Assessment of cognitive screening tests as predictors of driving cessation: A prospective cohort study of a median 4-year follow-up.

Kokkinakis, Ioannis; Vaucher, Paul; Cardoso, Isabel; Favrat, Bernard · 2021 · DOAJ

DOI: 10.1371/journal.pone.0256527

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Summary

This prospective cohort study addresses the challenge primary care physicians face in assessing driving fitness and predicting driving cessation among older adults. The research was motivated by the significant individual and societal impacts of driving cessation, which is associated with functional dependency, depression, and mortality. The study aimed to evaluate the predictive value of specific neuropsychological and functional screening tests—Trail Making Test (TMT), Clock Drawing Test (CDT), Montreal Cognitive Assessment (MoCA), Useful Field of View (UFOV), and Timed Up and Go (TUG)—in forecasting driving cessation for health reasons in drivers aged 70 and older. The study, known as the GARAge study, was conducted in French-speaking regions of Switzerland between 2011 and 2013. It included 441 participants who were active drivers aged 70 or older, recruited from a driving refresher course. Participants underwent baseline assessments using the five specified tests, with predefined cutoffs determining positive results (e.g., CDT score <5, TMT-A >54 seconds). The primary outcome was driving cessation due to health-related accidents, physician recommendations, or voluntary cessation for health reasons. Data on driving status were obtained objectively from the State Driver and Vehicle Licensing Agency. The cohort was followed for a median of 4 years, accumulating 1,738 person-years of observation. Statistical analysis employed Cox proportional hazards regression to calculate hazard ratios, adjusting for age and sex, and evaluated the predictive power of combining three or more positive test results. The results indicated that 19 participants (4.3%) ceased driving for health reasons during the follow-up period. Individually, the TMT and CDT demonstrated statistically significant predictive value. Participants with slower TMT performance (TMT-A >54 sec or TMT-B >150 sec) had a threefold higher hazard of driving cessation (adjusted HR 3.0, 95% CI: 1.16–7.78, p = 0.023). Similarly, those with a CDT score <5 had a 2.89 times higher hazard (adjusted HR 2.89, 95% CI: 1.01–7.71, p = 0.033). In contrast, MoCA, TUG, and UFOV scores did not show statistically significant associations with driving cessation when analyzed individually. However, when used as a battery, participants with three or more positive tests were 3.46 times more likely to cease driving (95% CI: 1.31–9.13, p = 0.012) compared to those with fewer positive results. The study concludes that the CDT and TMT are effective predictors of driving cessation in older adults, outperforming MoCA and UFOV in this cohort. Combining multiple screening tests enhances the predictability of driving cessation. However, the authors caution that despite these predictive associations, more than 95% of participants above the risk thresholds continued driving for four years without serious incidents, suggesting that while these tests identify risk, they should be interpreted with care in clinical practice.

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Topics

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• fitness to drive assessment
• cognitive impairment
• mci dementia driving
• useful field of view