Predictive validity of the Montreal Cognitive Assessment (MoCA) as a screening tool for on-road driving performance

Abstract

Introduction: The objectives of this study are to determine (1) the ability of the Montreal Cognitive Assessment to predict on-road driving performance in drivers with a neurological condition and elderly drivers with suspected cognitive decline, and (2) the association between the performance on the Useful Field of View and the performance on the Montreal Cognitive Assessment. Method: This study used a retrospective design. Clients were included who had completed the Montreal Cognitive Assessment and the on-road driving evaluation from November 2006 to May 2009 (n ¼ 154) in a driving rehabilitation program in the Montreal Area. Total scores on the Montreal Cognitive Assessment, Useful Field of View risk categories, pass or fail outcomes from an on-road evaluation, as well as demographic and clinical characteristics were recorded from participants' medical charts. Results: The Montreal Cognitive Assessment was found to have a sensitivity of 84.5% and a specificity of 50% with a cutoff of 425. It was significantly associated with the Useful Field of View risk category. Conclusion: The Montreal Cognitive Assessment could be a valuable screening tool. However, its predictive validity is not strong enough to recommend its use as the sole instrument for identifying unfit drivers.

Cognitive basis about risk level classifications for the self-assessment of older drivers

“…MOCA-K (used to measure the overall cognitive functions9 ) ) was significantly different in all of comparisons between three groups. In addition, it was confirmed that a significant difference between the sub-areas of naming, attention, language, delayed recall was present.…”

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study

“…Physical and cognitive abilities required for driving greatly differ between individuals [ 8 ]. Previous studies applied various cognitive tests such as the MMSE [ 9 ], MoCA [ 10 ], Trail Making Test [ 11 , 12 ], and Stroop test12 in order to evaluate the cognitive fitness of old individuals for driving. However, their results were inconsistent [ 13 , 14 ].…”

Characterization of Stable-Health Older Drivers Using Low-Speed Driving Maneuvers From In-Vehicle Sensor Data

“…For example, one task is to draw a picture of a clock within a time limit, and another is to recall a pattern of numbers and walk for a specific distance. Although these tests were designed to assess cognitive and physical ability, they may not always be an accurate assessment of their actual driving ability [6] [7]. As a result, situations may arise where the assessments indicate the patient is medically unfit to drive, but the patient is a perfectly safe driver.…”

“…Results showed that the scores from SIMARD-MD were not significantly different in performance than the other established assessments (e.g., MMSE), and should not be used as a standalone tool for making decisions. Kwok et al [7] studied the predictive validity of MoCA as a screening tool for driving ability. From retrospective analysis of 154 older drivers who completed the MoCA, the predictive performance had 84.5% sensitivity and 50% specificity and concluded that although MoCA can be a valuable screening tool, its predictive validity was not strong enough to be used as the sole tool for identifying medically unfit older drivers.…”

“…There are many challenges in screening older drivers [10] because there is no standardized procedure for quick screening. Several recent studies [6] [7] show that current methods of assessing medical fitness to drive (i.e.,…”