Driving Assessment for Persons with Dementia: How and when?

Abstract

Dementia is a progressive neurodegenerative disease leading to deterioration in cognitive and physical skills. Driving is an important instrumental activity of daily living, essential for independence. However, this is a complex skill. A moving vehicle can be a dangerous tool in the hand of someone who cannot maneuver it properly. As a result, the assessment of driving capacity should be part of the management of dementia. Moreover, dementia comprises of different etiologies and stages consisting of different presentations. As a result, this study aims to identify driving behaviors common in dementia and compare different assessment methods. A literature search was conducted using the PRISMA checklist as a framework. A total of forty-four observational studies and four meta-analyses were identified. Study characteristics varied greatly with regards to methodology, population, assessments, and outcome measures used. Drivers with dementia performed generally worse than cognitively normal drivers. Poor speed maintenance, lane maintenance, difficulty managing intersections and poor response to traffic stimuli were the most common behaviors in drivers with dementia. Naturalistic driving, standardized road assessments, neuropsychological tests, participant self-rating and caregiver rating were the most common driving assessment methods used. Naturalistic driving and on-road assessments had the highest predictive accuracy. Results on other forms of assessments varied greatly. Both driving behaviors and assessments were influenced by different stages and etiologies of dementia at varying degrees. Methodology and results in available research are varied and inconsistent. As a result, better quality research is required in this field.

Diagnosis of Alzheimer's dementia and vehicle driving restriction: a scoping review

“…In a recent paper, Camilleri and Whitehead (2023) revised 44 observational studies and four meta‐analyses that investigated driving activities of persons with dementia. Most conclusions were of grade D evidence (poor quality) due to the inconclusive or inconsistent nature of the results, namely the significant variability in methodology and assessment measures used 10 …”

“…The literature shows that some clinical signs in patients with dementia (Alzheimer's disease – AD) are associated with a worsened driving performance (Table 1). For instance, a recent review showed that inappropriate response to traffic stimuli, poor speed control, poor lane maintenance, and difficulty manoeuvring turns or intersections were traits found more consistently among drivers with dementia 10 …”