The association of physical activity, cognitive processes and automobile driving ability in older adults: A review of the literature

Alterations in driving ability and their relationship with morphometric magnetic resonance imaging indicators in patients with amnestic mild cognitive impairment and Alzheimer's disease

BACKGROUND

Drivers with dementia are at a higher risk of motor vehicle accidents. The characteristics of driving behaviour of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) have not been fully elucidated. We investigated driving ability and its relationship with cognitive function and magnetic resonance imaging (MRI) morphometry indicators.

METHODS

The driving abilities of 19 patients with AD and 11 with amnestic MCI (aMCI) were evaluated using a driving simulator. The association between each driving ability parameter and the Mini-Mental State Examination (MMSE) score or voxel-based specific regional analysis system for AD (VSRAD) was assessed.

RESULTS

Patients with AD made a significantly higher number of operational errors than those with aMCI in attention allocation in the complex task test (P = 0.0008). The number of operational errors in attention allocation in the complex task test significantly and negatively correlated with MMSE scores in all participants (r = -0.4354, P = 0.0162). The decision time in the selective reaction test significantly and positively correlated with the severity and extent of medial temporal structural atrophy (r = 0.4807, P = 0.0372; r = 0.4862, P = 0.0348; respectively).

CONCLUSION

An increase in the operational errors for attention allocation in the complex task test could be a potential indicator of progression from aMCI to AD. Atrophy of the medial temporal structures could be a potential predictor of impaired judgement in driving performance in aMCI and AD. A driving simulator could be useful for evaluating the driving abilities of individuals with aMCI and AD.

Baseline Differences in Driving Frequency as a Predictor of Cognitive Decline and Alzheimer's Disease

OBJECTIVE

To extend prior research by examining daily driving frequency as a predictor of cognitive decline and later diagnosis of Alzheimer's disease.

METHODS

1,426 older adults completed batteries of questionnaires and neuropsychological tests at baseline and yearly follow-ups (M = 6.8, SD = 4.9). Linear mixed effects models were estimated to examine whether daily driving frequency at baseline was predictive of cognitive decline while accounting for IADLs, mobility, depression, and demographics. Cox regression was used to examine driving frequency as a predictor of Alzheimer's disease diagnosis.

RESULTS

Less daily driving frequency was associated with greater decline in all cognitive domains over time except for working memory. Although driving frequency was associated with these changes in cognition, it did not uniquely predict the development of Alzheimer's disease when accounting for other factors (eg, other IADLs).

CONCLUSIONS

Our findings extend prior research linking driving cessation to greater levels of cognitive decline. Future work might benefit from examining the utility of driving habits (especially changes in driving) as measures of everyday functioning in older adult evaluations.

Handgrip strength in older adults and driving aptitude

OBJECTIVE

to analyze handgrip strength as a predictor of the inability to drive in older adults.

METHOD

a cross-sectional study conducted in traffic clinics with 421 older adults in Curitiba-Paraná from January 2015 to December 2018. A sociodemographic and clinical questionnaire, handgrip strength test, and queries from the National Registry of Qualified Drivers form were applied.

RESULTS

Reduced handgrip strength was not a predictor of inaptitude for vehicular driving (p=0.649). The predictors of inaptitude were: low education (p=0.011), incomplete elementary education (p=0.027), and cognition (p=0.020).

CONCLUSION

reduced handgrip strength was not shown to predict for loss of driving skills in older adults. Low education level and reduced cognition level are conditions that were shown to be predictors for loss of vehicular driving license.

Older adult driving performance assessed under simulated and on-road conditions

Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.

The Role of Virtual Reality in Screening, Diagnosing, and Rehabilitating Spatial Memory Deficits

Impairment of spatial memory, including an inability to recall previous locations and navigate the world, is often one of the first signs of functional disability on the road to cognitive impairment. While there are many screening and diagnostic tools which attempt to measure spatial memory ability, they are often not representative of real-life situations and can therefore lack applicability. One potential solution to this problem involves the use of virtual reality (VR), which immerses individuals in a virtually-simulated environment, allowing for scenarios more representative of real-life without any of the associated risks. Here, we review the evidence surrounding the use of VR for the screening and diagnosis of spatial memory impairments, including potential limitations and how it compares to standard neuropsychological tests. We will also discuss the evidence regarding the potential use of VR in the rehabilitation of spatial memory deficits, which has not been well studied, but which could be game-changing if proven successful.

Development of an iPad-based assessment tool for measuring attention and validation in older employees

BACKGROUND

In recent years, the elderly population has increasingly worked in various workplaces. Hence, measurements to assess the work attention of the elderly has become an important need.

OBJECTIVES

The aims of this research project are to develop an iPad-based attention assessment tool, "Shih-Hsu Test of Attention" (SHTA) for work attention, that adopts touchscreen as the medium interface, and to explore criterion-related validity and test-retest reliability of this new attention assessment tool for elders.

METHODS

Thirty-one participants aged between 65-85 years were recruited in this study on a voluntary basis. Each participant was assessed two times. The participants completed both the SHTA and Chu's Attention Test (CAT), and the SHTA was used to test participants after three weeks.

RESULTS

The analytical results demonstrate that the SHTA has acceptable criterion-related validity (γ= 0.400, p < 0.05*) and test-retest reliability (ICC = 0.920, p < 0.01**).

CONCLUSIONS

Our preliminary findings show that the iPad-based auditory attention assessment tool, SHTA, has satisfactory criterion-related validity and test-retest reliability, which supports the use of SHTA as an attention assessment tool for older employees.

Associations between vision impairment and driving and the effectiveness of vision-related interventions: protocol for a systematic review and meta-analysis

INTRODUCTION

Driving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with vision impairment is set to increase in the decades ahead. Vision impairment may negatively impact an individual's ability to safely drive. The association between vision impairment and motor vehicle crash involvement or driving participation has yet to be systematically investigated. Further, the evidence for the effectiveness of vision-related interventions aimed at decreasing crashes and driving errors has not been synthesised.

METHODS AND ANALYSIS

A search will be conducted for relevant studies on Medline (Ovid), EMBASE and Global Health from their inception to March 2020 without date or geographical restrictions. Two investigators will independently screen abstracts and full texts using Covidence software with conflicts resolved by a third investigator. Data extraction will be conducted on all included studies, and their quality assessed to determine the risk of bias using the Joanna Briggs Institute Critical Appraisal Tools. Outcome measures include crash risk, driving cessation and surrogate measures of driving safety (eg, driving errors and performance). The results of this review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Meta-analysis will be undertaken for outcomes with sufficient data and reported following the Meta-analyses of Observational Studies in Epidemiology guideline. Where statistical pooling is not feasible or appropriate, narrative summaries will be presented following the Synthesis Without Meta-analysis in systematic reviews guideline.

ETHICS AND DISSEMINATION

This review will only report on published data thus no ethics approval is required. Results will be included in the Lancet Global Health Commission on Global Eye Health, published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42020172153.

The Predictors of Driving Cessation among Older Drivers in Korea

Background: As the elderly population and the number of older drivers grow, public safety concerns about traffic accidents involving older drivers are increasing. Approaches to reduce traffic accidents involving older drivers without limiting their mobility are needed. This study aimed to investigate the driving cessation (DC) rate among older Korean adults and predictors of DC based on the comprehensive mobility framework. Method: In this cross-sectional study, data from 2970 to 10,062 older adults over 65 years old from the 2017 National Survey of Elderly People were analyzed in April 2020. Multivariate logistic regression analyses were conducted to identify the predictors of DC. Results: Residential area, an environmental factor, was a strong predictor of DC (Odds Ratio (OR) 2.21, 95% Confidential Interval (CI) 1.86–2.62). Older drivers living in an area with a metro system were 2.21 more likely to stop driving than those living in an area without a metro system. Other demographic, financial, psychosocial, physical, and cognitive variables also predicted DC. Conclusion: Environmental factors were strong predictors of older adults’ DC. Therefore, political and environmental support, such as the provision of accessible public transportation, is essential to increase the DC rate among older adults to increase public safety without decreasing their mobility.

Brake time is correlated with lower extremity strength, dynamic balance and low-contrast sensitivity in unpredictable driving situations in elderly drivers compared with young drivers: A cross-sectional study

AIMS

To compare physical function, driving fitness and brake time of young and elderly drivers, and to identify the association of physical function and driving fitness with brake time in elderly drivers in predictable or unpredictable situations during driving.

METHODS

This study included 86 participants (50 men and 36 women), comprising 52 elderly drivers (age: 72.44 years, weight: 60.39 kg, height: 158.06 cm) and 34 young drivers (age: 26.53 years, weight: 63.74 kg, height: 153.65 cm), with a valid driver's license who drive at least once a week. Physical function was measured as upper and lower body flexibility and strength, dynamic balance and aerobic endurance. Driving fitness was measured as high- and low-contrast sensitivity, route planning, visualization of missing information, visual search with divided attention and visual information processing speed using the DrivingHealth® Inventory. Brake time and braking distance was evaluated as unpredictable and predictable driving situations.

RESULTS

Measurements of all categories, except lower extremity flexibility, endurance and high-contrast sensitivity, were significantly lower in elderly drivers than in young drivers. Brake time did not differ in predictable situations but was slower (P = 0.004) in elderly drivers in unpredictable situations. In elderly drivers, upper body strength (P = 0.036), dynamic balance (P < 0.001) and low-contrast sensitivity (P = 0.003) were associated with brake time in unpredictable driving situations.

CONCLUSIONS

In unpredictable situations, slower brake time in elderly drivers is associated with lower limb muscle strength, agility and low-contrast sensitivity. Therefore, for safe driving, these parameters should be considered as guidelines for maintaining the driving ability of elderly drivers and aging people. Geriatr Gerontol Int 2020; ••: ••-••.

Behavior Evaluation Based on Electroencephalograph and Personality in a Simulated Driving Experiment

Assessments and predictions of driving behavior are very important to improve traffic safety. We hypothesized that there were some patterns of driving behaviors, and these patterns had some correlation with cognitive states and personalities. To test this hypothesis, an evaluation of driving status, based on electroencephalography (EEG) and steering behavior in a simulated driving experiment, was designed and performed. Unity 3D was utilized to design the simulated driving scene. A photoelectric encoder fixed on the steering wheel and the corresponding data collection, transmission, and storage device was developed by Arduino, to acquire the rotation direction, angle, angular velocity, and angular acceleration of the steering wheel. Biopac MP 150 was utilized to collect the EEG data simultaneously during driving. A total of 23 subjects (mean age 23.6 ± 1.3 years, driving years: 2.4 ± 1.6 years, 21 males and two females) participated in this study. The Fuzzy C-means algorithm (FCMA) was utilized to extract patterns of driving behavior and the cognitive state within the window width of 20 s. The behaviors were divided into five kinds, i.e., negative, normal, alert, stress, and violent behavior, respectively, based on the standard deviation of steering wheel data. The cognitive states were divided into four kinds, i.e., negative, calm, alert, and tension, respectively, based on the EEG data. The correlation of these data, together with the personality traits evaluated using Cattell 16 Personality Factor Questionnaire (16PF) were analyzed using multiclass logistic regression. Results indicated the significance of the cognitive state and seven personality traits [apprehension (O), rule consciousness (G), reasoning (B), emotional stability (C), liveliness (F), vigilance (L), and perfectionism (Q3)] in predicting driving behaviors, and the prediction accuracy was 80.2%. The negative and alert cognitive states were highly correlated with dangerous driving, including negative and violent behaviors. Personality traits complicate the relationship with driving behaviors, which may vary across different types of subjects and traffic accidents.

Associação entre cognição e habilitação para direção veicular em idosos

Objetivo: analizar la asociación entre la cognición y los resultados finales de los exámenes de aptitud física y mental para habilitación vehicular en adultos mayores.Método: Se trata de un estudio transversal realizado en clínicas de tránsito acreditadas para realizar exámenes de habilitación vehicular. La muestra del tipo probabilística fue constituida por 421 adultos mayores (≥ 60 años). Los datos fueron colectados por medio de Mini Examen del Estado Mental (MEEM) y consulta en el Registro Nacional de Conductores Habilitados. Para el análisis de los datos se utilizó estadística descriptiva y aplicación de los testes Kruskal-Wallis y Qui-cuadrado. Los valores de p≤0,05 indicaron significancia estadística.Resultados: Para el MEEM el puntaje promedio fue de 27,13 ± 2,53 puntos, 92,2 % (n =388) presentaron cognición normal y 7,8 % (n =33) comprometimiento cognitivo. En cuanto a los resultados de las pruebas de aptitud física y mental para habilitación vehicular 71,5 % (n =301) se consideraron aptos con restricción, el 21,9 % (n =92) aptos y el 6,7 % (n =28) inaptos temporales. Se observó una asociación significativa entre los resultados de la habilitación vehicular y los escores cognitivos (p<0,001) y no hubo asociación a las categorías cognitivas (p =0,172). Los escores más bajos de cognición se identificaron en ancianos aptos con restricción e inaptos temporalmente. Conclusión: Los resultados evidencian la inconsistencia del MEEM para evaluar la cognición. Se recomienda a las clínicas de tránsito la utilización del MEEM con cautela, como herramienta de evaluación cognitivo en conductores adultos mayores. 

Cruciferous vegetable intake and mortality in middle-aged adults: A prospective cohort study

BACKGROUND & AIMS

Cruciferous vegetables contain isothiocyanates, which effectively reduce inflammation and oxidative stress related to chronic diseases, inhibit the bioactivation of procarcinogens, and enhance the excretion of carcinogens. However, at present, no large cohort studies have investigated the effect of cruciferous vegetable on mortality. We aimed to examine the association between cruciferous vegetable intake and all-cause mortality, namely cancer, heart disease, cerebrovascular disease, and injuries, in a large cohort study conducted between 1990 and 1993, in Japan.

METHODS

The analysis included 88,184 participants (age: 45-74 years) with no history of cancer, myocardial infarction, and stroke. Participants were tracked for a median of 16.9 years, during which 15,349 deaths were occurred. The association between cruciferous vegetable intake and risk of all-cause and cause-specific mortality was determined by Cox proportional hazard regression analysis to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs), after adjustment for potential confounding factors.

RESULTS

An inverse association was found between cruciferous vegetable intake and total mortality in both gender. HRs (95% CI) for all-cause mortality in the highest compared to the lowest quintile were 0.86 (0.80, 0.93) for men (P = 0.0002 for trend) and 0.89 (0.81, 0.98) for women (P = 0.03 for trend). Cruciferous vegetable intake was associated with lower cancer mortality in men, as well as with heart disease-, cerebrovascular disease-, and injury-related mortality in women.

CONCLUSIONS

This prospective study suggests that a higher cruciferous vegetables intake is associated with reduced risk of all-cause mortality.

The association between Tai Chi exercise and safe driving performance among older adults: An observational study

BACKGROUND

Age-related cognitive and physical decline can impair safe driving performance. Tai Chi exercise benefits cognitive and physical function and may influence safe driving performance in older adults. The primary aim of this observational study was to compare cognitive processes and physical function related to safe driving performance among older adult Tai Chi practitioners to normative reference values. Secondary aims were to examine relationships between Tai Chi exercise habits, cognitive processes, and physical function related to safe driving performance and to explore potential predictors of safe driving performance.

METHODS

The DrivingHealth Inventory, the Driving Scenes Test, other driving-related cognitive and physical measures, and self-reported measures including the Mindful Attention Awareness Scale (MAAS) and the Vitality Plus Scale (VPS) were collected from current Tai Chi practitioners (n = 58; age 72.9 ± 5.9 years, mean ± SD) with median >3 years Tai Chi practice.

RESULTS

Compared to normative reference values, participants performed better on numerous cognitive measures including the Driving Scenes Test (p < 0.001, d = 1.63), maze navigation (p = 0.017, d = 0.27), the Useful Field of View Test (p < 0.001, r = 0.15), and on physical measures including the Rapid Walk Test (p < 0.001, r = 0.20), and the Right Foot Tapping Test, (p < 0.001, r = 0.35). Participants scored higher than normative reference values on MAAS and VPS (p < 0.001, d = 0.75; p = 0.002, d = 0.38, respectively). Statistically significant correlations were found between several study measures. The digit span backward test was the strongest predictor of safe driving performance (β = 0.34, p = 0.009).

CONCLUSION

Tai Chi exercise has the potential to impact cognitive processes and physical function related to safe driving performance. Further study using randomized controlled trials, structured Tai Chi exercise doses, and driving simulator or on-road driving performance as outcome measures are warranted.

Select physical performance measures and driving outcomes in older adults

BACKGROUND

Improving physical functioning may be a future intervention to keep older adults driving safely longer as it can help maintain both physical and cognitive health longer. This systematic review assesses the evidence on the association between three physical functioning measures: the Short Physical Performance Battery, the Timed Up-and-Go test, and the Rapid Pace Walk with driving outcomes in older adults.

METHODS

Older adult studies published between 1994 and 2015 that included the Short Physical Performance Battery, the Timed Up-and-Go test, or the Rapid Pace Walk as a measure of physical functioning and included a driving-related outcome were identified through a comprehensive search and reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Thirteen studies involving 5,313 older adults met the inclusion criteria. Lower Short Physical Performance Battery scores were associated with reduced driving exposure and increased cessation in all three Short Physical Performance Battery studies. The Timed Up-and-Go test was not associated with the driving outcomes (cessation, ability, crashes, and citations) in either of the two Timed Up-and-Go studies. Poorer Rapid Pace Walk scores were associated with decreased driving ability in two studies and with reduced driving exposure in one study, but not associated with driving ability, crashes, citations, or cessation in the remaining five Rapid Pace Walk studies.

CONCLUSIONS

The Timed Up-and-Go test measure appears not to be a useful measure of physical functioning for the driving outcomes included here. The Rapid Pace Walk may be useful in studies of driving ability and exposure. More driving studies should consider using the Short Physical Performance Battery to determine if it may be useful as a risk factor assessment for identifying individuals at risk of certain driving outcomes.