Effort Testing in Dementia Assessment: A Systematic Review.

Area of Science:

• Neuropsychology
• Cognitive Assessment
• Geriatrics

Background:

• Accurate neuropsychological testing relies on adequate effort.
• Effort assessment is inconsistently applied, particularly in dementia evaluations.
• Suboptimal effort can invalidate cognitive test results.

Purpose of the Study:

• Systematically review literature on effort-sensitive indices in dementia, MCI, and healthy controls.
• Identify effort tests most sensitive to poor effort and least affected by dementia-related cognitive decline.
• Evaluate the utility of purpose-built and embedded effort measures.

Main Methods:

• Systematic literature search conducted up to October 2017.
• Included studies investigating effort-sensitive indices in dementia, MCI, and healthy controls.
• Analyzed 25 studies, categorizing them by methodological quality assessment tools.

Main Results:

• Twenty-five studies were included in the review.
• Methodological quality was assessed using a tailored checklist (5 studies) and the Crowe Critical Appraisal Tool (20 studies).
• Hierarchical performance validity tests (PVTs) show promise for dementia assessment.

Conclusions:

• Hierarchical PVTs (e.g., WMT, MSVT, NV-MSVT) are preferred for dementia evaluations.
• These tests offer a more nuanced approach than traditional pass/fail measures by analyzing score profiles.
• Methodological limitations and research challenges in effort testing are discussed.