Evaluation of Naturalistic Driving Behavior Using In-Vehicle Monitoring Technology in Preclinical and Early Alzheimer’s Disease
DOI: 10.3389/fpsyg.2020.596257
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Summary
This pilot study investigates naturalistic driving behaviors in older adults across the spectrum of Alzheimer’s disease (AD), specifically comparing symptomatic early AD drivers with cognitively normal drivers who either have evidence of cerebral amyloidosis (preclinical AD) or do not. The research addresses a critical gap in understanding how driving safety is affected during the preclinical phase of AD, a period where cognitive symptoms are not yet overt but pathological changes are present. The study aims to characterize unsafe driving behaviors in symptomatic AD using video capture and compare driving habits across all three groups using GPS dataloggers. The study included 33 drivers aged 60 and older, divided into three matched groups of 11: symptomatic early AD (CDR 0.5–1), cognitively normal with amyloid positivity (CN/A+), and cognitively normal with amyloid negativity (CN/A−). Participants were monitored over three months using two in-vehicle technologies. Symptomatic AD drivers were equipped with a G-force-triggered video camera (DriveCam) to capture safety errors, while all participants used a GPS datalogger (DRIVES) to record speeding, hard braking, and sudden acceleration every 30 seconds. Cognitive assessments, including the Mini-Mental State Examination (MMSE) and Trail Making Test, were conducted at enrollment. Statistical analyses employed generalized linear modeling to determine event frequencies per 1,000 miles driven, controlling for exposure. Results indicated that symptomatic AD drivers frequently exhibited safety errors such as driving unbelted, late responses, poor judgment, and failure to scan intersections, though actual collisions were rare. In contrast, the preclinical AD group (CN/A+) demonstrated the lowest rates of adverse driving events across all categories, particularly speeding, compared to both the symptomatic AD and healthy control groups. This suggests that drivers in the preclinical phase may engage in self-regulatory behaviors, driving more cautiously to compensate for subtle cognitive changes. Psychomotor speed, measured by Trail Making Part A, showed a non-linear relationship with driving events; slower psychomotor speed was associated with fewer speeding events but more hard acceleration events. Additionally, GPS-recorded speeding correlated strongly with video-captured near-collisions and driving fundamentals errors in the AD group. The findings highlight the utility of electronic monitoring technologies in identifying unsafe driving behaviors in early and preclinical AD. The study concludes that self-regulatory changes in driving behavior likely occur during the preclinical phase of AD, allowing these individuals to maintain safety despite underlying pathology. However, as cognitive impairment progresses to the symptomatic stage, the ability to self-monitor declines, leading to increased safety errors. These results imply that driving risk assessment should consider the disease stage, as preclinical drivers may appear safer than expected due to compensatory behaviors, while symptomatic drivers require closer monitoring for specific judgment and awareness deficits.
Provenance
The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed.
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | OpenAlex-citations | — | — | 1 | 2026-06-20 |
| archive | success | unpaywall | — | — | 2 | 2026-06-26 |
| extract | success | cached | — | — | 2 | 2026-06-26 |
| clean | success | clean | — | — | 1 | 2026-06-25 |
| chunk | success | chunk | — | — | 1 | 2026-06-25 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-25 |
| promote | success | — | — | — | 1 | 2026-06-20 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 1 | 2026-06-26 |
| tag | success | vector_similarity | — | — | 6 | 2026-06-25 |
| verify | success | — | — | — | 1 | 2026-06-26 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified.
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- Empirical Findings: observational prevalence
- Methodological Resource: dataset resource