Drivers with Dementia: Environment, Errors and Performance Outcomes
DOI: 10.17077/drivingassessment.1268
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Summary
This observational study investigates the on-road driving performance of individuals with dementia to identify specific environmental tasks and error types that distinguish safe from unsafe drivers. Motivated by the increasing prevalence of dementia and the consensus that drivers with moderate to severe dementia must cease driving, the research aims to refine assessment criteria for those with very mild to mild dementia. The goal is to establish essential environmental and task criteria for on-road assessments, ensuring they are sensitive enough to detect impairment without discriminating against healthy older adults. The study recruited 117 licensed drivers aged 48–88 with clinically diagnosed cognitive impairment from a Memory Disorders Clinic in Adelaide, Australia. After excluding two participants due to safety concerns, 115 drivers underwent a 60-minute on-road assessment comprising 110 specific driving tasks. Assessments were conducted by a driver-trained occupational therapist and a professional driving instructor who were blinded to the participants' severity scores. Performance was scored binary (pass/fail) for each task, and qualitative field notes recorded error types. Statistical analyses, including unpaired t-tests and Fisher’s Exact Tests, compared pass and fail groups regarding age, Mini-Mental State Exam (MMSE) scores, error frequencies, and specific task locations. Results indicated that advancing age and lower MMSE scores were significantly associated with failing the assessment. The mean error rate for the fail group (54 errors) was significantly higher than for the pass group (27 errors). The study distinguished between "criterion" errors, which differentiated the groups, and "non-criterion" errors, which did not. Criterion errors included hazardous lapses, mirror observation failures, turn positioning errors, speeding, and poor vehicle control. Hazardous errors, defined as those requiring instructor intervention or evasive action by other road users, were most frequent in complex environments. U-turns, dog-leg turns at traffic signals, and lane changes presented the highest odds ratios for failure, with fail-group drivers up to 42 times more likely to commit hazardous errors in these scenarios compared to the pass group. Conversely, common errors like signal lapses and minor positioning issues occurred similarly in both groups. The findings confirm that driving errors in dementia increase in frequency and severity with cognitive decline and age. The study identifies specific high-risk environmental tasks, such as complex turns and lane changes, as critical indicators of unsafe driving. These results support the use of standardized, sensitive on-road assessments that focus on criterion errors to accurately determine fitness to drive. The authors conclude that these identified task locations should serve as minimum criteria for future on-road assessment designs, aiding in the objective evaluation of drivers with early-stage dementia.
Provenance
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| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | Crossref | — | — | 1 | 2026-06-25 |
| archive | success | canonical_url | — | — | 1 | 2026-06-26 |
| extract | success | cached | — | — | 2 | 2026-06-26 |
| clean | success | clean | — | — | 1 | 2026-06-26 |
| chunk | success | chunk | — | — | 1 | 2026-06-26 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-26 |
| enrich | success | openalex | — | — | 1 | 2026-06-26 |
| promote | success | — | — | — | 1 | 2026-06-25 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 1 | 2026-06-26 |
| tag | success | vector_similarity | — | — | 6 | 2026-06-26 |
| verify | partial | — | — | — | 1 | 2026-06-26 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified_with_issues.
Topics
Ranked by relevance to this paper. Hover a topic for its definition.
- mci dementia driving
- cognitive impairment
- human error taxonomy
- cognitive capacity variation
- pedal misapplication
- pre crash contributing factors
Information type
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- Methodological Resource: validation psychometrics
- Theoretical Contribution: computational model