The use of the Halstead-Reitan test battery with older adults

As with younger individuals, neuropsychological evaluation of the older patient with suspected cognitive decline should be reasonably comprehensive. Only through careful analysis of the overall pattern as well as level of performance across various measures can both the likelihood and nature of cerebral dysfunction be ascertained. A neuropsychological battery such as an expanded HRB appears to be well suited for the comprehensive evaluation of the older individual who may be mildly to moderately impaired, whereas briefer test batteries may be sufficient and more practical in some cases. The HRB is widely used in clinical and research settings, yet only a few published studies have provided reference data with respect to large groups of adults over the age of 60. Preliminary data suggest that the HRB has adequate reliability and validity in older as well as younger age groups. However, information regarding the level and pattern of performance of normal individuals over the age of 75 is lacking for the HRB as well as for virtually all other popular neuropsychological measures. Studies consistently have shown that many of the component HRB measures are quite sensitive to the effects of age (as well as education), and therefore, traditional normative cutoff scores produce an unacceptably high rate of false positive diagnostic predictions in older populations. Until more appropriate older age norms are available, great caution must be used in the interpretation of results.