Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM).
DOI: 10.1371/journal.pone.0052710
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Summary
This study investigates the factors influencing driving cessation in patients with dementia, addressing a gap in evidence-based guidelines for assessing driving fitness in this population. While previous research indicates an increased accident risk for dementia patients, legal requirements for medical assessment vary significantly across countries, and existing practice parameters often rely on expert opinion rather than robust data. The authors aimed to determine which cognitive, functional, behavioral, and caregiver-related factors predict when dementia patients stop driving. The research utilized data from the Prospective Registry on Dementia in Austria (PRODEM), a longitudinal multi-center cohort study. The analysis focused on 240 participants who were former or current drivers, with a mean age of 74.2 years and 80.8% diagnosed with Alzheimer’s disease. Data were collected via standardized questionnaires and clinical assessments, including the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), CERAD neuropsychological battery, Disability Assessment for Dementia (DAD) for activities of daily living (ADL), and the Neuropsychiatric Inventory (NPI). Caregiver burden was measured using the Zarit Burden Interview. Reasons for driving cessation were categorized based on caregiver reports into unacceptable risk, car accidents, or license revocation. Statistical analyses included univariate comparisons and multivariate logistic regression to identify independent predictors. The results revealed that caregiver judgment of "unacceptable risk" was the primary reason for driving cessation in 93.8% of cases, whereas car accidents and license revocations accounted for only 5.5% and 0.7%, respectively. In multivariate analysis, only three factors were significantly and independently associated with driving cessation: female gender (OR 5.057), poorer constructional abilities on the CERAD battery (OR 0.611), and greater impairment in activities of daily living (OR 0.941). Notably, traditional screening tools such as the MMSE and CDR, which are often recommended in clinical guidelines, were not significantly associated with driving cessation in the multivariate model. Univariate analysis showed that those who ceased driving were older, had lower MMSE and CDR scores, and exhibited more behavioral symptoms, but these associations did not hold independently when controlling for constructional ability and ADL impairment. The study concludes that caregiver risk estimation, rather than objective accidents or legal revocation, drives the decision to cease driving in dementia patients. The findings challenge current practice parameters that emphasize global cognitive screening tools like the MMSE and CDR, suggesting instead that visuospatial constructional abilities and functional independence in daily activities are more critical predictors. The authors highlight the pivotal role of caregivers in this decision-making process, noting that caregiver characteristics themselves did not influence the cessation decision. These results imply that clinical assessments for driving fitness should prioritize specific cognitive domains and functional status over general dementia severity scores, though further research is needed to link these factors directly to traffic safety outcomes.
Provenance
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| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | DOAJ | — | — | 1 | 2026-06-24 |
| archive | success | unpaywall | — | — | 1 | 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 | 2026-06-24 |
| 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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