Would a rose by any other name smell as sweet? Complexity, context, and consequences of neuropsychology performance labels.

Abstract

Objective: The American Academy of Clinical Neuropsychology (AACN) has proposed standardized performance labels to enhance consistency in neuropsychological reporting. While valuable in forensic and medicolegal contexts, these guidelines may limit interpretive flexibility and clinical relevance in diverse practice settings. This manuscript examines the contextual appropriateness of AACN labels across diverse clinical and research settings, highlighting the need for diagnostic flexibility over rigid adherence to normative descriptors. Methods: We reviewed the historical and conceptual underpinnings of neuropsychological assessment, focusing on Ward Halstead's distinction between "biological" and "psychometric" intelligence. This framework was used to explore how interpretive models shape clinical reasoning and test interpretation. Special attention was given to the implications of score labeling in multidisciplinary team settings (e.g. dementia diagnosis, epilepsy surgery and within large-scale research initiatives, including Alzheimer's Disease Research Centers (ADRCs). Conclusions: Although AACN performance labels support greater transparency and consistency in select contexts, their universal implementation may obscure meaningful cognitive patterns and diminish diagnostic precision. Labels such as "below average" may fail to capture clinically meaningful decline in high-functioning individuals or obscure clinically relevant cognitive patterns critical for diagnosis and treatment planning. We argue for a context-sensitive approach to score interpretation that allows flexible, informed use of descriptors aligned with specific referral questions and clinical goals. Neuropsychological assessment is most effective when guided by integrative clinical reasoning rather than uncritical application of standardized labeling conventions.