Driving Ability in Alzheimer Disease Spectrum: Neural Basis, Assessment, and Potential Use of Optic Flow Event-Related Potentials

Abstract

Driving requires multiple cognitive functions including visuospatial perception and recruits widespread brain networks. Recently, traffic accidents in dementia, particularly in Alzheimer disease spectrum (ADS), have increased and become an urgent social problem. Therefore, it is necessary to develop the objective and reliable biomarkers for driving ability in patients with ADS. Interestingly, even in the early stage of the disease, patients with ADS are characterized by the impairment of visuospatial function such as radial optic flow (OF) perception related to self-motion perception. For the last decade, we have studied the feasibility of event-related potentials (ERPs) in response to radial OF in ADS and proposed that OF-ERPs provided an additional information on the alteration of visuospatial perception in ADS (1, 2). Hence, we hypothesized that OF-ERPs can be a possible predictive biomarker of driving ability in ADS. In this review, the recent concept of neural substrates of driving in healthy humans are firstly outlined. Second, we mention the alterations of driving performance and its brain network in ADS. Third, the current status of assessment tools for driving ability is stated. Fourth, we describe ERP studies related to driving ability in ADS. Further, the neural basis of OF processing and OF-ERPs in healthy humans are mentioned. Finally, the application of OF-ERPs to ADS is described. The aim of this review was to introduce the potential use of OF-ERPs for assessment of driving ability in ADS.

Use of VEPs as electrodiagnostic biomarkers of mild cognitive impairment

“…Coherent motion stimuli using random dots can be useful for examining higher‐level dorsal function (global motion processing) 39 . In my VEP studies, 39 two major components (N170 [equivalent to N2 9,15 or N200 29‐32 ] and P200 [equivalent to P2 9 ]) were elicited by radial OF and HO stimuli (Figure 3, right upper row). The occipito‐temporal N170 exhibited a V5/MT origin and was evoked by both types of stimuli.…”

“…[35][36][37][38] Coherent motion stimuli using random dots can be useful for examining higher-level dorsal function (global motion processing). 39 In my VEP studies, 39 two major components (N170 [equivalent to N2 9,15 or N200 [29][30][31][32] ] and P200 [equivalent to P2 9 ])…”

“…For the higher‐level visual pathways, face and word stimuli are useful to evaluate the functional specialization of the ventral pathway 35‐38 . Coherent motion stimuli using random dots can be useful for examining higher‐level dorsal function (global motion processing) 39 . In my VEP studies, 39 two major components (N170 [equivalent to N2 9,15 or N200 29‐32 ] and P200 [equivalent to P2 9 ]) were elicited by radial OF and HO stimuli (Figure 3, right upper row).…”

Mandarin version of dementia and driving decision aid (DDDA): Development and stakeholder evaluation in Taiwan

“…Resources that specifically support caregivers to address driving concerns for people with dementia are currently available (The Hartford, 2007), but lacked the mechanisms to facilitate a shared decision-making approach about driving among people with dementia, family caregivers and practitioners. Many participants raised that family conflict can occur in making decisions on driving, particularly if family caregivers do not fully understand or value the individual's preferences; or make decisions that reflect an important perspective on their own quality of life.…”

“…People with dementia experience cognitive and memory difficulties that can compromise their safety when driving (Yamasaki & Tobimatsu, 2018). Safe driving requires many skills including attention, memory, judgment and visuospatial ability.…”