Cognition and driving in older persons

Abstract

In Switzerland, approximately 350,000 people aged 70 years or older own a valid driving license. By law, these drivers are medically assessed every other year, most commonly by their general practitioner, to exclude that a medical condition is interfering with their driving skills. A prerequisite for driving is the integration of high-level cognitive functions with perception and motor function. Ageing, per se, does not necessarily impair driving or increase the crash risk. However, medical conditions, such as cognitive impairment and dementia, become more prevalent with advancing age and may contribute to poor driving and an increased crash risk. The extent to which driving skills are impaired depends on the cause of dementia, disease severity, other co-morbidities and individual compensation strategies. Dementia often remains undiagnosed and therefore general practitioners (GPs) can find themselves in the difficult situation to disclose a suspicion about cognitive impairment and queries about medical fitness to drive, at the same time. In addition, the literature suggests that cognitive screening tests, most commonly used by GPs, have a limited role in judging whether an older person remains fit to drive. Further specialist assessment, for example in a memory clinic or on the road testing (ORT), may be helpful when the diagnosis or its implication for driving remain unclear. Here, we review the literature about cognition and driving, for GPs who advise older drivers who wish to continue driving.

Barriers to Assessing Fitness to Drive in Dementia in Nova Scotia: Informing Strategies for Knowledge Translation

“…Furthermore, while the American Academy of Neurology recently recommended using the Clinical Dementia Rating (CDR) Scale (24) combined with caregiver input, driving history, changes in driving behavior, an MMSE score ≤24, and aggressive behavior as useful for identifying patients at increased risk for unsafe driving, (20) the CDR is not often used by PCPs. (25) …”

Normal Cognitive Aging

“…These domains include visual attention/processing (the ability to select visual stimuli based on spatial location), visual perception (the ability to accurately perceive and interpret what is seen), executive function, and memory. 59 Interestingly, tests of visual processing speed, such as the Useful Field of View® test can predict at-fault motor-vehicle crashes in older adults. 60–62 …”

Can a Novel Web-Based Computer Test Predict Poor Simulated Driving Performance? A Pilot Study With Healthy and Cognitive-Impaired Participants

“…A literature review of the most important driving-relevant cognitive functions and how they are affected by cognitive impairment was conducted [6]. This analysis was used to develop a novel computer test [25], which we extended in the context of this study to the wBCST.…”

“…Therefore, health professionals need easy access to screening tests in order to assess fitness to drive. Due to the ageing population in the Western world and increasing numbers of older drivers, identifying drivers at risk without unnecessarily restricting others is a challenging but important task [6]. This task requires reliable and valid cognitive screening tests with good sensitivity and specificity to identify at-risk drivers.…”