Neuropsychological Correlates of Hazard Perception in Older Adults

Cognitive correlates of reduced driving performance in healthy older adults: A meta-analytic review

AIMS / OBJECTIVES

This meta-analytic review examines the evidence for the relationship between cognitive function and driving performance in older adults. The primary aims of this review were: (a) to identify cognitive correlates of reduced driving performance in older adults and (b) to determine whether such measures reliably predict reductions in driving performance over time.

METHODS

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peer reviewed studies that examined the (cross-sectional or longitudinal) relationship between standardised neuropsychological test performance measures and driving performance (e.g., via an on-road test, in-vehicle monitoring system, hazard perception test or driving simulator) in healthy adults aged 60 years and older, were included.

RESULTS/DISCUSSION

Eighteen studies were eligible for inclusion, of which 12 met requirements for meta-analysis. The results indicated that reaction time and Trail Making Test (TMT) A scores exhibited small-to-moderate correlations with driving performance, with moderate effects identified for block design, TMT B, Useful Field of View (UFOV) 2 and 3 tests. Further, no significant relationships were observed between the Mini-Mental State Examination and UFOV 1 with driving performance. Due to a paucity of data, the longitudinal relationship between such measures and driving could not be identified. The findings highlight (a) the potential of cognitive assessments to identify older adults at risk of driving impairment (as part of a larger diagnostic assessment), and (b) the urgent need for prospective longitudinal studies in investigating the impact of age-related changes in cognition on driving performance over time.

Executive Function Brain Network Activation Predicts Driving Hazard Detection in ADHD

Drivers with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are at increased risk of experiencing driving difficulties. An important aspect of driving safety and skill involves hazard detection. This functional magnetic resonance imaging study examined the neural responses associated with driving hazard detection in drivers with ASD, ADHD, and typically developing (TD) drivers. Forty participants (12 ASD, 15 ADHD, 13 TD) ages 16-30 years completed a driving simulator task in which they encountered social and nonsocial hazards; reaction time (RT) for responding to hazards was measured. Participants then completed a similar hazard detection task in the MRI scanner so that neural response to hazards could be measured. Activation of regions of interest considered part of the executive function (EF) and theory of mind (ToM) networks were examined and related to driving simulator behavior. Results showed that stronger activation of the EF network during social hazard processing, including the bilateral dorsolateral prefrontal cortex and posterior parietal cortex, was associated with faster RT to social hazards among drivers with ADHD, but not among drivers with ASD. This provides the first evidence of a relationship between EF network brain activation and driving skills in ADHD and suggests that alterations in this network may underlie driving behavior. In comparison, the current study did not observe a relationship between ToM network activation and RT to social hazards in any group. This study lays the groundwork for relating neural activation to driving behavior among individuals with NDDs.

Differential effects of stimulant versus opiate drugs on driving performance

BACKGROUND AND AIMS

Pharmacological differences among different drug classes influence human cognition, visual, and motor behavior in different ways. These differences impact driving safety, and therefore individuals who use stimulant and opioid drugs might experience different patterns in driving safety and impairment in driving performance. This study examined the effect of long-term use of stimulant drugs and of opiate drugs on driving performance, hazard perception, visual search skills and psychomotor skills related to driving.

METHODS

A total of 75 individuals, including 28 predominantly stimulant users, 22 predominantly opiate users and 25 healthy non-drug users, participated. Driving performance and psychomotor skills were assessed via a 15-minute drive in a simulator; hazard perception was assessed via a computerized task; and visual search skill was assessed by eye tracking.

RESULTS

ANOVA analyses indicate both stimulant and opiate users drove at higher speeds and experienced more crashes than the healthy non-drug users. Stimulant but not opiate users violated red light regulations more often than the healthy non-drug users. In the hazard perception task, stimulant drug users performed more poorly than both opioid drug users and healthy non-drug users. Specifically, they had lower saccade movement scores and higher average fixation times.

CONCLUSIONS

Results confirm that both stimulant drug users and opiate drug users show impaired driving performance compared to healthy non-drug users. Stimulant drug users possessed poorer hazard perception skills compared to the opiate users and the control group, perhaps as a result of cognitive deficits created by the drug use.

Neuropsychological Assessment of Driving Capacity

Clinicians are increasingly requested to make determinations regarding patients' driving capacity in the context of neurological injury/conditions and a growing cohort of older drivers. The capability to drive safely involves a number of cognitive, physical, and sensorimotor abilities that may be impacted by injury, illness, or substances that influence alertness. Neuropsychological measures are an important component of a multidisciplinary approach for evaluation of driving capacity. Clinicians should become familiar with measures that have the best predictive validity so they may incorporate a patient's neurocognitive strengths and weaknesses in decisions about driving ability.