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Interpretation of cognitive test data depends on sufficient effort and motivation, yet existing research indicates effort tests may not always be formally administered. The review evaluates both purpose-built and embedded effort-sensitive indices, identifying which effort tests best detect suboptimal effort while remaining least sensitive to the specific cognitive impairment profile in dementia.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/effort-testing-in-dementia-assessment-a-systematic-review/501559/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/effort-testing-in-dementia-assessment-a-systematic-review/501559.png","ImageObject",300,407,{"name":92,"@type":93},"AfterMidnight","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-20","2026-10-03",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is effort testing important in dementia assessment?","Question",{"text":113,"@type":114},"Neuropsychological test scores are only valid when appropriate effort is exerted. Because motivation and effort affect interpretation, clinicians need to evaluate effort during the assessment process.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What kinds of effort tests were examined in the review?",{"text":118,"@type":114},"The review evaluated purpose-built tests and embedded effort-sensitive indices in dementia, MCI, and healthy control samples, including hierarchical performance validity tests.",{"name":120,"@type":111,"acceptedAnswer":121},"What do the review results suggest about which effort tests to use?",{"text":122,"@type":114},"Results indicate that hierarchical approach PVTs such as the WMT, MSVT, and NV-MSVT are preferable for older adults investigated for possible dementia, beyond simple pass/fail methods.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},501559,1791025873,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":26,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090896061,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","McGuire, C., Crawford, S. and Evans, J. J. (2019) Effort testing in dementia assessment: a systematic review. Archives of Clinical Neuropsychology, 34(1), pp. 114-131.  \nThere may be differences between this version and the published version. You are advised to consult the publisher’s version if you wish to cite from it.  \n[http://eprints.gla.ac.uk/156539/](http://eprints.gla.ac.uk/156539/)  \nDeposited on: 31 January 2018  \nEnlighten – Research publications by members of the University of Glasgow   \n[http://eprints.gla.ac.uk](http://eprints.gla.ac.uk)  \nEffort testing in dementia assessment: A systematic review  \nClaire McGuire, Stephanie Crawford and Jonathan J Evans  \nAbstract  \nObjective  \nInterpretation of neuropsychological test data is only valid when appropriate effort has been exerted. Research however suggests that neuropsychologists do not always formally test for effort and that this may especially be the case in the context of dementia assessment. This review systematically examined the literature that has investigated the use of both purposebuilt and embedded effort-sensitive indices in dementia, mild cognitive impairment (MCI) and healthy control samples. The aim was to determine which tests of effort are most sensitive to suboptimal effort and least sensitive to the type of cognitive impairment seen in dementia.  \nMethods  \nA systematic search of databases was conducted to October 2017. There was no start date.  \nResults  \nTwenty five studies were included for review. The studies were divided into two categories according to methodology. One category of studies (n=5) was reviewed using a tailored methodological quality rating checklist whilst the remaining studies (n=20) were reviewed using the Crowe Critical Appraisal Tool (CCAT) .  \nConclusions  \nThe results of this review suggest that PVTs which take a hierarchical approach to effort testing such as the WMT, MSVT and NV-MSVT are preferable for use with older adults who are under investigation for possible dementia. These tests go above and beyond the traditional pass/fail approach of more traditional tests of effort since they allow the examiner to analyse  \nthe examinee’s profile of scores. The methodological limitations and challenges involved in this field of research are discussed.  \nIntroduction  \nCognitive testing is used in many clinical settings, alongside information gathered from other sources, to develop a comprehensive understanding of a person’s difficulties. Scores on cognitive tests are usually interpreted alongside published normative data which assume that the examinee has put forth good effort. The value and accuracy of an assessment therefore relies on the quality of the data to be interpreted and, as such, it is of great importance that the clinician has evaluated the examinee’s level of effort and motivation during the assessment process. Effort testing is considered a crucial component of neuropsychological evaluation according to both the British Psychological Society (BPS; McMillan et al., 2009) and the American Academy of Clinical Neuropsychology (AACN; Heilbronner et al., 2009) .  \nThis has led to the creation of both purpose-built tests designed to detect non-credible effort such as the Test of Memory Malingering (TOMM; Tombaugh, 1996), the Word Memory Test (WMT; Green, 2003) and the Rey 15-Item Test (RFIT; Rey, 1964) and those which have been developed from existing neuropsychological test batteries such as the Effort Index (EI; Silverberg, Wertheimer, & Fichtenberg, 2007) and the Effort Scale (ES; Novitski, Steele, Karantzoulis & Randolph, 2012) both derived from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, Tierney, Mohr & Chase, 1998) . Effort tests are also known as symptom validity tests (SVTs) or performance validity tests (PVTs) however Larrabee (2012) distinguishes between these two terms. SVTs are selfreport measures which tell the examiner whether a person’s symptomatic complaint","cbCaiiYn4kzdXQUC","https://ap.wps.com/l/cbCaiiYn4kzdXQUC","pdf",899447,"English","# Abstract\n## Objective\n## Methods\n## Results\n## Conclusions\n# Introduction","[{\"question\":\"Why is effort testing important in dementia assessment?\",\"answer\":\"Neuropsychological test scores are only valid when appropriate effort is exerted. Because motivation and effort affect interpretation, clinicians need to evaluate effort during the assessment process.\"},{\"question\":\"What kinds of effort tests were examined in the review?\",\"answer\":\"The review evaluated purpose-built tests and embedded effort-sensitive indices in dementia, MCI, and healthy control samples, including hierarchical performance validity tests.\"},{\"question\":\"What do the review results suggest about which effort tests to use?\",\"answer\":\"Results indicate that hierarchical approach PVTs such as the WMT, MSVT, and NV-MSVT are preferable for older adults investigated for possible dementia, beyond simple pass/fail methods.\"}]","Effort testing in dementia assessment - A systematic review | PDF",1791020565,151]