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A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean cor...
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Citations
... Previous reports have investigated the relationship between CDT scores and whether older drivers are safe to drive (Freund et al., 2005), or whether CDT performance can predict the occurrence of accidents (Diegelman et al., 2004). Driving is a very complicated task that requires multiple cognitive functions, including attention, visual perception, and visuospatial abilities (Reger et al., 2004), to deal with the various situations that occur during driving. Tinella et al. (2022) explained that both egocentric (self-to-object) and allocentric (object-to-object) spatial representations are assumed to be crucial for driving skills. ...
Objectives
To keep older drivers safe, it is necessary to assess their fitness to drive. We developed a touch screen-based digital Clock Drawing Test (dCDT) and examined the relationship between the dCDT scores and on-road driving performance of older drivers in a community-setting.
Methods
One hundred and forty-one community-dwelling older drivers (range; 64–88 years old) who participated in this study were included in the analysis. Participants completed the dCDT, the Mini-Mental State Examination-Japanese (MMSE-J), and an on-road driving assessment. We examined the relationship between dCDT scores using the method by Rouleau et al. (maximum 10 points) and the on-road driving performance based on a driving assessment system originally developed by Nagoya University.
Results
Multiple regression analyses showed that errors in the driving test were associated with dCDT score for the items “confirmation,” “turning left” and “maintains driving lane position”.
Discussion
This study confirmed the relationship between the dCDT score and driving errors, such as confirmation, turning left and maintaining driving lane position. The increase in these errors indicates a decline in visuospatial ability while driving. The dCDT score may reflect older drivers’ visuospatial abilities while driving.
... Nevertheless, since driving is a behavior that requires multidimensional abilities, such as physical and cognitive abilities [4][5][6], older adults with deteriorating physical functions are more stressed about driving behavior and can easily experience cessation of driving [7,8]. In other words, to drive safely, it is necessary to have visuospatial abilities, such as securing a safe driving distance, and various cognitive judgments, such as responding quickly to emergencies and making appropriate judgments about various driving situations [9][10][11]. However, older adults find it easy to stop driving because their physical and cognitive abilities, such as visuospatial abilities, reaction speed, decision making, and situational judgment, decrease due to aging, which reduces their driving ability [9][10][11]. ...
... In other words, to drive safely, it is necessary to have visuospatial abilities, such as securing a safe driving distance, and various cognitive judgments, such as responding quickly to emergencies and making appropriate judgments about various driving situations [9][10][11]. However, older adults find it easy to stop driving because their physical and cognitive abilities, such as visuospatial abilities, reaction speed, decision making, and situational judgment, decrease due to aging, which reduces their driving ability [9][10][11]. This driving cessation in older adults imposes limitations on their freedom of movement, substantially diminishing their mobility [12,13]. ...
Compared to the driving group, the driving cessation group in this study was found to be a high-risk population in terms of their life satisfaction. This study evaluated data from 315 older adults, aged 55 or older, using the 2018 Korean Older Adults Driving and Mobility Service Trend Survey. These data were collected from 17 representative cities and provinces in South Korea. To minimize the potential for selection bias and the confounding factors inherent in observational studies, this study employed the propensity score matching (PSM) method. Following the matching, multivariate regression analyses were conducted to compare the driving cessation group (n = 65) with the driving group (n = 50) in terms of their life satisfaction. After adjusting for demographic and health-related variables, the older adults who had ceased driving were found to have lower life satisfaction (Coef. = −1.39, p-value = 0.018). Our results highlight the importance of establishing preliminary evidence to guide the development of tailored programs for older adults—especially for those likely to experience diminished life satisfaction and heightened risk—to address the mobility challenges stemming from driving cessation.
... Physical and cognitive function tests have been performed in medical institutions to perform rehabilitation for individuals with stroke. Several studies have investigated the association between physical and cognitive function tests and driving aptitude [9][10][11]. Reger et al. reported relationships among the results of cognitive function tests, including attention, visuospatial cognition, memory, and executive function, and the results of on-road testing and the evaluation results from a driving simulator [10]. ...
... Several studies have investigated the association between physical and cognitive function tests and driving aptitude [9][10][11]. Reger et al. reported relationships among the results of cognitive function tests, including attention, visuospatial cognition, memory, and executive function, and the results of on-road testing and the evaluation results from a driving simulator [10]. Yamada et al. performed two cognitive function tests, the mini-mental state examination (MMSE) and the trail-making test (TMT), on participants with stroke and reported relationships between the results of tests and driving aptitude [11]. ...
Background
People who were previously hospitalised with stroke may have difficulty operating a motor vehicle, and their driving aptitude needs to be evaluated to prevent traffic accidents in today’s car-based society. Although the association between motor-cognitive functions and driving aptitude has been extensively studied, motor-cognitive functions required for driving have not been elucidated.
Methods
In this paper, we propose a machine-learning algorithm that introduces sparse regularization to automatically select driving aptitude-related indices from 65 input indices obtained from 10 tests of motor-cognitive function conducted on 55 participants with stroke. Indices related to driving aptitude and their required tests can be identified based on the output probability of the presence or absence of driving aptitude to provide evidence for identifying subjects who must undergo the on-road driving test. We also analyzed the importance of the indices of motor-cognitive function tests in evaluating driving aptitude to further clarify the relationship between motor-cognitive function and driving aptitude.
Results
The experimental results showed that the proposed method achieved predictive evaluation of the presence or absence of driving aptitude with high accuracy (area under curve 0.946) and identified a group of indices of motor-cognitive function tests that are strongly related to driving aptitude.
Conclusions
The proposed method is able to effectively and accurately unravel driving-related motor-cognitive functions from a panoply of test results, allowing for autonomous evaluation of driving aptitude in post-stroke individuals. This has the potential to reduce the number of screening tests required and the corresponding clinical workload, further improving personal and public safety and the quality of life of individuals with stroke.
... A comprehensive review by Bennett and colleagues [88] examining 28 studies on cognitive function and driving in people with dementia found no single cognitive domain consistently reliable in determining driving capability. These findings align with previous research showing that various cognitive domain fields' effect sizes range from weak to moderate [89]. Similarly, assessments based on brief mental examinations have proven inadequate in distinguishing between safe and unsafe drivers [90,91]. ...
Driving is a critical aspect of personal mobility and autonomy, but ensuring road safety requires a comprehensive evaluation of driving abilities beyond self-reported behaviors and practical skills. This article emphasizes the importance of cognitive assessment in determining fitness to drive and explores the potential benefits of using digital tools for such evaluations to enhance road safety. Implementing these digital tools does come with challenges, such as unfamiliarity with digital cognitive reviews for some and the requirement of adaptability to evaluate cognitive skills across various age demographics. Additionally, the absence of standardization in driving assessments across different regions can result in inconsistencies in judging who is fit to drive. Despite these hurdles, integrating digital cognitive evaluations and training into conducting assessments and educational initiatives can more effectively comprehend and address mental aspects of driving, thereby potentially reducing crash risk and promoting road safety. This hypothesis-driven approach proposes that a thorough assessment of an individual's readiness to drive, focusing on vital cognitive domains associated with safe driving, can contribute to safer roads and yield substantial social, economic, and personal benefits. We encourage future research and educators to consider these insights when developing driving education programs and assessments of driving fitness.
... However, programs addressing cognitive risk factors have yet to be deployed on a similar scale. This is a critical gap in light of the clear links between safe driving and cognitive skills including visuospatial awareness, object/space perception, psychomotor control, attention, working memory and executive functioning (see: Aksan et al., 2015;Barkley et al., 2002;Ledger et al., 2019;Reger et al., 2004;Ross et al., 2015;Woodward et al., ...
Research suggests, action video games (AVGs) can benefit cognitive performance across multiple domains including attention, visual-spatial awareness, psychomotor control, and executive functioning. Many of these domains overlap with the skills needed to safely drive a vehicle. We therefore predicted that experience playing AVGs may be associated with improved driving performance and greater spare capacity. One-hundred-and-thirty-eight participants who varied in action video game experience, completed a driving simulation under distracted and non-distracted conditions. Driving performance was measured through participants’ ability to maintain a consistent speed and lane position, and their spare cognitive capacity (via detection response task; DRT). Results showed participants with experience playing AVGs performed significantly better than non-gamers, demonstrating lower speed variability, improved lane maintenance, and better performance on the DRT. The effects of distraction were predictably observed, though distraction negated the improvements to DRT response times for AVG players. These findings indicate action video game players had better driving performance and increased spare cognitive capacity compared to individuals who did not play AVGs and highlight a potential avenue for improving driver safety through video game use.
... Currently more than 55 million people worldwide have been diagnosed with dementia, with Alzheimer's disease (AD) being the most common form of dementia (World Health Organization [WHO], 2021). Driving is a highly complicated task that requires multiple cognitive functions, such as attention, visuoperceptual and visuospatial abilities, which may be considerably compromised in individuals with dementia (Reger et al., 2004;Hird et al., 2016). ...
Background
Impaired driving ability in patients with Alzheimer’s disease (AD) is associated with a decline in cognitive processes and a deterioration of their basic sensory visual functions. Although a variety of ocular abnormalities have been described in patients with AD, little is known about the impact of those visual disorders on their driving performance.
Aim
Aim of this mini-review is to provide an update on the driving ability of patients with dementia and summarize the primary visual disorders affecting their driving behavior.
Methods
Databases were screened for studies investigating dementia, associated visual abnormalities and driving ability.
Results
There is consistent evidence that dementia affects driving ability. Patients with dementia present with a variety of visual disorders, such as visual acuity reduction, visual field defects, impaired contrast sensitivity, decline in color vision and age-related pathological changes, that may have a negative impact on their driving ability. However, there is a paucity in studies describing the impact of oculovisual decline on the driving ability of AD subjects. A bidirectional association between cognitive and visual impairment (VI) has been described.
Conclusion
Given the bidirectional association between VI and dementia, vision screening and cognitive assessment of the older driver should aim to identify at-risk individuals and employ timely strategies for treatment of both cognitive and ocular problems. Future studies should characterize the basic visual sensory status of AD patients participating in driving studies, and investigate the impact of vision abnormalities on their driving performance.
... Other functions, such as other executive functions, memory, or perceptual abilities, are also required for driving (Whelihan et al., 2005;Mäntylä et al., 2009;León-Domínguez et al., 2017). Some of these cognitive abilities deteriorate with aging, but only deficits in visuospatial abilities have been consistently associated with impaired driving, both real and simulated, in older adults (Reger et al., 2004;Hoffman et al., 2005;Mathias and Lucas, 2009). Investigating the mediating mechanisms of visuospatial abilities in driving is important since its deficit has been associated with real-world crashes and performance in a driving simulator in older adults (Anderson et al., 2005) and patients with cognitive impairment (Apolinario et al., 2009). ...
The ability to appropriately perceive distances in activities of daily living, such as driving, is necessary when performing complex maneuvers. With aging, certain driving behaviors and cognitive functions change; however, it remains unknown if egocentric distance perception (EDP) performance is altered and whether its neural activity also changes as we grow older. To that end, 19 young and 17 older healthy adults drove in a driving simulator and performed an functional magnetic resonance imaging (fMRI) experiment where we presented adults with an EDP task. We discovered that (a) EDP task performance was similar between groups, with higher response times in older adults; (b) older adults showed higher prefrontal and parietal activation; and (c) higher functional connectivity within frontal and parietal-occipital-cerebellar networks; and (d) an association between EDP performance and hard braking behaviors in the driving simulator was found. In conclusion, EDP functioning remains largely intact with aging, possibly due to an extended and effective rearrangement in functional brain resources, and may play a role in braking behaviors while driving.
... has been associated with declines in ability to independently perform tasks of daily living (Reppermund et al., 2011;Watson, Gignac, Weinborn, Green, & Pestell, 2020) and driving ability (Reger et al., 2004). ...
Objective
The Benton Visual Form Discrimination Test (VFDT) is a commonly used measure of visual discrimination and visual recognition memory and has shown promise in distinguishing between different levels of cognitive impairment. We assess the predictive diagnostic utility of the VFDT in a sample of older Veterans with cognitive concerns.
Method
Subjects included a total of 172 mostly male Veterans over the age of 64 (mean = 76.0; SD = 7.6) recruited from a VA clinic specializing in neuropsychological assessment of older Veterans. The clinical sample included 56 subjects diagnosed with Major Neurocognitive Disorder, 74 diagnosed with Mild Neurocognitive Disorder, and 42 with No Neurocognitive Impairment. Impairment categories were modeled in separate multinomial logistic regressions with two versions of the VFDT as predictors: the Visual Form Discrimination Test-Recognition Subtest (VFDT-Rec) test (visual recognition memory) and the Visual Form Discrimination Test-Matching Subtest VFDT-Mat test (visual form discrimination). Years of education were included as a covariate.
Results
After adjusting for education, higher VFDT-Rec total scores were associated with lower odds of being categorized with a greater degree of cognitive/functional impairment (OR 0.66–0.83, p < .001). VFDT-Mat scores showed a similar pattern, but only reached statistical significance for the Major versus No Neurocognitive Impairment (OR = 0.77, p = .0010) and Major versus Mild comparisons (OR = 0.89, p = .0233).
Conclusions
The VFDT may enhance the confidence of differential diagnosis of dementia in older adult Veterans. Formal education-adjusted norms need to be established for clinical use.
... Individuals with cognitive disorders have an increased risk of traffic accidents (2)(3)(4). The risk of individuals with major cognitive disorders being involved in a collision is up to 4.5 times higher than for older people without cognitive disorders (4,5). Most on-road studies (4,(6)(7)(8)(9)(10) and simulator studies (9,11) have also shown that, on average, the ability to drive is more affected in drivers with cognitive disorders than in drivers without cognitive disorders. ...
Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.
Clinical trial registration number
NCT04493957.
... The four standard tests studied here cover general cognition/mental ability (MMSE), attention and concentration (TMT-A), executive function (TMT-B) and visuospatial skills/construction (clock drawing) [22,23]. Reger et al. [22], but also Mathias et al. [23], report these tests to be the most frequently used in the respective domain within their literature-or meta-analyses, the only exception being of the clock-drawing test. ...
... The four standard tests studied here cover general cognition/mental ability (MMSE), attention and concentration (TMT-A), executive function (TMT-B) and visuospatial skills/construction (clock drawing) [22,23]. Reger et al. [22], but also Mathias et al. [23], report these tests to be the most frequently used in the respective domain within their literature-or meta-analyses, the only exception being of the clock-drawing test. ...
... As safe driving requires "the complex interaction of physical, cognitive, perceptual, and psychological skills and abilities" [24], there is a wide range of combinations, either focusing on cognitive abilities or also capturing vision, motor function and recorded or self-reported driving incidents [25][26][27]. Of the "cognitive" tests, each might focus on different domains, such as attention, construction/visuospatial skills, memory, executive function, perception or span general mental ability [22,23,28]. Furthermore, such studies, measures of "safe driving" might be, on the one hand, (odds ratios for subsequently recorded) motor vehicle crashes (MCV), study-associated tests of on-road driving performance or non-road (e.g. ...
Abstract Background With age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations. Methods We present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data. Results Using N = 188 complete data sets of a total of 225 included cases, AIC identified age (p
