Early cognitive decline in amyotrophic lateral sclerosis and its relation to driving: an observational study

Taule, Tina; Tysnes, Ole-Bjørn; Aßmus, Jörg; Morland, Annbjørg Spilde; Renså, Marit Arnevik; Revheim, Tone; Glesnes, Synnøve; Rekand, Tiina · 2025 · DOAJ

DOI: 10.2340/jrm.v57.43483

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Summary

This observational study investigates whether early cognitive function in patients with amyotrophic lateral sclerosis (ALS) predicts future cognitive status and influences the decision to cease driving. The research addresses a critical gap in ALS management, where cognitive impairment—occurring in 30% to 75% of patients—is frequently overlooked despite its potential impact on complex activities like driving. The authors aimed to determine if baseline cognitive assessments could identify patients at risk for earlier cessation of driving, thereby informing clinical safety measures. The study recruited 31 native Norwegian-speaking ALS patients from the outpatient clinic at Haukeland University Hospital within four months of diagnosis. Participants underwent baseline assessments of cognitive function using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS-N) and driving ability via a modified questionnaire adapted from the Norwegian ParkWest study. Follow-up evaluations were conducted approximately four months later, up to eight months post-diagnosis. The researchers tested two hypotheses: (H1) that cognitive status remains stable between baseline and follow-up, and (H2) that patients with baseline cognitive impairment cease driving earlier than those without such impairment. Statistical analyses included paired t-tests for cognitive changes and Cox proportional hazard models for driving cessation, though graphical tools were primarily used for the latter due to skewed data. Results indicated that cognitive function remained stable over the study period, supporting H1. Of the 31 subjects at baseline, 11 (36%) exhibited cognitive impairment, and 61% were driving regularly. At follow-up, 21 subjects were reassessed cognitively, and no significant change in ECAS-N scores was observed. Regarding H2, there was no significant association between baseline cognitive function and driving status at follow-up. Among the 22 subjects who retained a driver’s license, 13 continued to drive regularly, including two individuals with cognitive impairment. Consequently, the hypothesis that cognitive impairment leads to earlier cessation of driving was rejected. The study concludes that while early cognitive assessment in ALS is valuable for predicting future cognitive function, it does not currently influence patients’ decisions to stop driving. This disconnect suggests that either driving ability declines slowly, or patients and clinicians fail to recognize or act upon cognitive deficits affecting driving safety. The findings emphasize the need for early evaluation and proactive discussions regarding driving safety to balance patient independence with public safety. The authors highlight that current clinical practices may neglect these cognitive challenges, urging healthcare professionals to prioritize this area to prevent potential traffic accidents associated with undetected cognitive decline.

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Topics

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• mci dementia driving
• cognitive impairment