Evaluating Driving Performance of Outpatients with Alzheimer Disease

Cox, D. J.; Quillian, W. C.; Thorndike, F. P.; Kovatchev, B. P.; Hanna, G. · 1998 · OpenAlex-citations

DOI: 10.3122/jabfm.11.4.264

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Summary

This study addresses the critical clinical challenge of determining when patients with Alzheimer disease (AD) should cease driving, a decision complicated by ethical dilemmas and the limitations of subjective assessment. The authors aimed to evaluate whether an interactive driving simulator could objectively differentiate driving performance between AD patients and age-matched controls, and whether simulator performance correlated with cognitive status as measured by the Mini-Mental State Exam (MMSE). The researchers compared 29 outpatients with probable AD to 21 age-matched control participants using a sophisticated three-screen Atari driving simulator. The experimental course simulated an 8-mile drive on a typical US highway, incorporating various traffic demands such as stop signs, left turns, and speed limit changes. Participants completed a background questionnaire, the MMSE, and the simulator test. Data were recorded eight times per second, generating 12 driving performance variables including steering variability, braking pressure, speed adherence, and collision frequency. Due to cognitive inability or simulator sickness, 10 AD patients and 2 controls could not complete the test; thus, driving performance analysis was conducted on the remaining 17 AD patients and 21 controls. Results indicated that AD patients performed significantly worse than controls on multiple metrics. They drove off the road more frequently, spent more time driving below the speed limit, applied less brake pressure in stop zones, and took longer to negotiate left turns. Conversely, there were no significant differences in midline crossing or speed variability. Factor analysis identified five driving factors—poor steering control, poor stopping control, speed control, weak braking, and improper braking—that explained 93% of the variance and correctly classified 85% of participants as either AD or control. The total driving score correlated significantly with MMSE scores (r = -.403, P = 0.011). Notably, AD patients who had already stopped driving did not perform worse on the simulator than those who continued driving, suggesting that self-reported cessation of driving does not necessarily reflect objective driving ability. The study concludes that driving simulators provide a sensitive, objective tool for assessing driving safety in AD patients, outperforming reliance on diagnosis alone. The findings suggest that blanket restrictions based solely on an AD diagnosis may be inappropriate, as some patients retain safe driving capabilities. Instead, clinicians should utilize objective performance metrics, such as simulator testing or on-road evaluations, alongside cognitive screening tools like the MMSE, to make informed decisions regarding driving fitness. This approach helps balance patient autonomy with public safety, addressing a significant public health concern given the high prevalence of AD among older drivers.

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• mci dementia driving
• cognitive impairment

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