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He is not going to be able to fake forever. There will come a time when the desease progresses and they really can't fake anymore.
Written tests are given more than once and the tests are then compared so there can show a difference between the 2 testing phases. Questions are often asked in several different ways over the course of the testing process so it might be difficult to recall each answer and how each question is phrased.
Also the way the person responds , the affect of the person being tested, as well as just simple conversation is all taken into account for the results of the testing process.
When stepdad was dying we had a conversation about dementia (he had it and cancer). Her comment was that the testing is primarily qualitative, not quantitative. It is not like taking a pulse nor measuring respiration or oxygen concentration in the blood. There are no definitive tests for dementia, they are all subject to interpretation.
NPD people tend to mold reality to their point of view. It can become a he said she said situation. This is where good record keeping, video or audio recordings of 'off' behaviour can help the clinicians make a diagnosis.
Some days they are "there." An hour later, not so much. Then you have showtiming, cognitive camouflage, and a determined effort by LO to show they are not one if of " those people." My mother did this for years. She was in a geriatric behavioral unit for a week. She was worse than what we thought. She was just clever. Very.
I’m not sure why narcissism in particular would suggest the likelihood of attempting to “fool” an examiner? Why would there be an advantage to “faking”?