Race-specific norms: Using the model of hypertension to understand issues of race, culture, and education in neuropsychology

Development of appropriate and clear guidelines for proper use of neuropsychological tests among ethnic minorities is a current and significant challenge. Although development of race/ethnicity-specific norms is popular, it is also controversial. Some have argued that these norms will improve the sensitivity and specificity of neuropsychological measures in detecting cognitive impairment. However, two major arguments have surfaced that: (1) race-specific norms ignore underlying cultural and educational factors for which race serves as a proxy, and (2) setting "more lenient" cutoffs for impairment among ethnic minorities denies these groups needed services. In this paper, we argue that recent research on hypertension reveals a number of crucial lessons for neuropsychologists who are struggling with this issue. The model of hypertension is helpful in understanding issues of construct validity in neuropsychological testing, and is also helpful in revealing possible underlying causes of poor cognitive test performance for which race serves as a proxy.