Predictors of driving safety in early Alzheimer disease

Dawson, Jeffrey D.; Anderson, Steven W.; Ebadi, Manuchair; Dastrup, Elizabeth; Rizzo, M. · 2009 · OpenAlex-citations

DOI: 10.1212/01.wnl.0000341931.35870.49

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Summary

This study investigates the association between cognitive, visual, and motor functions and driving safety in individuals with early Alzheimer disease (AD). As the prevalence of dementia increases, determining when patients with AD can no longer drive safely is a critical public health challenge. While diagnosis alone indicates a risk, it does not account for the wide variability in cognitive preservation among early-stage patients. The authors aimed to determine if specific neuropsychological tests provide predictive value for driving performance beyond the diagnosis itself, thereby offering clinicians a tool to assess driving safety more precisely. The study included 40 drivers with probable early AD (mean Mini-Mental State Examination score of 26.5) and 115 elderly control drivers without neurologic disease. Participants underwent a comprehensive battery of off-road tests assessing cognition (e.g., Benton Visual Retention Test, Trail-Making Test), visual perception (e.g., Useful Field of View, contrast sensitivity), and motor function (e.g., Functional Reach, Get-Up-and-Go). Additionally, each participant drove a standardized 35-mile route in urban and rural settings in an instrumented vehicle. A certified driving expert reviewed video recordings to classify and count safety errors, which were categorized as serious or less serious. Statistical analyses, including multiple linear regression adjusted for age and gender, were used to identify predictors of safety errors. Drivers with AD committed significantly more safety errors per drive (mean 42.0) compared to controls (mean 33.2), with lane violations being the most frequent error type. Increased age was a significant predictor of errors, with 2.3 additional errors observed for every 5-year age increment. Within the AD group, lower performance on a composite cognitive score (COGSTAT) significantly predicted higher error rates; specifically, a one standard deviation decrease in cognitive function corresponded to a 4.1 increase in safety errors. Individual tests that significantly predicted safety errors in AD patients included the Benton Visual Retention Test (working memory), Trail-Making Test-A (visual search and motor speed), Complex Figure Test-Copy (visuoconstruction), and Functional Reach (motor balance). A multivariable model combining age, Benton Visual Retention Test scores, and Trail-Making Test-A performance provided the best fit for predicting total safety errors. The findings demonstrate that drivers with early AD exhibit a range of performance on cognitive, visual, and motor tests, and that these specific metrics offer predictive value for driving safety beyond the diagnosis alone. The study concludes that clinicians can utilize these standardized neuropsychological assessments to help determine whether a patient with AD can safely operate a motor vehicle. This approach supports a more nuanced decision-making process that balances patient safety with the preservation of mobility and independence.

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Topics

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• mci dementia driving
• cognitive impairment