B – 74 Judging Judgment: Evaluating the TOP-J Against Behavioral Disinhibition on the NPI-Q

Abstract Objective Accurate assessment of judgment is critical in evaluation of cognitive impairment, as deficits in judgment can significantly impact safety, independence, and decision-making in daily life. This study examined whether the Test of Practical Judgment (TOP-J), a structured performance-based measure of practical decision-making, aligns with caregiver perception of poor judgment, measured by disinhibition. The study evaluated the relationship between TOP-J raw scores and caregiver-rated disinhibition, a proxy for impaired judgment, as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q). Method Data from a sample of 511 participants seen in an outpatient clinic for a comprehensive neuropsychological evaluation were included. Spearman’s rank-order correlation was used to assess the association between TOP-J scores and disinhibition severity (ordinal: 0 = not present to 3 = severe). A one-way ANOVA was conducted to compare TOP-J scores across disinhibition severity levels, further assessing whether performance on the TOP-J differed meaningfully by caregiver perception. Results Spearman’s correlation revealed no significant relationship between TOP-J raw scores and NPI-Q disinhibition severity, rₛ(511) = –.049, p = .266. One-way ANOVA similarly found no significant differences in TOP-J scores across disinhibition severity levels, F(4, 502) = 0.289, p = .885, with a negligible effect size (η2 = .002). Conclusion Findings suggest that performance on the TOP-J does not correspond meaningfully with the presence or severity of caregiver-observed disinhibition. While the TOP-J captures hypothetical reasoning, it may have limited ecological validity for assessing real-world impulsivity or socially inappropriate behavior. Findings highlight the importance of using both performance-based and informant-report measures when evaluating judgment in clinical neuropsychological assessment.