A multitest approach is optimal for the identification of at-risk driving among older adults. This study examined the predictive validity of a combination of office-based screening tests for on-road driving performance in older adults with and without mild cognitive impairment (MCI)/dementia.
Methods:
Forty-four normal control, 20 participants with MCI, and 20 participants with dementia completed a battery of office-based assessments. On-road driving evaluation classified participants as not at-risk (n = 65) or at-risk drivers (n = 19).
Results:
Logistic regression revealed age and 2 tests of visual attention abilities (Useful Field of View [UFOV] Divided Attention and Neuropsychological Assessment Battery [NAB] Driving Scenes) best predicted at-risk drivers (C statistic = 0.90); no cutoff score had both sensitivity and specificity >80%.
Conclusions:
Future research on larger and more clinically representative neurological samples will improve understanding of the utility of the UFOV Divided Attention and NAB Driving Scenes in detecting at-risk older adult drivers in the clinic.
SivakMSchoettleB. Recent changes in the age composition of drivers in 15 countries. Traffic Inj Prev. 2012;13(2):126–132.
2.
Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Centers for Disease Control and Prevention. Atlanta, GA: US Dept of Health and Human Services; 2013.
3.
CarrDBOttBR. The older adult driver with cognitive impairment: it’s a very frustrating life. JAMA. 2010;303(23):1632–1641.
4.
AnsteyKJWoodJLordSWalkerJG. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev. 2005;25(1):45–65.
5.
GorrieCABrownJWaitePM. Crash characteristics of older pedestrian fatalities: dementia pathology may be related to “at risk” traffic situations. Accid Anal Prev. 2008;40(3):912–919.
6.
KomarovaNLThalhauserCJ. High degree of heterogeneity in Alzheimer’s disease progression patterns. PLoS Comput Biol. 2011;7(11):e1002251.
7.
SternY. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol. 2012;11(11):1006–1012.
8.
BrownLBOttBR. Driving and dementia: a review of the literature. J Geriatr Psychiatry Neurol. 2004;17(4):232–240.
9.
WheatleyCJCarrDBMarottoliRA; National Highway Traffic Safety Administration; American Occupational Therapy Association; Association for Driver Rehabilitation Specialists. Consensus statements on driving for persons with dementia. Occup Ther Health Care. 2014;28(2):132–139.
10.
OlsenKTaylorJThomasA. Mild cognitive impairment: safe to drive?Maturitas2014;78(2):82–85.
11.
OttBRAnthonyDPapandonatosGD. Clinician assessment of the driving competence of patients with dementia. J Am Geriatr Soc. 2005;53(5):829–833.
12.
BrownLBOttBRPapandonatorsGD. Prediction of on-road driving performance in patients with early Alzheimer’s disease. J Am Geriatr Soc. 2005;53(1):94–98.
13.
RegerMAWelshRKWatsonGS. The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychol. 2004;18(1):85–93.
14.
WhelihanWMDiCarloMAPaulRH. The relationship of neuropsychological functioning to driving competence in older persons with early cognitive decline. Arch Clin Neuropsychol. 2005;20(2):217–228.
15.
OttBRFestaEKAmickMMGraceJDavisJDHeindelWC. Computerized maze navigation and on-road performance by drivers with dementia. J Geriatr Psychiatry Neurol. 2008;21(1):18–25.
16.
WeaverBWalterSDBedardM. How to report and interpret screening test properties: guidelines for driving researchers. Traffic Inj Prev. 2014;15(3):252–261.
17.
WoodJMAnsteyKJKerrGKLacherezPFLordS. A multidomain approach for predicting older driver safety under in-traffic road conditions. J Am Geriatr Soc. 2008;56(6):986–993.
18.
CarrDBBarcoPPWallendorfMJSnellgroveCAOttBR. Predicting road test performance in drivers with dementia. J Am Geriatr Soc. 2011;59(6):2112–2117.
19.
Korner-BitenskyNBitenskyJSoferSMan-Son-HingMGelinasI. Driving evaluation practices of clinicians working in the United States and Canada. Am J Occup Ther. 2006;60(4):428–434.
20.
American Geriatrics Society & PomidorA, Ed. (2016). Clinician’s Guide to Assessing and Counseling Older Drivers (Report No. DOT HS 812 228). 3rd ed. Washington, DC: National Highway Traffic Safety Administration.
21.
DickersonAE. Screening and assessment tools for determining fitness to drive: a review of the literature for the Pathways Project. Occup Ther Health Care. 2014;28(2):82–121.
22.
HoggarthPAInnesCRDalrymple-AlfordJCJonesRD. Predicting on-road assessment pass and fail outcomes in older drivers with cognitive impairment using a battery of computerized sensory-motor cognitive tests. J Am Geriatr Soc. 2013;61(12):2192–2198.
23.
OttBRDavisJDPapandonatosGDHewittS. Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. J Am Geriatr Soc. 2013;61(7):1164–1169.
24.
BowersARAnastasioRJSheldonSSO’ConnorMG. Can we improve clinical prediction of at-risk older drivers?Accid Anal Prev. 2013;59:537–547.
25.
HuntLAMurphyCFCarrDDuchekJMBucklesVMorrisJC. Reliability of the Washington university road test. A performance-based assessment for drivers with dementia of the Alzheimer type. Arch Neurol. 1997;54(6):707–712.
26.
UnsworthCALovellRKTerringtonNS. Review of tests contributing to the occupational therapy off-road driver assessment. Aust Occup Ther J. 2005;52(1):57–74.
27.
WangCCKosinskiCJSchwartzbergJGShanklinA. Physician’s Guide to Assessing and Counseling Older Drivers. Washington, DC: National Highway Traffic Safety Administration; 2003.
28.
StaplinLLococoKHGishKWDecinaLE. Model driving screening and evaluation program. Vol 2. Washington: US DOT; 2003.
29.
Korner-BitenskyNGelinasIMan-Son-HingMMarshallS. Recommendations of the Canadian consensus conference on driving evaluation in older drivers. Phys Occup Ther Geriatr. 2005;23(2-3):123–144.
30.
DubinskyRMSteinACLyonsK. Practice parameter: risk of driving and Alzheimer’s disease (an evidence based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurol. 2000;54(12):2205–2211.
31.
RabinsPBlackerDBlandW. The American Psychiatric Association Work Group on Alzheimer’s Disease and Related Dementia. Practice Guidelines for the treatment of patients with Alzheimer’s disease and other dementias of late life. Am J Psychiatry1997;154(suppl 5):1–39.
Older patients & driving. New AMA/NHTSA guide helps physicians assess patient ability. Tennessee medicine. J Tenn Med Assoc. 2003;96:405.
34.
MarottoliRACooneyLMJrWagnerRDoucetteJTinettiME. Predictors of automobile crashes and moving violations among elderly drivers. Ann Intern Med. 1994;121(11):842–846.
35.
SternRAWhiteT. The Neuropsychological Assessment Battery (NAB): development and psychometric properties. Arch Clin Neuropsych. 2003;18:805.
36.
BallKKRoenkerDLWadleyVGEdwardsJD. Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting?J Am Geriatr Soc. 2006;54(1):77–84.
37.
FreundBGravensteinSFerrisRBurkeBLShaheenE. Drawing clocks and driving cars. J Gen Intern Med. 2005;20(3):240–244.
SternRSingerLDukeNMoreyEDaughtreyEKaplanE. The Boston Qualitative Scoring System for the Rey Osterrieth Complex Figure: Description and inter-rater reliability. Clin Neuropsychol1994;8(3): 309–322.
40.
ReitanRMWolfsonD. The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson, Ariz: Neuropsychology Press; 1985.
41.
FolsteinMFFolsteinSEMchughPR. Mini-mental state – practical method for grading cognitive state of patients for clinician. J Psychiat Res. 1975;12(3):189–198.
42.
MorrisJC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurol. 1993;43(11):2412–2414.
43.
FleissJL. The Design and Analysis of Clinical Experiments. New York, NY: John Wiley & Sons; 1986.
44.
ManlyBFJ.Multivariate Statistical Methods: A Primer. 3rd ed. Boca Raton, FL: Chapman and Hall; 2005.
45.
HosmerDWLemeshowS. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley & Sons; 2000.
46.
Seong-YoulCJae-ShinLA-YoungS. Cognitive test to forecast unsafe driving in older drivers: meta-analysis. NeuroRehabilitation. 2014;35(4):771–778.
47.
BrownLBSternRACahn-WeinerDA. Driving scenes test of Neuropsychological Assessment Battery (NAB) and on-road driving performance in aging and very mild dementia. Arch Clin Neuropsychol. 2005;20(2):209–215.
48.
MaddenDJ. Aging and visual attention. Curr Dir Psychol Sci. 2007;16(2):70–74.
49.
GliskyEL. Changes in cognitive function in human aging. In: RiddleDR, ed. Brain Aging: Models, Methods, and Mechanisms. Boca Raton, FL: CRC Press; 2007.
50.
DuchekJMHuntLBallKBucklesVMorrisJC.The role of selective attention in driving and dementia of the Alzheimer type. Alzheimer Dis Assoc Disord. 1997;11suppl 1:48–56.
51.
AndersonSWAksanNDawsonJDUcEYJohnsonAMRizzoM. Neuropsychological assessment of driving safety risk in older adults with and without neurologic disease. J Clin Exp Neuropsychol. 2012;34(9):895–905.
52.
StavWBJustissMDMcCarthyDPMannWCLanfordDN. Predictability of clinical assessments of driving performance. J Safety Res. 2008;39(1):1–7.
53.
DobbsBMShergillSS. How effective is the Trail Making Test (Parts A and B) in identifying cognitively impaired drivers. Age Ageing. 2013;42(5):577–581.
54.
ManningKJDavisJDPapandonatosGDOttBR. Clock drawing as a screen for impaired driving in aging and dementia: is it worth the time?Arch Clin Neuropsychol. 2014;29(1):1–6.
55.
EsserPDentSJonesC. Utility of the MOCA as a cognitive predictor for fitness to drive. J Neurol Neurosurg Psychiatry. 2015;87(5):567–568.
56.
MarshallGADekhtyaMBrunoJM. The Harvard Automated Phone Task: new performance-based activities of daily living tests for early Alzheimer’s disease. J Prev Alzheimers Dis. 2015;2(4):242–253.
