally takes 5 minutes of the patient’s time on task but the above table, based on patients tested by Dr. R. Gervais, Psychologist, shows that 15% of cases fail MSVT but pass TOMM. The above table shows that those who failed MSVT and passed TOMM (group 3) scored at a significantly lower level on the CVLT than those passing both. This is important.