Detecting feigned cognitive impairment using pupillometry on the Warrington Recognition Memory Test for Words.

OBJECTIVE: Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious control. This study examined pupillary dilation patterns during a performance validity test (PVT) among adults with true and feigned impairment of traumatic brain injury (TBI). PARTICIPANTS AND METHODS: Participants were 214 adults in three groups: adults with bona fide moderate to severe TBI (TBI; n = 51), healthy comparisons instructed to perform their best (HC; n = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; n = 91). The Recognition Memory Test (RMT) was administered in the context of a comprehensive neuropsychological battery. Three pupillary indices were evaluated. Two pure pupil dilation (PD) indices assessed a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillary-behavioral index was also evaluated. Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer). RESULTS: All three indices differed significantly among the groups, with medium-to-large effect sizes. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI; adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, subgroup analyses indicated that DRI differed significantly for simulators who scored in the invalid range on the RMT (n = 45) versus adults with genuine TBI who scored invalidly (n = 15). CONCLUSIONS: The findings support continued research on the application of pupillometry to performance validity assessment: Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.

Lowered cutoffs to reduce false positives on the Word Memory Test.

OBJECTIVE: To adjust the decision criterion for the Word Memory Test (WMT, Green, 2003) to minimize the frequency of false positives. METHOD: Archival data were combined into a database (n = 3,210) to examine the best cut score for the WMT. We compared results based on the original scoring rules and those based on adjusted scoring rules using a criterion based on 16 performance validity tests (PVTs) exclusive of the WMT. Cutoffs based on peer-reviewed publications and test manuals were used. The resulting PVT composite was considered the best estimate of validity status. We focused on a specificity of .90 with a false-positive rate of less than .10 across multiple samples. RESULTS: Each examinee was administered the WMT, as well as on average 5.5 (SD = 2.5) other PVTs. Based on the original scoring rules of the WMT, 31.8% of examinees failed. Using a single failure on the criterion PVT (C-PVT), the base rate of failure was 45.9%. When requiring two or more failures on the C-PVT, the failure rate dropped to 22.8%. Applying a contingency analysis (i.e., X2) to the two failures model on the C-PVT measure and using the original rules for the WMT resulted in only 65.3% agreement. However, using our adjusted rules for the WMT, which consisted of relying on only the IR and DR WMT subtest scores with a cutoff of 77.5%, agreement between the adjusted and the C-PVT criterion equaled 80.8%, for an improvement of 12.1% identified. The adjustmeny resulted in a 49.2% reduction in false positives while preserving a sensitivity of 53.6%. The specificity for the new rules was 88.8%, for a false positive rate of 11.2%. CONCLUSIONS: Results supported lowering of the cut score for correct responding from 82.5% to 77.5% correct. We also recommend discontinuing the use of the Consistency subtest score in the determination of WMT failure.

Age effects in autobiographical memory depend on the measure.

Studies examining age effects in autobiographical memory have produced inconsistent results. This study examined whether a set of typical autobiographical memory measures produced equivalent results in a single participant sample. Five memory tests (everyday memory, autobiographical memory from the past year, autobiographical memory from age 11-17, word-cued autobiographical memory, and word-list recall) were administered in a single sample of young and older adults. There was significant variance in the tests' sensitivity to age: word-cued autobiographical memory produced the largest deficit in older adults, similar in magnitude to word-list recall. In contrast, older adults performed comparatively well on the other measures. The pattern of findings was broadly consistent with the results of previous investigations, suggesting that (1) the results of the different AM tasks are reliable, and (2) variable age effects in the autobiographical memory literature are at least partly due to the use of different tasks, which cannot be considered interchangeable measures of autobiographical memory ability. The results are also consistent with recent work dissociating measures of specificity and detail in autobiographical memory, and suggest that specificity is particularly sensitive to ageing. In contrast, detail is less sensitive to ageing, but is influenced by retention interval and event type. The extent to which retention interval and event type interact with age remains unclear; further research using specially designed autobiographical memory tasks could resolve this issue.

Apparatus design and behavioural testing protocol for the evaluation of spatial working memory in mice through the spontaneous alternation T-maze.

Spatial working memory can be assessed in mice through the spontaneous alternation T-maze test. The T-maze is a T-shaped apparatus featuring a stem (start arm) and two lateral goal arms (left and right arms). The procedure is based on the natural tendency of rodents to prefer exploring a novel arm over a familiar one, which induces them to alternate the choice of the goal arm across repeated trials. During the task, in order to successfully alternate choices across trials, an animal has to remember which arm had been visited in the previous trial, which makes spontaneous alternation T-maze an optimal test for spatial working memory. As this test relies on a spontaneous behaviour and does not require rewards, punishments or pre-training, it represents a particularly useful tool for cognitive evaluation, both time-saving and animal-friendly. We describe here in detail the apparatus and the protocol, providing representative results on wild-type healthy mice.

When 10 is enough: Errors on the first 10 items of the Test of Memory Malingering (TOMMe10) and administration time predict freestanding performance validity tests (PVTs) and underperformance on memory measures.

It is critical that we develop more efficient performance validity tests (PVTs). A shorter version of the Test of Memory Malingering (TOMM) that utilizes errors on the first 10 items (TOMMe10) has shown promise as a freestanding PVT. Retrospective review included 397 consecutive veterans administered TOMM trial 1 (TOMM1), the Medical Symptom Validity Test (MSVT), and the Brief Visuospatial Memory Test-Revised (BVMT-R). TOMMe10 accuracy and administration time were used to predict performance on freestanding PVTs (TOMM1, MSVT). The impact of failing TOMMe10 (2 or more errors) on independent memory measures was also explored. TOMMe10 was a robust predictor of TOMM1 (area under the curve [AUC] = 0.97) and MSVT (AUC = 0.88) with sensitivities = 0.76 to 0.89 and specificities = 0.89 to 0.96. Administration time predicted PVT performance but did not improve accuracy compared to TOMMe10 alone. Failing TOMMe10 was associated with clinically and statistically significant declines on the BVMT-R and MSVT Paired Associates and Free Recall memory tests (d = -0.32 to -1.31). Consistent with prior research, TOMMe10 at 2 or more errors was highly accurate in predicting performance on other well-validated freestanding PVTs. Failing just 1 freestanding PVT (TOMMe10) significantly impacted memory measures and likely reflects invalid test performance.

Remote Ecological Momentary Testing of Learning and Memory in Adults With Serious Mental Illness.

Smartphone-based ecological mobile cognitive tests (EMCTs) can measure cognitive abilities in the real world, complementing traditional neuropsychological assessments. We evaluated the validity of an EMCT of recognition memory designed for use with people with serious mental illness, as well as relevant contextual influences on performance. Participants with schizophrenia (SZ), schizoaffective disorder, and bipolar disorder (BD) completed in-lab assessments of memory (Hopkins Verbal Learning Test, HVLT), other cognitive abilities, functional capacity, and symptoms, followed by 30 days of EMCTs during which they completed our Mobile Variable Difficulty List Memory Test (VLMT) once every other day (3 trials per session). List length on the VLMT altered between 6, 12, and 18 items. On average, participants completed 75.3% of EMCTs. Overall performance on VLMT 12 and 18 items was positively correlated with HVLT (ρ = 0.52, P < .001). People with BD performed better on the VLMT than people with SZ. Intraindividual variability on the VLMT was more specifically associated with HVLT than nonmemory tests and not associated with symptoms. Performance during experienced distraction, low effort, and out of the home location was reduced yet still correlated with the in-lab HVLT. The VLMT converged with in-lab memory assessment, demonstrating variability within person and by different contexts. Ambulatory cognitive testing on participants' personal mobile devices offers more a cost-effective and "ecologically valid" measurement of real-world cognitive performance.

Sex-, age- and education-adjusted norms for the WHO/UCLA version of the Rey Auditory Verbal Learning Test for Sinhala-speaking Sri Lankan adults.

OBJECTIVE: The aim of this study was to create sex-, age- and education-adjusted norms for the WHO/UCLA version of the Rey Auditory Verbal Learning Test (RAVLT) for Sinhala-speaking Sri Lankan adults. METHODS: Five-hundred and sixty-one healthy, community-living adults (252 men), aged 19-83 years, and had 0-23 years of education completed the WHO/UCLA RAVLT in Sinhala language. We conducted multiple linear regression analyses with sex, age and years of education to predict RAVLT list A1-A5 individual trial scores; trials A1-A5 total learning; list B score; immediate and delayed recall and recognition trial scores; and retroactive interference. RESULTS: We report regression equations to predict RAVLT norms based on sex, age and years of education; and the test variances accounted by those variables. Accordingly, all measures, except retroactive interference had a significant age-related decline. All measures, except the recognition trial hits, significantly improved with more years of education. Women had significantly higher scores in all measures except in trial B and retroactive interference. Proactive interference, learning rate, learning over trials were not associated with sex, age or education. A confirmatory factor analysis loaded the RAVLT outcome measures into two factors: acquisition and retention. CONCLUSIONS: We report sex-, age- and education-adjusted WHO/UCLA RAVLT norms for Sinhala-speaking Sri Lankans aged 19-83 years; and supplement the regression formulae with a calculator that produces predicted and standard scores for given test participant. These norms would help clinicians accurately interpret individual test results, accounting for the variability introduced by sex, age and education.

Development, psychometric properties, and pilot norms of the first Arabic indigenous memory test: The Verbal Memory Arabic Test (VMAT).

BACKGROUND: Tests of verbal memory (list learning) are particularly useful for clinicians and researchers globally, yet there are no psychometrically robust tests that are built indigenously for Arabic-speaking populations, which comprise more than 370 million. OBJECTIVE: To develop a verbal memory Arabic test using a systematic procedure of item selection and then provide evidence of validity and reliability in an Arabic-speaking sample in Lebanon. METHOD: In study 1, we conducted a word prototypicality study (n = 77), and identified 932 words across 7 semantic categories. Following quantitative analyzes and qualitative judgments by an expert panel, we selected a sufficient number of words and categories, and constructed and piloted the items, instructions, and protocol for the Verbal Memory Arabic Test (VMAT). In study 2, we administered the VMAT on a community sample (n = 199; screened for depression and cognitive impairment) and patients with Multiple Sclerosis (n = 16). RESULTS: Scores decreased with age as expected, they discriminated well between healthy and clinical populations (matched on age, sex, and years of education), and showed acceptable consistency within items and across time. Conclusions: The VMAT is the first Arabic test developed indigenously. It can be used in clinical and research settings with Arabic-speaking populations to assess verbal learning.

Utility of abbreviated versions of the test of memory malingering in children with traumatic brain injury.

We evaluated the classification accuracy of two abbreviated versions of the Test of Memory Malingering (TOMM) in prediction of results on the full-length instrument in a sample of 126 children who were evaluated within 1-12 months after traumatic brain injury. Both a version based on administration of Trial 1 and a version based on administration of only the first 10 items of Trial 1 had acceptable specificity (i.e., > .90) and sensitivity (i.e., > .60) with regard to prediction of pass/fail results on the complete TOMM. Failure on the TOMM suppressed performance on measures of processing speed that were otherwise sensitive to severity of traumatic brain injury. We conclude that these abbreviated versions of the TOMM can be used in clinical practice with children with traumatic brain injury, at the discretion of the neuropsychologist.

A review of performance and symptom validity testing with pediatric populations.

Growing recognition and concerns of non-credible performance in pediatric populations have led clinicians to investigate the utility of performance and symptom validity tests (PVT/SVTs) among children and adolescents. Yet current research has indicated that a minority of clinicians routinely utilize a free-standing PVT in pediatric neuropsychological evaluations. The current article investigates the rationale for using PVT/SVTs, and the impact that failure of such exams have on other neurocognitive tests. A review of common adult PVTs and their appropriateness for use with specific pediatric clinical populations is presented, as well as empirical evidence for evaluating embedded validity indicators. The limited literature on SVTs with youth is also reviewed and provides additional insight into symptom exaggeration. There are various reasons children would provide noncredible performance, many of which are different from adults. A review of how the clinician should handle this behavior in pediatric evaluations is provided and what patient populations may present with a higher base rate of failure. Finally, various approaches are offered on how to explain these results to children and their caregivers.

Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in a Colombian Population.

BACKGROUND: Cognitive impairment has been recognized as an important factor in multiple sclerosis (MS) in the past few years. One brief, reliable and valid tool to assess cognition in MS is the BICAMS, which encompasses the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test (CVLT II), and the Brief Visuospatial Memory Test - Revised (BVMT-R). Continuing with the international initiative to validate the BICAMS in different countries, here we present the results obtained from the efforts in validating such test in the Colombian population. METHOD: 100 healthy controls and 50 MS patients participated in the study, group matched for age, education and gender. Subjects completed all three tests of the BICAMS. Instead of the CVLT-II, the Colombian validated form PAMCL (Prueba de Aprendizaje y Memoria con Codificación Libre) was used. Test-retest measures were obtained for 16 patients in order to test for reliability. RESULTS: Evidence of criterion validity was obtained, MS group performing significantly worse than HC group in all three tests (SDMT: p= .001, d= 0.59; PAMCL: p= .03, d= 0.38; BVMT-R: p<.001, d= 0.58). Test-retest was also obtained, finding significant correlations for all three tests (SDMT: r=0.932, p<.00; BVMT-R: r=0.863, p<.001; PAMCL: r=0.889, p<.001). Standardization of raw scores to uncontrolled scaled scores was done and these scores were then adjusted for age and years of schooling using a multiple linear regression. CONCLUSIONS: The BICAMS proved to be a valid and sensitive tool to screen for cognitive impairment in MS patients.

Identification of Subtle Verbal Memory Deficits in Premanifest Huntington Disease Using the California Verbal Learning Test.

BACKGROUND: Verbal memory impairment in individuals with Huntington disease (HD) is well-documented; however, the nature and extent of verbal memory impairment in individuals with premanifest HD (pre-HD) are less understood. OBJECTIVE: To evaluate verbal memory function in individuals with pre-HD by comparing their performance on the California Verbal Learning Test to that of individuals with a clinical diagnosis of HD and that of a demographically similar group of adults with no family history of, or genetic risk for, HD, thereby reducing possible complications of psychiatric difficulties commonly experienced by individuals who are at risk for HD but are gene negative. METHODS: Participant groups included 77 adults with a diagnosis of HD, 23 premanifest gene carriers for HD (pre-HD), and 54 demographically similar, healthy adults. The California Verbal Learning Test-Second Edition (CVLT-II) was used to evaluate the participants' immediate and delayed recall, recognition, learning characteristics, errors, and memory retention. RESULTS: The pre-HD group performed significantly worse than the healthy group, yet significantly better than the HD group, on Short and Long Delay Recall (Free and Cued) and Recognition Discriminability. On Total Immediate Recall, Learning Slope, Semantic Clustering, and Intrusions, the pre-HD group performed similarly to the healthy group and significantly better than the HD group. None of the groups differed in their performance on Repetitions and a measure of retention. CONCLUSIONS: Subtle memory deficits can be observed during the premanifest stage of HD with use of a subset of indices from the CVLT-II.

Minimizing evaluation time while maintaining accuracy: Cross-validation of the Test of Memory Malingering (TOMM) Trial 1 and first 10-item errors as briefer performance validity tests.

Current standards of practice in neuropsychology advocate for including validity tests (PVTs). Abbreviating PVTs, such as the Test of Memory Malingering (TOMM), may help reduce overall evaluation time while maintaining diagnostic accuracy. TOMM Trial 1 performance (T1), as well as the number of errors within the first 10 items of Trial 1 (TOMMe10), have shown initial promise as abbreviated PVTs but require additional external cross-validation. This study sought to replicate findings from other mixed, diverse, clinical samples and provide further validation of abbreviated administrations of the TOMM. Data included 120 veterans who completed the TOMM and 3 criterion PVTs during clinical evaluation. In total, performance from 68% of the sample was classified as valid (52% met criteria for cognitive impairment), and performance from 32% of the sample was invalid. Group differences, diagnostic accuracy statistics, and receiver operating characteristic (ROC) curves were analyzed for relevant TOMM indices. There were large (η²p= .45-.66), significant differences between validity groups (p < .001) on TOMM T1 and TOMMe10, with lower TOMM T1 and higher TOMMe10 scores for participants with invalid performance. Using established cut-scores, sensitivities/specificities were: TOMMe10 ≥1 error: .84/.66; ≥2 errors: .74/.93; TOMM T1 ≤40: .82/.93. ROC curve analysis yielded significant areas under the curve for both TOMMe10 and T1 with respective optimal cut-scores of ≥2 errors (.74 sensitivity/.93 specificity) and ≤41 (.84 sensitivity/.91 specificity). TOMMe10 and T1 performances are minimally impacted by cognitive impairment. Although both evidenced robust psychometric properties, TOMM T1 continued to show greater accuracy than TOMMe10. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Verbal fluency and digit span variables as performance validity indicators in experimentally induced malingering and real world patients with TBI.

Objective: This study was designed to examine the classification accuracy of verbal fluency (VF) measures as performance validity tests (PVT).Method: Student volunteers were assigned to the control (n = 57) or experimental malingering (n = 24) condition. An archival sample of 77 patients with TBI served as a clinical comparison.Results: Among students, FAS T-score ≤29 produced a good combination of sensitivity (.40-.42) and specificity (.89-.95). Animals T-score ≤31 had superior sensitivity (.53-.71) at .86-.93 specificity. VF tests performed similarly to commonly used PVTs embedded within Digit Span: RDS ≤7 (.54-.80 sensitivity at .93-.97 specificity) and age-corrected scaled score (ACSS) ≤6 (.54-.67 sensitivity at .94-.96 specificity). In the clinical sample, specificity was lower at liberal cutoffs [animals T-score ≤31 (.89-.91), RDS ≤7 (.86-.89) and ACSS ≤6 (.86-.96)], but comparable at conservative cutoffs [animals T-score ≤29 (.94-.96), RDS ≤6 (.95-.98) and ACSS ≤5 (.92-.96)].Conclusions: Among students, VF measures had higher signal detection performance than previously reported in clinical samples, likely due to the absence of genuine impairment. The superior classification accuracy of animal relative to letter fluency was replicated. Results suggest that existing validity cutoffs can be extended to cognitively high functioning examinees, and emphasize the importance of population-specific cutoffs.

Rey 15 item test plus recognition trial and TOMM in a community pediatric sample.

In pediatric evaluations, performance validity test (PVT) selection is often constrained by reading level, developmental appropriateness of stimuli, and administration time. The Rey 15 Item Test (FIT) addresses these constraints, and ranks among the most frequently used PVTs. Unfortunately, research indicates poor sensitivity of the FIT recall trial. Boone et al. developed a FIT recognition trial and demonstrated in an adult sample that its use increased sensitivity while maintaining high specificity. These results are promising, but, to the authors' knowledge, have only been replicated once in a pediatric sample. The present study examined the FIT plus recognition trial in a sample of 72 young athletes ages 8-16 years. All data for the present study were collected during baseline cognitive evaluations. The Test of Memory Malingering (TOMM) was used as the comparison criterion. Receiver operating characteristic curve analyses showed the addition of the recognition trial did not substantially improve sensitivity of the FIT. There was a surprising lack of concordance between TOMM and FIT scores, and, whereas the FIT correlated with multiple cognitive measures, the TOMM did not correlate with any other measures. Results suggest the FIT is not appropriate for pediatric clinical care, even with the additional recognition trial.

Assessing performance validity with the TOMM and automatized sequences task in a pediatric psychiatric inpatient setting.

This study examined the performance of children consecutively admitted to an inpatient psychiatric unit on the Test of Memory Malingering (TOMM) (aged 5-12; n = 96) and Automatized Sequences Task (aged 8-12; n = 67). Eighty-three percent of children passed the TOMM Trial 2 (M raw score = 47.7, SD = 4.7) and 76% of children passed the Automatized Sequences Task total time (M = 23.1 seconds; SD = 8.2). The concordance rate between the TOMM and the total time on the Automatized Sequences Task was 73.1%. Receiver operating characteristic curves indicated that of the Automatized Sequences Task subtests, only Counting 1-20 significantly differentiated children who passed Trial 2 of the TOMM from those who did not pass Trial 2 of the TOMM (area under the curve = .756, p = .006). Performance on both PVTs was unrelated to demographic characteristics and measures of psychological and neuropsychological functioning on both the TOMM and Automatized Sequences Task. Further research is needed to determine whether the nearly 1 in 4 children (23.9%) who performed below recommended cutoffs on Automatized Sequences Task reflects genuine suboptimal effort, cognitive difficulties among these children, and/or other factors.

Classification accuracy of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) and Effort Scale (ES) relative to the Test Of Memory Malingering (TOMM) in a mixed clinical sample.

Performance Validity Testing has become an integral part of neuropsychological assessment, and a variety of embedded screening measures for performance validity have been proposed. Several performance validity indexes have been developed for the Repeatable Battery for the Assessment of Neuropsychological Status. Although the RBANS Effort Index (EI) and Effort Scale (ES) have garnered some empirical support, other research has raised questions regarding their accuracy in a number of assessment contexts. We evaluated the classification accuracy of the EI and ES against a standalone performance validity measure (Test of Memory Malingering; TOMM) in a mixed clinical patient sample. Our results showed limited utility for the ES in a mixed sample and modest classification accuracy for the EI, raising concerns about the appropriate scope of use for these scales in general clinical practice, which suggested that an alternate EI cutoff score of >0 may be most appropriate.

Establishing supplementary response time validity indicators in the Word Memory Test (WMT) and directions for future research.

Response time (RT) measures in the Word Memory Test (WMT) offer to complement information derived from conventional accuracy measures. The current study aimed to validate the findings of Lupu, Elbaum, Wagner, and Braw in which RT variability was assessed, for the first time, in the WMT. A secondary aim was to suggest directions for the future research of RT measures in Forced-Choice Recognition Memory Performance Validity Tests (FCRM-PVTs). The study utilized a simulation research design, with participants performing the WMT's immediate recognition (IR) subtest (N = 59). Mean RTs and a scale which combines accuracy and RT measures, but not variability in RTs, possessed adequate discrimination capacity. Enhanced discrimination capacity was found after discarding the first items' RTs, though the IR-subtest's accuracy measure still showed superiority as a stand-alone validity indicator. The promise of RT measures may, therefore, lie in their ability to illuminate speed-accuracy tradeoffs among examinees with border-zone accuracy scores in FCRM-PVTs. They should, therefore, be regarded as complementary to conventional accuracy measures.

Normative values of the Rey Word Recognition Test in college athletes.

Improved detection of sport-related concussions can be enhanced by performance validity tests, such as the Rey Word Recognition Test (WRT). The WRT is brief and in the public domain but no norms exist for healthy college-athletes. The present study identified such normative values in a large college-athlete sample. Participants included 1,147 college-athletes, and four measures were collected: total words correct, words correct of the first 8, total number of intrusions, and combination score. The WRT was administered individually during baseline evaluations. Means and standard deviations were as follows: total correct words recognized, 10.47 (SD = 2.12); number of correct words out of the first eight words presented, 6.01 (SD = 1.41); number of intrusions, 0.89 (SD = 1.09); combination score, 15.59 (SD = 3.55). Females scored significantly higher than males in total words correct, number correct of the first eight, and combination score, and significantly lower in intrusions. The WRT proved to be a quick, easily administer test in the baseline testing setting. Only 22 athletes recognized all 15 words, and close to a normal distribution of scores was obtained, suggesting that an expectation of optimum performance by college-athletes as an inference of effortful performance would be misplaced.

Validation of a computerized Hong Kong - vigilance and memory test (HK-VMT) to detect early cognitive impairment in healthy older adults.

Objectives: Hong Kong - Vigilance and Memory Test (HK-VMT) is developed to distinguish early cognitive impairment in the pre-symptomatic phase from normal cognitive ageing in older adults. The objectives were to validate HK-VMT to differentiate mild cognitive impairment (MCI) and healthy control (HC), and to explore the cut-off scores for different educational levels.Method: A total of 606 older adults underwent the HK-VMT and conventional cognitive tests. HK-VMT is a 15 minutes cognitive battery that assesses episodic memory, attention, and visuospatial ability. The HK-VMT total is the sum of accuracy of all subtests with a range of 0 to 40. Differences in socio-demographic and clinical characteristics between groups were explored. Receiver operating characteristic (ROC) analyses were used to compare HK-VMT and Cantonese Mini Mental State Examination (CMMSE). A sample of 50 participants repeated the HK-VMT in 1 month to evaluate test-retest reliability.Results: ROC analysis of Area Under Curve (AUC) demonstrated that HK-VMT (AUC 0.793) was comparable to CMMSE (AUC 0.748) in differentiating MCI from HC in a matched sample. A cutoff at 21/22 was chosen yielding a sensitivity of 86.1% and a specificity of 75.3% for differentiating MCI and HC. Test-retest reliability of HK-VMT total was 0.71 (p<.001) in a month time.Conclusion: HK-VMT has demonstrated satisfactory validity in detecting cognitive impairment with good test-retest reliability in local older adults. It also performed favourably in the highly educated group when compared to CMMSE.