Evaluation of Naturalistic Driving Behavior Using In-Vehicle Monitoring Technology in Preclinical and Early Alzheimer’s Disease

Abstract

Cognitive impairment is a significant risk factor for hazardous driving among older drivers with Alzheimer's dementia, but little is known about how the driving behavior of mildly symptomatic compares with those in the preclinical, asymptomatic phase of Alzheimer's disease (AD). This study utilized two in-car technologies to characterize driving behavior in symptomatic and preclinical AD. The goals of this pilot study were to (1) describe unsafe driving behaviors in individuals with symptomatic early AD using G-force triggered video capture and (2) compare the driving habits of these symptomatic AD drivers to two groups of cognitively normal drivers, those with and those without evidence of cerebral amyloidosis (CN/A+ and CN/A−) using a global positioning system (GPS) datalogger. Thirty-three drivers (aged 60+ years) were studied over 3 months. G-force triggered video events captured instances of near-misses/collisions, traffic violations, risky driver conduct, and driving fundamentals. GPS data were sampled every 30 s and all instances of speeding, hard braking, and sudden acceleration were recorded. For the early AD participants, video capture identified driving unbelted, late response, driving too fast for conditions, traffic violations, poor judgment, and not scanning intersections as the most frequently occurring safety errors. When evaluating driving using the GPS datalogger, hard breaking events occurred most frequently on a per trip basis across all three groups. The CN/A+ group had the lowest event rate across all three event types with lower instances of speeding. Slower psychomotor speed (Trail Making Part A) was associated with fewer speeding events, more hard acceleration events, and more overall events. GPS tracked instances of speeding were correlated with total number of videocaptured near-collisions/collisions and driving fundamentals. Results demonstrate the utility of electronic monitoring to identify potentially unsafe driving events in symptomatic and preclinical AD. Results suggest that drivers with preclinical AD may compensate for

Driving assessment in preclinical Alzheimer’s disease: progress to date and the path forward

“…A few attempts have been made to address the limitations of on-road assessments and self-reported questionnaires by adopting mobile sensor technologies to enable thorough monitoring of everyday driving behaviours in naturalistic settings. A number of studies that implemented naturalistic driving methodologies, such as the Driving Real-world In-Vehicle Evaluation System (DRIVES), provided additional support for earlier findings on the differences in driving behaviours of cognitively normal older adults with and without preclinical AD [29][30][31]. These studies indicate that persons Fig.…”

“…1 Methods of driving assessments used in the literature to investigate the impact of preclinical Alzheimer's disease with preclinical AD already exhibit a pattern of driving restriction similar to those with early Alzheimer's disease. More specifically, their findings suggest that older adults with preclinical AD are likely to drive less often and have fewer aggressive behaviours such as hard braking, speeding, and sudden acceleration [29][30][31][32]. Furthermore, a 2.5-year longitudinal assessment using DRIVES indicated that persons with preclinical AD also show a greater decline across the followup period in the number of days driving per month and the number of trips between 1-5 miles [33].…”

Controlled register‐based study of road traffic accidents in 12,651 Finnish cancer patients during 2013–2019

“…Therefore, we cannot rule out the possibility that cancer patients drive less and more carefully and limit their driving to essential trips only, as seen in patients with early Alzheimer's disease. 28 , 29 , 30 Most cancer patients undergoing treatment in Finland are eligible for reimbursed taxi travel, which may further reduce the need to drive oneself.…”

The role of geographic information system and global positioning system in dementia care and research: a scoping review

“…Eighteen studies were identified in this category, and all applied GPS as a space-based technology to gather tracking data in exploring patients' behavior patterns. In most studies, analysis and interpretation of spatial GPS data were used to assess patients' out-of-home behavior [20][21][22][23], mobility patterns [52,53,65,[114][115][116][117], life-space metrics [118,119], and driving behavior [24,25]. In one study, GPS data were used to propose a Bayesian classifier model to estimate the probability of wandering [120].…”

“…GPS was originally intended for use in the military but then widely used in healthcare, especially for mental health disorders, to monitor, follow, track and manage the care process of patients [18,19]. GPS assesses and analyses patients' out-of-home and driving behavior [20][21][22][23][24][25]. Out-of-home behavior patterns can predict cognitive impairment disorders [21].…”