It is now highly recommended that when assessing the Neuropsychological (NP) status of individuals, one should use effort measures to determine the effect of the individual's level of personal effort on his test results.
Studies indicate that depressed individuals often do not produce good effort on NP testing.
Suggestions at how to control for effort when looking at the effect of depression on NP variables will be much appreciated.
Most widely published effort tests, such as the TOMM, Victoria and WMT have been validated in depressed patients. Thus, unless teh patient is obtunded, these types of tests should be useful. Also, depessed patients will tend to show problems with encoding, bu not retrieval on memory tests.
Dear Jacob,
oftentimes, cognitive effort is measured as the time an individual spends on specific material (e.g., solving as many simple math problems as possible). Alternatively, you can use a self-report measure (such as the need for cognition [NFC] scale). I have appended two articles you may consider useful for your own research purpose.
Enge et al. (2011). On the role of serotonin and effort in voluntary attention:
Evidence of genetic variation in N1 modulation.
Hoffman (2012). Cognitive efficiency: A conceptual and methodological comparison.
http://www.ncbi.nlm.nih.gov/pubmed/?term=On+the+role+of+serotonin+and+effort+in+voluntary+attention%3A+Evidence+of+genetic+variation+in+N1+modulation
it's generally accepted that a full neuropsychological battery should include stand alone and embedded measure of effort (now called performance.) These tests should be spaced throughout the battery, as we know that performance varies over time and is affected by fatigue and other factors. The Word Memory Test (WMT) compares scores on a number of measures with various clinical populations, including depressed individuals. This, in addition to the clinical interview and depression scales, could help you determine whether the low effort scores are likely the result of depression or not.
Most widely published effort tests, such as the TOMM, Victoria and WMT have been validated in depressed patients. Thus, unless teh patient is obtunded, these types of tests should be useful. Also, depessed patients will tend to show problems with encoding, bu not retrieval on memory tests.
Absolutely. Include performance validity measures that included individuals with depression in the normative studies, and consider the clinical history and pattern of performance across the entire test battery when interpreting data.
This is a very difficult issue. I assume you're interested in accounting for effort as a factor independent of cognitive/affective capacity. In that case, effort clearly cannot be quantified in terms of performance. I also have reservation about subjective report, particularly from depression patients. One possibility is to identify a neural correlate of effort; see e.g., http://www.ncbi.nlm.nih.gov/pubmed/19761851
The TOMM, Rey-15, WMT, and Hiscok are great validity measures. One should administer at least 2 tests. Utilization of the CVLT-2 as well, looking at the forced choice part of the test, learning curve, perseverations...
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