Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment

Anstey, Kaarin J.; Eramudugolla, Ranmalee; Chopra, Sidhant; Price, Jasmine; Wood, Joanne M. · 2017 · OpenAlex-citations

DOI: 10.3233/jad-161209

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Summary

This study addresses the lack of evidence regarding the on-road driving safety of older adults with mild cognitive impairment (MCI). As the population ages, the number of drivers with MCI is increasing, yet previous research has been limited by small sample sizes and unclear implications for licensing decisions. The authors aimed to evaluate the risk of unsafe driving performance in this group compared to cognitively normal (CN) adults and to determine whether off-road screening tests or traditional neuropsychological assessments better predict on-road safety. The research utilized a cross-sectional observational design involving 302 non-demented, current drivers aged 65 to 96 years recruited from the community and clinical settings in Canberra, Australia. Participants underwent a comprehensive assessment including a standardized 50-minute on-road driving test (ORT), a battery of off-road screening measures specifically designed for older drivers (UFOV®, DriveSafe, and the Multi-D battery), and a neurocognitive test battery. Using Winblad criteria, 57 participants were classified as having MCI and 245 as cognitively normal. The ORT generated a safety rating on a scale of 1 to 10, with lower scores indicating poorer safety. Statistical analyses included generalized linear models to compare group performance and hierarchical logistic regression to identify predictors of unsafe driving (defined as an ORT score of 1–3). Results indicated that while the MCI group had a significantly lower average safety rating on the ORT (5.61) compared to the CN group (6.05), the difference was less than one point on a 10-point scale, and there was substantial overlap in the distribution of scores between groups. The MCI group performed worse on several off-road screening tests, including Dot Motion, the Multi-D risk score, and DriveSafe measures. Crucially, traditional neuropsychological tests did not significantly predict unsafe driving in the combined sample. Instead, the best-fitting predictive model for ORT performance included age, the DriveSafe score, and the Multi-D battery, correctly classifying 90.4% of the sample. Driving-specific tests were more strongly associated with safety ratings than general cognitive assessments. The study concludes that a diagnosis of MCI alone should not be used to determine fitness to drive, as individuals with MCI exhibit a wide range of driving abilities similar to those with normal cognition. Although MCI is associated with slightly poorer performance on average, many individuals in this group drive safely. The findings emphasize that specialized assessments targeting skills relevant to driving, such as visual processing and traffic reasoning, are more effective than general neuropsychological tests for evaluating driving safety. This suggests that clinical evaluations for older drivers should prioritize validated, driving-specific screening tools to accurately identify those at risk.

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Topics

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• mci dementia driving
• cognitive impairment
• fitness to drive assessment
• cognitive capacity variation

Information type

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• Methodological Resource: validation psychometrics
• Theoretical Contribution: computational model