Naturalistic Driving Study Investigating Self-Regulation Behavior in Early Alzheimer’s Disease: A Pilot Study

Paire‐Ficout, Laurence; Lafont, Sylviane; Conte, Fanny; Coquillat, Amandine; Fabrigoule, Colette; Ankri, Joël; Blanc‬, ‪Frederic; Gabel, Cécilia; Novella, Jean‐Luc; Morrone, Isabella; Mahmoudi, Rachid

doi:10.3233/jad-171031

Cited by 15 publications

(26 citation statements)

References 51 publications

(87 reference statements)

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“…Awareness can be assessed at the level of performance (online) monitoring, and research has demonstrated the contribution of this aspect of awareness to overall functioning, using error detection methods, for example. 72 - 74 Although these metamemory studies, as well as some naturalistic studies 64 , 69 , 75 investigate error responses and/or evaluation of performance after a test, only a few validated measures of awareness incorporate this approach, such as MARS, MAFS, and CMT. Online monitoring of performance is an ability that could be targeted in goal-orientated cognitive rehabilitation programs, 76 and testing awareness at this level would be a useful component of a clinical tool to direct interventions.…”

Section: Discussionmentioning

confidence: 99%

Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review

Alexander

Martyr

Savage

et al. 2020

J Geriatr Psychiatry Neurol

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Background: Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. Method: A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. Results: We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. Conclusions: Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.

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Section: Discussionmentioning

confidence: 99%

Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review

Alexander

Martyr

Savage

et al. 2020

J Geriatr Psychiatry Neurol

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“…Previous studies examining naturalistic driving behavior among persons with normal cognition and those with cognitive impairment have typically used in-car cameras [16–18, 38, 39], although use of OBD II-connected data loggers, as in this study, is increasing [19, 20]. The differences found in this study are consistent with previous studies comparing persons with symptomatic AD and controls [16], but provide further insight demonstrating that differences in naturalistic driving behavior are evident even during the long preclinical stage of AD.…”

Section: Discussionmentioning

confidence: 99%

A 2.5-Year Longitudinal Assessment of Naturalistic Driving in Preclinical Alzheimer’s Disease

Roe

Stout

Rajasekar

et al. 2019

JAD

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Background: Emerging evidence shows that cognitively normal older adults with preclinical Alzheimer’s disease (AD) make more errors and are more likely to receive a marginal/fail rating on a standardized road test compared to older adults without preclinical AD, but the extent to which preclinical AD impacts everyday driving behavior is unknown. Objective: To examine self-reported and naturalistic longitudinal driving behavior among persons with and without preclinical AD. Method: We prospectively followed cognitively normal drivers (aged 65 + years) with (n = 10) and without preclinical AD (n = 10) for 2.5 years. Preclinical AD was assessed using amyloid positron emission tomography (PET) with Pittsburgh Compound B. The Driving Habits Questionnaire assessed self-reported driving outcomes. Naturalistic driving was captured using a commercial GPS data logger plugged into the on-board diagnostics II port of each participant’s vehicle. Data were sampled every 30 seconds and all instances of speeding, hard braking, and sudden acceleration were recorded. Results: Preclinical AD participants went to fewer places/unique destinations, traveled fewer days, and took fewer trips than participants without preclinical AD. The preclinical AD group reported a smaller driving space, greater dependence on other drivers, and more difficulty driving due to vision difficulties. Persons with preclinical AD had fewer trips with any aggression and showed a greater decline across the 2.5-year follow-up period in the number of days driving per month and the number of trips between 1–5 miles. Conclusion: Changes in driving occur even during the preclinical stage of AD.

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“…This is consistent with prior work showing that AD drivers whose naturalistic driving was video recorded showed poorer tactical self-regulation behavior and made twice as many critical events as healthy older drivers. They were also three times more likely to be unaware of these events (Paire-Ficout et al, 2018). Unfortunately, the early AD group may need to continue to use compensatory strategies (i.e., cautious driving) to prevent more egregious safety errors and accidents.…”

Section: Discussionmentioning

confidence: 99%

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

Davis

Babulal²,

Papandonatos

et al. 2020

Front. Psychol.

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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

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Naturalistic Driving Study Investigating Self-Regulation Behavior in Early Alzheimer’s Disease: A Pilot Study

Abstract: This pilot study used a naturalistic approach to accurately show that AD drivers have poorer tactical self-regulation behavior than healthy older drivers. Future deployment of assistance systems in vehicles should specifically target tactical self-regulation components.

Cited by 15 publications

References 51 publications

Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review

Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review

A 2.5-Year Longitudinal Assessment of Naturalistic Driving in Preclinical Alzheimer’s Disease

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

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