One interpretation of these results is that the group that made a more realistic evaluation of their driving performance were more aware of their cognitive capacity compared to those who failed the driving test. They seemed to have a better ability to adjust their driving behaviour at a tactical level. Thus, the subject's metacognition, awareness of his/her own cognitive capacity, is important for coping with cognitive impairments at tactical driving.

Twenty-nine patients with brain lesion and 29 matched controls participated in the study. The patients were socially well recovered with a high rate of employment. Compared with the controls, they performed significantly worse on a neuropsychological test battery, especially on executive and cognitive functions. Patients drove as well as controls in predictable situations in the advanced simulator used. In unpredictable situations, they demonstrated longer reaction times and safety margins, as well as difficulties in allocating processing resources to a secondary task. The patients showed significantly less attention, worse traffic behavior, and less risk awareness when driving in real traffic. Forty-one percent of the patients did not pass the driving test. The neuropsychological test battery was factor analyzed into four factors: executive capacity, cognitive capacity, automatic attentional capacity, and simple perceptual-motor capacity. The second factor was the mast significant with a simultaneous capacity test predicting driving performance with 78% confidence.

Neuropsychological tests focusing on information processing speed and attention is a useful screening tool for predicting driving competence. Stroke patients are vulnerable if they continue to drive and need to be evaluated for their driving capacity to drive.

The question of whether a person can resume driving after acquired cognitive dysfunction is raised in primary care services and in hospital departments where patients suffering from brain injury are treated. These organizations rarely have a specialized program that evaluates driving fitness. This article describes a semi-structured and individualized model that serves as clinical guidelines for determining fitness to drive. The model is based on former research and clinical experience. It is exemplified by the procedure of forty-three individuals with congenital or acquired cognitive dysfunction due to head trauma or disease. A multidisciplinary team including medical, neuropsychological, occupational, and practical driving specialists optimised the clinical applicability of a driving assessment using quantitative and qualitative methods. The team discussions, including several professional evaluations and assessments, are considered very important for interpreting results, for understanding whether the cognitive impairments will have consequences on driving, and whether the individual can compensate for cognitive difficulties. The current way to determine a patient's fitness to drive after cognitive dysfunction is an individually adapted combination of assessment methods that are often performed stepwise. This well-practiced evaluation process reveals that in many cases neither off-road tests nor on-road tests alone are sufficient to ensure sound decisions. To improve on these evaluations, this study concludes that a team-based consensus approach consisting of specialized national teams should be established to support primary care services in assessing fitness to drive in more complicated cases.