Abstract Objective Testing of bilingual individuals still poses a challenge among neuropsychologists. Self-reported language proficiency and objective measures differ considerably. Consequently, we present a literature review on the neuropsychological testing of bilinguals and a case study to guide the discussion. Data Selection A narrative literature review approach to identify and describe variables that pose challenges in the neuropsychological testing of bilinguals. Interfaced search terms include (not limited to) biculturalism, acculturation, oppression, testing, bilingualism, types of bilingualism, and mastery of languages. The case study constitutes a bilingual/bicultural 68-year-old male native from Cuba who migrated to the United States at 14 years old and was referred secondary to memory concerns. The patient asked and insisted on being tested in English. Data Synthesis The following elements will be discussed: fairness in testing, the language of tester and testee, and optimal language for testing (i.e., native, preferred, or dominant) while considering the referral question. Challenging variables include age and method of languages acquisition, language of schooling, frequency and contexts of both languages, and personal/social/cultural attitudes toward each language. Conclusion This review presents 1) factors influencing bilingualism, 2) potential challenges in determining a neuropsychologically fair testing battery for bilinguals, and 3) highlights the importance of using a qualitative historic-sociocultural approach and quantitative measurements to inform this process. Hence, reducing the possibility of misdiagnosis. Lastly, based on the review, we will discuss the influence of various sociocultural variables that might have influenced the patient’s decision to be tested in English, such as, acculturation, cultural perception, and geographical location.