This article highlights trends that show the influence of age, education, IQ, gender, and alcohol abuse on Halstead-Reitan Neuropsychological Test Battery (HRB) performance. These factors must be considered as possible competing hypotheses that might account for a patient's HRB performance. HRB scores among normal, community-living persons can resemble scores of individuals with known neuropsychological impairment due only to the effects of these variables. Accordingly, when clinical neuropsychologists use "levels of current performance" or research based "cut-off score" methods to make inferences about the adequacy of brain function, appropriate comparison norms must be used to minimize the likelihood of false-positive errors. This paper summarizes and provides references to some of these comparison norms. Additionally, robust estimates of premorbid ability are essential when one is making neuropsychological inferences. Such estimates can be obtained from nationally standardized measures of intellectual ability found on most grade and high school transcripts, as well as Scholastic Aptitude Test, military, and related aptitude test scores, plus the individual's social and occupational history.
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