Practice Effects: A Unique Cognitive Variable
Abstract
Practice effects are improvements in cognitive test performance due to repeated evaluation with the same or similar test materials. Prior studies have reported that these improvements can vary with age, education/intellect, and disease status. However, additional information is needed about variables that influence practice effects. The current study prospectively quantified short-term practice effects in 268 community-dwelling older adults and compared these practice effects to demographic variables, global cognition, premorbid intellect, depression, and individual cognitive domains. Overall, practice effects were not significantly related to most demographic and clinical characteristics or individual cognitive domains, which was contrary to our hypotheses. However, since practice effects appear to be uninfluenced by many variables that typically affect cognitive scores, they may be a unique and valuable tool that could be applied in a number of diverse patient groups.
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The capacity to improve performance is not directly affected by either depressive symptoms or cognitive impairment.
“This suggests that the capacity to improve performance is not directly affected by either depressive symptoms or cognitive impairment, consistent with research in a previous study showing that practice effects in cognitive tasks were not moderated by depressive symptomatology [50].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [50]
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“The finding that some older adults maintained or slightly improved their cognitive function at follow-up (while others showed an expected cognitive decline) could be related to practice effects, defined as an improvement in cognitive test performance due to repeated exposure to the test materials (Duff et al., 2012; M…”
Reliable Change on Neuropsychological Tests in the Uniform Data Set
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“Prior studies have examined these other phases along the continuumof late-life cognition (Bläsi et al., 2009;Duff et al., 2012; Gavett, Ashendorf, & Gurnani, 2015), and the current results would not necessarily generalize to those other groups.”
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ResultEgo Depletion in Real-Time: An Examination of the Sequential-Task Paradigm
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“Given that in other domains, deficits in executive function are associated with the absence of or weaker repetition effects (Darby et al., 2002; Duff et al., 2012), it is plausible that intrinsic carry-over depletion effects might be reflected in absent or weakened repetition effects.”
BackgroundEffects of age and ability on components of cognitive change
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Kardan, O., Stier, A. J., Layden, E. A., Choe, K. W., Lyu, M., Zhang, X.-H., Beilock, S. L., Rosenberg, M. D., & Berman, M. G. (2023) · Network Neuroscience · doi:10.1162/netn_a_00319 · Cited by 26 · see citing works
“respondent, and can be used for diagnosis of clinical conditions as well as responsiveness to clinical interventions (Duff et al., 2012).”
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Duff, K. M., Horn, K. P., Foster, N. L., & Hoffman, J. M. (2015) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acv018 · Cited by 25 · see citing works
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“consistent with the neuropsychological literature (Duff et al., 2012; Fernandez-Ballesteros et al., 2005; Nguyen et al., 2015) and with test results from adolescent Egyptian pesticide applicators who worked in the cotton fields, and were tested repeatedly (Ismail et al.”
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“improvements in scores with repeated administrations (Calamia et al., 2013a, 2013b; Duff et al., 2012; McCaffrey et al., 2000).”
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“37 Inlinewiththissuggestion,ourresultsshowthatprac-tice effects are not consistently related to any demographic variables when initial performance is not considered.”
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“…effects in a clinical test may complicate the interpretation of true change due to an intervention, these effects may also have high clinical prognostic utility as a simple, convenient, and noninvasive way to test one’s learning capacity or treatment responsiveness (Duff et al., 2007, 2012).”
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“The fact that patients declined across time on specific repeated measures is concerning given that practice effects have been shown to provide diagnostic information (Duff et al., 2012).”
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“Nevertheless, our participants underwent the assessments at 6 to 12 month intervals while practice effect studies repeated cognitive tests after 1 week [50].”
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“Although some studies found a positive influence [16], other failed to find such relationship [13,17].”
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Two-Month Cognitive Changes Enhance Prediction of Nonremission in Clinical High-Risk Individuals
Zhang, T., Wei, Y., Tang, X., Xu, L., Cui, H., Hu, Y., Liu, H., Wang, Z., Chen, T., Tang, Y., et al. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.01.021 · Cited by 11 · see citing works
Dynamic modeling of practice effects across the healthy aging-Alzheimer’s disease continuum
Bender, A. R., Ganguli, A., Meiring, M., Hampstead, B. M., & Driver, C. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.911559 · Cited by 9 · see citing works
“However, as a measure of the capacity to benefit from repetition, PE may represent an independent behavioral dimension sensitive to declines in older age and neurodegenerative disease (Yang, 2011; Duff et al., 2012).”
BackgroundAssessing individual-level change in dementia research: a review of methodologies
Murray, A., Vollmer, M., Deary, I., Muñiz-Terrera, G., & Booth, T. (2021) · Alzheimer's Research & Therapy · doi:10.1186/s13195-021-00768-w · Cited by 12 · see citing works
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Self-citationgo4cognition: Combined Physiological and Cognitive Intervention in Mild Cognitive Impairment
Lissek, V. J., Abdallah, H. B., Praetorius, A., Ohmann, T., & Boris Suchan, A. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-220145 · Cited by 8 · see citing works
“It is not clear whether the practice effect might be time dependent as Duff and colleagues (2012) could demonstrate a practice effect for MCI patients within a time interval of 1 week [82].”
White, N. J., Kouwenhoven, M., & Machado, L. (2021) · Experimental Aging Research · doi:10.1080/0361073x.2021.1919475 · Cited by 7 · see citing works
“…(Salthouse, 2013; Salthouse & Tucker-Drob, 2008), and that practice effects can persist beyond the second testing occasion (Collie et al., 2003; Duff, 2012; White et al., 2019), we hypothesized that performance shifts on computerized tests would be larger in older compared to young adults,…”
BackgroundResultInfluentialNaggayi, S. K., Kalibbala, D. M., Mboizi, V., Ssenkusu, J. M., Jin, Z., Rosano, C., Munube, D., Wambaka, B., Namazzi, R., Kasirye, P., et al. (2025) · Blood Advances · doi:10.1182/bloodadvances.2024015073 · Cited by 6 · see citing works
Leadership Intelligence Before and After Participation in UGL Leadership Training
Ekegren, M., & Dåderman, A. M. (2015) · International Journal of Transpersonal Studies · doi:10.24972/ijts.2015.34.1-2.23 · Cited by 6 · see citing works
Are Clinicians Better Than Lay Judges at Recalling Case Details? An Evaluation of Expert Memory
Webb, C. A., Keeley, J. W., & Eakin, D. K. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22256 · Cited by 6 · see citing works
Bartholomaeus, V., Chronowski, N. H., Santiago, P. H. R., Kuring, J. K., & Sawyer, A. C. P. (2024) · The Clinical Neuropsychologist · doi:10.1080/13854046.2024.2335117 · Cited by 6 · see citing works
“Practice effects are improvements in cognitive test performance due to repeated evaluation with the same or similar test materials (Duff et al., 2012) and can threaten the validity of equivalence testing findings (Dixon et al., 2018).”
Four year practice effects on the RBANS in a longitudinal study of older adults
Reed, C., Calamia, M. R., Sanderson‐Cimino, M. E., Vito, A. N. D., Toups, R., & Keller, J. N. (2023) · Applied Neuropsychology Adult · doi:10.1080/23279095.2023.2180361 · Cited by 6 · see citing works
“One study of older adults retested after one week failed to show a practice effect for semantic fluency (Duff et al. 2012).”
Using Mahalanobis Distance to Evaluate Recovery in Acute Stroke
Tehan, H., Witteveen, K., Tolan, G. A., Tehan, G., & Senior, G. (2017) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx107 · Cited by 6 · see citing works
“In conclusion, the study is best thought of as a proof-of-concept demonstration that in a hospital setting the repeated administration of a battery of brief standardized tests can produce stable data; cognitive domains that have been impaired by a stroke and those that are unimpaired can be identified; recovery proces…”
BackgroundDemirlek, C., Keshavan, M., Murray, R. M., & Bora, E. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf237 · Cited by 5 · see citing works
Pensky, A. C., Jackson, L. E., Melville, M. C., Pottmeyer, L., Mineroff, Z., Chawla, A., Brooks, J., Hershock, C., & Lovett, M. C. (2026) · Computers & Education · doi:10.1016/j.compedu.2026.105640 · Cited by 7 · see citing works
Pérez‐Enríquez, C., Oliveira, L. P., Manero, R. M., Peña‐Casanova, J., Príncipe, A., Zucca, R., Langohr, K., Conesa, G., Infante, N., & Rocamora, R. (2024) · Journal of neurosurgery · doi:10.3171/2024.4.jns232417 · Cited by 4 · see citing works
Stone, A. A., Schneider, S., Toledo, M. J. L., & Hernandez, R. (2025) · JMIR mhealth and uhealth · doi:10.2196/68735 · Cited by 4 · see citing works
“There is already substantial evidence that responses are not invariant over time, given that repeated measures can create practice effects, a phenomenon supported by abundant research on memory and performance [13-15].”
Khan, K. M., Hatch, L. C., Akhter, S., Eunus, M., Zhou, Z., Parvez, F., & Rohlman, D. S. (2021) · NeuroToxicology · doi:10.1016/j.neuro.2021.04.005 · Cited by 4 · see citing works
Jadick, M. F., Robinson, T. L., Farrell, M. E., Klinger, H. M., Buckley, R. F., Marshall, G. A., Vannini, P., Rentz, D. M., Johnson, K. A., Sperling, R. A., et al. (2024) · Neurology · doi:10.1212/wnl.0000000000209447 · Cited by 4 · see citing works
Dall’Antonia, I., Nepožitek, J., Hlavnička, J., Rusz, J., Peřinová, P., Dostálová, S., Zogala, D., y Losada, V. I. L., Bezdíček, O., Nikolai, T., et al. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106812 · Cited by 3 · see citing works
Lee, J., Byun, K., Lee, M. C., & Ha, M. (2025) · Brain and Behavior · doi:10.1002/brb3.70942 · Cited by 3 · see citing works
“…impaired practice effects, operationally defined in this study as the absence of behavioral improvement across repeated blocks of the same cognitive task despite increased task familiarity, accompanied by sustained or even elevated prefrontal activation (Calamia et al. 2012; Duff et al. 2012).”
Kenwright, M., Awty, P., Bye, C., Doherty, D. T., Leese, D., & Edwards, E. (2025) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2025.101734 · Cited by 3 · see citing works
Forgetting Rates of Prose Memory in Mild Cognitive Impairment
Sacripante, R., Girtler, N. G., Doglione, E., Nobili, F. M., & Sala, S. D. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220803 · Cited by 3 · see citing works
“In support of the hypothesis of a differential ben-efit of practice effect in MCI-AD, in a recent review of the literature, Jutten et al. [48] observed greater average practice effects among healthy older adults compared to people with MCI [59, 65–67].”
Lissek, V. J., Orth, S., & Suchan, B. (2024) · Journal of Alzheimer's Disease · doi:10.3233/jad-230802 · Cited by 3 · see citing works
“Duff et al. (2012) showed a practice effect in a sampleofMCIpatientsforatimeintervalofoneweek [9,80],whichisaveryshortperiod.”
Prior test experience confounds longitudinal tracking of adolescent cognitive and motor development
Sullivan, E., Thompson, W., Brumback, T., Prouty, D., Tapert, S., Brown, S. A., Bellis, M. D., Nooner, K., Baker, F., Colrain, I., et al. (2022) · BMC Medical Research Methodology · doi:10.1186/s12874-022-01606-9 · Cited by 4 · see citing works
“Many studies that have considered practice effects have focused on adult aging to senescence [1, 8, 15] or on repeated testing necessary in clinical settings to track the progression of CNS injury due to accident, stroke, or dementia [16–19] or recovery with treatment [20] or time [21].”
BackgroundInfluentialOn the Measurement of Episodic Empowerment
Bartholomaeus, J. D., Mandrell, J., & Strelan, P. (2025) · British Journal of Social Psychology · doi:10.1111/bjso.12838 · Cited by 2 · see citing works
Shayman, C. S., Hines, P. D., McCracken, M. K., Koff, J., Finney, H. C., Stefanucci, J. K., & Creem-Regehr, S. H. (2025) · Spatial Cognition and Computation · doi:10.1080/13875868.2025.2492553 · Cited by 2 · see citing works
“Effects of practice are also well-studied in the neuropsychological literature (Duff et al., 2012; Rawlings & Crewe, 1992).”
A multi-timescale, multi-method perspective on older adult neurocognitive adaptability
Mulligan, B. P., Segalowitz, S. J., Hofer, S. M., & Smart, C. M. (2020) · The Clinical Neuropsychologist · doi:10.1080/13854046.2020.1723706 · Cited by 2 · see citing works
Test–Retest Reliability of Temporal Processing Tests in Normal Hearing Young Adults
Ghosh, P., & Nayaka, Y. N. H. (2024) · Journal of Indian Speech Language & Hearing Association · doi:10.4103/jisha.jisha_43_24 · Cited by 1 · see citing works
Zając-Lamparska, L., Zabielska‐Mendyk, E., Zapała, D., & Augustynowicz, P. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100568 · Cited by 1 · see citing works
“This effect is common in studies that measure cognitive function repeatedly and is considered a factor that biases the results obtained and conclusions drawn (Duff et al., 2012; Scharfen et al., 2018).”
Dølven, S., Moroń, M., Eriksen, I., Toft, J. E. G., & Semkovska, M. (2025) · Neuropsychology Review · doi:10.1007/s11065-025-09686-2 · Cited by 1 · see citing works
Karrasch, M., Hermann, B. P., Roos, T., Joutsa, J., Rinne, J. O., Parkkola, R. K., Tiitta, P., & Sillanpää, M. L. (2025) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617725101021 · Cited by 1 · see citing works
“…is now recognized as a relevant cognitive marker that has been found to be associated with a more problematic cognitive course, conversion to preclinical or clinical AD (Jutten et al., 2020; Machulda et al., 2013), and found by some to be associated with biomarkers (Duff et al., 2011, 2012).”
Factores asociados con el declive cognitivo en población menor de 65 años. Una revisión sistemática
Aguirre–Acevedo, D. C., Henao, E., Tirado, V., Muñoz, C., Arango, D. G., Restrepo, F. J. L., & Jaimes, F. A. (2014) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2014.02.009
Tamburri, N., McDowell, C., & MacDonald, S. W. S. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.885621
Schaeffer, M. J., Reaume, N., Wang, M., Aftab, A., Pan, A., Tariq, S., Reid, M., Smith, E. E., d’Esterre, C. D., & Barber, P. A. (2023) · Cerebral Circulation - Cognition and Behavior · doi:10.1016/j.cccb.2023.100177
Harjoitusvaikutus toistotestauksessa kognitiivisilla testeillä
Vainikainen, M.-P., & Roivainen, E. (2025) · Psykologia · doi:10.62443/psykologia.v53i4.70359
“voi johtua kognitiota heikentävästä sairaudesta (Darby, Maruff, Collie & McStephen, 2002; Duff, Callister, Dennett & Tometich, 2012).”
(2025) · Wiley eBooks · doi:10.1002/9781394184507.refs
Belzile, F., Chantal, S., Nolin, A., Nadeau, Y., Verret, L., & Hudon, C. (2025) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/cjn.2025.10363
Cognitive trajectories of psychosis risk: temporal patterns and association with progression
Zhang, T., Xu, L., Wei, Y., Cui, H., Tang, X., Tang, Y., Hu, Y., Zhang, D., Ju, M., Liu, H., et al. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03371-9
Task Complexity Amplifies Practice Effects on Quarterly Self-Administered Cognitive Tasks (Preprint)Preprint
Christianson, K., Lyu, C., Karjadi, C., Devine, S., Ang, T. F. A., Anda‐Duran, I. D., Kolachalama, V. B., Lin, H., Ding, H., Gifford, K. A., et al. (2025) · doi:10.2196/preprints.87208
Arnold, M., Cui, L., Stemmler, M., & Guo, Q. (2025) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2025.2599256
“The literature suggests that practice effects become smaller with longer time intervals, such as several years between tests (Duff et al., 2012).”
A novel 1-channel EEG marker may associate with perioperative cognitive change
Shahaf, D. B., Bolotin, G., Cohen, O., Raad, M., Derman, R., & Shahaf, G. (2026) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2026.1688834
“…characterization of the association between perioperative changes in the assessment score and brain dysfunction is not trivial, because there is a known effect of improvement in the assessment due to its repetition within a short time window (Duff et al., 2012; Baron Shahaf and Shahaf, 2024b).”
Improvements in Cogstate Test Performance Depend on Number and Frequency of Prior Tests
Murchland, A. R., Chen, R., Blacker, D., Kang, J. H., Glymour, M. M., & Haneuse, S. (2026) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000728
Stasenko, A., Campbell, L. M., Heaton, A., Paolillo, E. W., Moore, D. J., Heaton, R. K., Depp, C. A., Pinkham, A. E., Ackerman, R. A., Harvey, P. D., et al. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1792496
“Practice effects, or improved cognitive performance following repeated exposure to test materials, are increasingly recognized as a meaningful cognitive signal rather than a methodological nuisance (35, 36).”
Lee, Y. (2026) · The International Journal of Management Education · doi:10.1016/j.ijme.2026.101507
Christianson, K., Lyu, C., Karjadi, C., Devine, S., Ang, T. F. A., Anda‐Duran, I. D., Kolachalama, V. B., Lin, H., Ding, H., Gifford, K. A., et al. (2026) · JMIR Aging · doi:10.2196/87208
“Evidence on sex and education effects has been mixed in both traditional tests [23-25] and digital studies, with some reporting no demographic moderation [26] and others identifying task-specific associations [27-29].”
Fankhauser, S., Cattaneo, G., Albi-Villuendas, G., Sánchez, J. S., Pascual‐Leone, Á., & David Bartrés-faz, A. (2026) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2026.1933991
- Authors
- Duff, K., Callister, C., Dennett, K., & Tometich, D.
- Affiliations
- University of Utah (US)
- Corresponding author
- Duff, Kevin
- Venue
- The Clinical Neuropsychologist
- Publisher
- Informa UK Limited
- Published
- 2012-10
- Volume
- 26
- Issue
- 7
- Pages
- 1117-1127
- ISSN
- 0920-1637 (ISSN-L)
- 1385-4046
- 1744-4144
- OpenAlex
- W2068605110
- Cited by
- 94
- References
- 31
- Citations by year
- 2026: 7 · 2025: 20 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 8 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 6 · 2015: 7 · 2014: 3 · 2013: 3 · 2012: 1
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Clinical Neuropsychologist (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- practice effects, cognitive test performance, older adults, global cognition, depression, cognitive domain, demographic factors, cognitive assessment
- MeSH terms
- Aged, Aged, 80 and over, Aging, Cognition, Female, Humans, Male, Neuropsychological Tests, Predictive Value of Tests, Prospective Studies, Psychomotor Performance, Time Factors, Geriatric Assessment
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