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The Coin-in-the-Hand Test and Dementia: More Evidence for a Screening Test for Neurocognitive Symptom Exaggeration

Schroeder, Ryan W. PsyD; Peck, Caleb P. PsyD; Buddin, William H. Jr PhD; Heinrichs, Robin J. PhD; Baade, Lyle E. PhD

Cognitive and Behavioral Neurology: September 2012 - Volume 25 - Issue 3 - p 139–143
doi: 10.1097/WNN.0b013e31826b71c1
Original Studies

Background: The Coin-in-the-Hand Test was developed to help clinicians distinguish patients who are neurocognitively impaired from patients who are exaggerating or feigning memory complaints. Previous findings have shown that participants asked to feign memory problems and patients suspected of malingering performed worse on the test than patients with genuine neurocognitive dysfunction.

Objective: We reviewed the literature on the Coin-in-the-Hand Test and evaluated test performance by 45 hospitalized patients who had dementia with moderately to severely impaired cognition.

Methods: We analyzed Coin-in-the-Hand Test scores, neuropsychological findings, and other data to determine whether demographic or neurocognitive variables affected Coin-in-the-Hand Test scores. We also calculated base rates of these scores and provided cutoff ranges for clinical use.

Results: Coin-in-the-Hand Test scores were independent of neurocognitive functioning, age, education level, and type of dementia. Base rates of scores suggest that a low cutoff can help differentiate between patients with true neurocognitive impairments and those exaggerating or feigning memory complaints.

Conclusions: Both the literature and our findings show the Coin-in-the-Hand Test to have potential as a quick and easy screening tool to detect neurocognitive symptom exaggeration. This test could effectively supplement commonly used neurocognitive screens such as the Mini-Mental State Examination, the Saint Louis University Mental Status Examination, and the Montreal Cognitive Assessment.

Division of Psychology, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS

The authors declare no conflicts of interest.

Reprints: Ryan W. Schroeder, PsyD, University of Kansas School of Medicine, 7829 E. Rockhill, Suite 105, Wichita, KS 67206 (e-mail:

Received February 27, 2012

Accepted June 4, 2012

© 2012 Lippincott Williams & Wilkins, Inc.