Inconsistent relationships between subjective and objective performance have been found across various clinical groups. Discrepancies in these relationships across studies have been attributed to various factors such as patient characteristics (e.g., level of insight associated with cognitive impairment) and test characteristics (e.g., using too few measures to assess different cognitive domains). Although performance and symptom invalidity are common in clinical and research settings and have the potential to impact responding on testing, previous studies have not explored the role of performance and symptom invalidity on relationships between objective and subjective performance. Therefore, the current study examined the impact of invalidity on performance and symptom validity tests (PVTs and SVTs, respectively) on the relationship between subjective and objective cognitive functioning.

Data were obtained from 299 Veterans (77.6% male, mean age of 48.8 years (SD = 13.5)) assessed in a VA medical center epilepsy monitoring unit from 2008-2018. Participants completed a measure of subjective functioning (i.e., the Patient Competency Rating Scale), PVTs (i.e., Word Memory Test, Test of Memory Malingering, Reliable Digit Span), SVTs (i.e., Minnesota Multiphasic Personality Inventory-2-Restructured Form Response Bias Scale, Structured Inventory of Malingered Symptomatology), and neuropsychological measures assessing objective cognitive performance (e.g., Trail Making Test parts A and B). Pearson correlations were conducted between subjective functioning and objective cognitive performance in the following groups: 1.) PVT and SVT valid, 2.) PVT and SVT invalid, 3.) PVT-only invalid, 4.) SVT-only invalid. Using Fisher’s r-to-z transformation, tests for the differences between correlation coefficients were then conducted between the PVT and SVT valid vs. PVT and SVT invalid groups, and the PVT-only invalid vs. SVT-only invalid groups.

Participants with fully valid PVT and SVT performances demonstrated generally stronger relationships between subjective and objective scores (r’s = .058 - .310) compared to participants with both invalid PVT and SVT scores (r’s = -.033 - .132). However, the only significant difference in the strengths of correlations between the groups was found on Trail Making Test Part B (p = .034). In separate exploratory analyses due to low group size, those with invalid PVT scores only (fully valid SVT) demonstrated generally stronger relationships between subjective and objective scores (r’s = -.101 - .741) compared to participants with invalid SVT scores only (fully valid PVT; r’s = -.088 - .024). However, the only significant difference in the strengths of correlations between the groups was found on Trail Making Test Part A (p = .028).

The present study suggests that at least some of the discrepancies in previous studies between subjective and objective cognitive performance may be related to performance and symptom validity. Specifically, very weak relationships between objective and subjective performance were found in participants who only failed SVTs, whereas relationships were stronger in those who only failed PVTs. Therefore, findings suggest that including measures of PVTs and SVTs in future studies investigating relationships between subjective and objective cognitive performance is critical to ensuring accuracy of conclusions that are drawn.

Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.

To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.

Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.

Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.

Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.