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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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Detection of Risky Driving Behaviors in the Naturalistic Environment in Healthy Older Adults and Mild Alzheimer's Disease. Geriatrics (Basel) 2018; 3. [PMID: 29632868 PMCID: PMC5889300 DOI: 10.3390/geriatrics3020013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Analyzing naturalistic driving behavior recorded with in-car cameras is an ecologically valid method for measuring driving errors, but it is time intensive and not easily applied on a large scale. This study validated a semi-automated, computerized method using archival naturalistic driving data collected for drivers with mild Alzheimer’s disease (AD; n = 44) and age-matched healthy controls (HC; n = 16). The computerized method flagged driving situations where safety concerns are most likely to occur (i.e., rapid stops, lane deviations, turns, and intersections). These driving epochs were manually reviewed and rated for error type and severity, if present. Ratings were made with a standardized scoring system adapted from DriveCam®. The top eight error types were applied as features to train a logistic model tree classifier to predict diagnostic group. The sensitivity and specificity were compared among the event-based method, on-road test, and composite ratings of two weeks of recorded driving. The logistic model derived from the event-based method had the best overall accuracy (91.7%) and sensitivity (97.7%) and high specificity (75.0%) compared to the other methods. Review of driving situations where risk is highest appears to be a sensitive data reduction method for detecting cognitive impairment associated driving behaviors and may be a more cost-effective method for analyzing large volumes of naturalistic data.
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Jacobs M, Hart EP, Roos RAC. Driving with a neurodegenerative disorder: an overview of the current literature. J Neurol 2017; 264:1678-1696. [PMID: 28424901 PMCID: PMC5533843 DOI: 10.1007/s00415-017-8489-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
Driving is important for employment, social activities, and for the feeling of independence. The decision to cease driving affects the quality of life and has been associated with reduced mobility, social isolation, and sadness. Patients with neurodegenerative disorders can experience difficulties while driving due to their cognitive, motor, and behavioral impairments. The aim of this review is to summarize the available literature on changes in driving competence and behavior in patients with neurodegenerative disorders, with a particular focus on Huntington's (HD), Parkinson's (PD), and Alzheimer's disease (AD). A systematic literature search was conducted in the PubMed/Medline database. Studies using on-road or simulated driving assessments were examined in this review. In addition, studies investigating the association between cognitive functioning and driving were included. The review identified 70 studies. Only a few publications were available on HD (n = 7) compared to PD (n = 32) and AD (n = 31). This review revealed that driving is impaired in patients with neurodegenerative disorders on all levels of driving competence. The errors most commonly committed were on the tactical level including lane maintenance and lane changing. Deficits in executive functioning, attention, and visuospatial abilities can partially predict driving competence, and the performance on neuropsychological tests might be useful when discussing potential driving cessation. Currently, there is no gold standard to assess driving ability using clinical measures such as neuropsychological assessments, so more studies are necessary to detect valid screening tools and develop useful and reliable evidence-based guidelines.
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Affiliation(s)
- Milou Jacobs
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ellen P Hart
- Center for Human Drug Research, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Bhorade AM, Yom VH, Barco P, Wilson B, Gordon M, Carr D. On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma. Am J Ophthalmol 2016; 166:43-51. [PMID: 26949136 DOI: 10.1016/j.ajo.2016.02.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving. DESIGN Case-control pilot study. METHODS A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded. RESULTS Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14; P = .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03-21.17; P = .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P = .62) or worse (P = .88) eye, binocular distance (P = .15) or near (P = .23) visual acuity, contrast sensitivity (P = .28), or glare (P = .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P = .03) and B (P = .05), right-sided Jamar grip strength (P = .02), Rapid Pace Walk (P = .03), Braking Response Time (P = .03), and identifying traffic signs (P = .05). CONCLUSIONS Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving-particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.
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Affiliation(s)
- Anjali M Bhorade
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
| | - Victoria H Yom
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
| | - Peggy Barco
- Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Bradley Wilson
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
| | - Mae Gordon
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
| | - David Carr
- Department of Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri
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Bixby K, Davis JD, Ott BR. Comparing caregiver and clinician predictions of fitness to drive in people with Alzheimer's disease. Am J Occup Ther 2015; 69:6903270030p1-7. [PMID: 25871601 DOI: 10.5014/ajot.2015.013631] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This observational study investigated family caregiver and clinician ratings of 75 drivers with Alzheimer's disease against scores on a standardized road test and a naturalistic driving evaluation. Clinician ratings by a physician specialized in dementia were significantly associated with road test error scores (r=.25, p=.03) but not naturalistic driving errors or global ratings of road test and naturalistic driving performance. Caregiver ratings were unrelated to either driving assessment, with two exceptions; adult child ratings of driving ability were correlated with road test error scores (r=.43, p=.02), and spousal ratings were inversely correlated with global ratings. Clinician ratings of driving competence were modestly correlated with road test performance, but caregiver ratings were more complex. Adult children may be more accurate reporters of driving ability than spouses, possibly because of less personal bias, but the reasons behind this discrepancy need further investigation.
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Affiliation(s)
- Kimberly Bixby
- Kimberly Bixby is Clinical Research Assistant, Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence
| | - Jennifer D Davis
- Jennifer D. Davis, PhD, is Associate Professor, Department of Psychiatry, Alpert Medical School of Brown University, Providence, RI;
| | - Brian R Ott
- Brian R. Ott, MD, is Professor, Department of Neurology, Alpert Medical School of Brown University, Providence, RI
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Prado Vega R, van Leeuwen PM, Rendón Vélez E, Lemij HG, de Winter JCF. Obstacle avoidance, visual detection performance, and eye-scanning behavior of glaucoma patients in a driving simulator: a preliminary study. PLoS One 2013; 8:e77294. [PMID: 24146975 PMCID: PMC3797776 DOI: 10.1371/journal.pone.0077294] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/01/2013] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to evaluate differences in driving performance, visual detection performance, and eye-scanning behavior between glaucoma patients and control participants without glaucoma. Glaucoma patients (n = 23) and control participants (n = 12) completed four 5-min driving sessions in a simulator. The participants were instructed to maintain the car in the right lane of a two-lane highway while their speed was automatically maintained at 100 km/h. Additional tasks per session were: Session 1: none, Session 2: verbalization of projected letters, Session 3: avoidance of static obstacles, and Session 4: combined letter verbalization and avoidance of static obstacles. Eye-scanning behavior was recorded with an eye-tracker. Results showed no statistically significant differences between patients and control participants for lane keeping, obstacle avoidance, and eye-scanning behavior. Steering activity, number of missed letters, and letter reaction time were significantly higher for glaucoma patients than for control participants. In conclusion, glaucoma patients were able to avoid objects and maintain a nominal lane keeping performance, but applied more steering input than control participants, and were more likely than control participants to miss peripherally projected stimuli. The eye-tracking results suggest that glaucoma patients did not use extra visual search to compensate for their visual field loss. Limitations of the study, such as small sample size, are discussed.
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Affiliation(s)
- Rocío Prado Vega
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Peter M. van Leeuwen
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Elizabeth Rendón Vélez
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Hans G. Lemij
- Rotterdam Ophthalmic Institute (ROI), Rotterdam, The Netherlands
- Rotterdam Eye Hospital (REH), Rotterdam, The Netherlands
| | - Joost C. F. de Winter
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
- * E-mail:
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Davis JD, Papandonatos GD, Miller LA, Hewitt SD, Festa EK, Heindel WC, Ott BR. Road test and naturalistic driving performance in healthy and cognitively impaired older adults: does environment matter? J Am Geriatr Soc 2012; 60:2056-62. [PMID: 23110378 DOI: 10.1111/j.1532-5415.2012.04206.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To relate the standardized road test to video recordings of naturalistic driving in older adults with a range of cognitive impairment. DESIGN Cross-sectional observational study. SETTING Academic medical center memory disorders clinic. PARTICIPANTS One hundred three older drivers (44 healthy, 59 with cognitive impairment) who passed a road test. MEASUREMENTS Error rate and global ratings of safety (pass with and without recommendations, marginal with restrictions or training, or fail) made by a professional driving instructor. RESULTS There was fair agreement between global ratings on the road test and naturalistic driving. More errors were detected in the naturalistic environment, but this did not affect global ratings. Error scores between settings were significantly correlated, and the types of errors made were similar. History of crashes corrected for miles driven per week was related to road test error scores but not naturalistic driving error scores. Global cognition (Mini-Mental State Examination) was correlated with road test and naturalistic driving errors. In healthy older adults, younger age was correlated with fewer errors on the road test and more errors in naturalistic driving. CONCLUSION Road test performance is a reasonable proxy for estimating fitness to drive in older individuals' typical driving environments, but differences between performance assessed using these two methods remain poorly understood and deserve further study.
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Affiliation(s)
- Jennifer D Davis
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island 02903, USA.
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Ott BR, Papandonatos GD, Davis JD, Barco PP. Naturalistic validation of an on-road driving test of older drivers. HUMAN FACTORS 2012; 54:663-674. [PMID: 22908688 PMCID: PMC3568996 DOI: 10.1177/0018720811435235] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The objective was to compare a standardized road test to naturalistic driving by older people who may have cognitive impairment to define improvements that could potentially enhance the validity of road testing in this population. BACKGROUND Road testing has been widely adapted as a tool to assess driving competence of older people who may be at risk for unsafe driving because of dementia; however, the validity of this approach has not been rigorously evaluated. METHOD For 2 weeks, 80 older drivers (38 healthy elders and 42 with cognitive impairment) who passed a standardized road test were video recorded in their own vehicles. Using a standardized rating scale, 4 hr of video was rated by a driving instructor. The authors examine weighting of individual road test items to form global impressions and to compare road test and naturalistic driving using factor analyses of these two assessments. RESULTS The road test score was unidimensional, reflecting a major factor related to awareness of signage and traffic behavior. Naturalistic driving reflected two factors related to lane keeping as well as traffic behavior. CONCLUSION Maintenance of proper lane is an important dimension of driving safety that appears to be relatively underemphasized during the highly supervised procedures of the standardized road test. APPLICATION Road testing in this population could be improved by standardized designs that emphasize lane keeping and that include self-directed driving. Additional information should be sought from observers in the community as well as crash evidence when advising older drivers who may be cognitively impaired.
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Affiliation(s)
- Brian R Ott
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Vrkljan BH, McGrath CE, Letts LJ. Assessment Tools for Evaluating Fitness to Drive: A Critical Appraisal of Evidence. The Canadian Journal of Occupational Therapy 2011; 78:80-96. [DOI: 10.2182/cjot.2011.78.2.3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background. Many office-based assessment tools are used by occupational therapists to predict fitness to drive. Purpose. To appraise psychometric properties of such tools, specifically predictive validity for on-road performance. Methods. A literature search was conducted to identify assessment tools and studies involving on-road outcomes (behind-the-wheel evaluation, crashes, traffic violations). Using a standardized appraisal process, reviewers rated each tool's psychometrric properties, including its predictive validity with on-road performance. Findings. Seventeen measures met the inclusion criteria. Evidence suggests many tools do not have cut-off scores linked with on-road outcomes, although some had stronger evidence than others. Implications. When making a determination regarding driver fitness, clinicians should consider the psychometric properties of the tool as well as existing evidence concerning its utility in predicting on-road performance. Caution is warranted in using any one office-based tool to predict driving fitness; rather, a multifactorial-based assessment approach that includes physical, cognitive, and visual-perceptual components, is recommended.
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Affiliation(s)
| | - Colleen E. McGrath
- Colleen E. McGrath, MSc, O.T. Reg. (Ont.), Occupational Therapist, is doing her PhD in Health and Rehabilitation Sciences at The University of Western Ontario, London, ON, Canada
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Lim TS, Iaria G, Moon SY. Topographical disorientation in mild cognitive impairment: a voxel-based morphometry study. J Clin Neurol 2010; 6:204-11. [PMID: 21264201 PMCID: PMC3024525 DOI: 10.3988/jcn.2010.6.4.204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 01/29/2023] Open
Abstract
Background and Purpose To assess the neural substrates underlying topographical disorientation (TD) in patients affected by mild cognitive impairment (MCI), forty-one patients diagnosed with MCI and 24 healthy control individuals were recruited. Methods TD was assessed clinically in all participants. Neurological and neuropsychological evaluations and a volumetric-head magnetic resonance imaging scan were performed in each participant. Voxel-based morphometry was used to compare patterns of gray-matter atrophy between patients with and without TD, and a group of normal controls. Results We found TD in 17 out of the 41 MCI patients (41.4%). The functional abilities were significantly impaired in MCI patients with TD compared to in MCI patients without TD. Voxel-based morphometry analyses showed that the presence of TD in MCI patients is associated with loss of gray matter in the medial temporal regions, including the hippocampus and parahippocampal cortex, the fusiform gyrus, the inferior occipital gyrus, the amygdala, and the cerebellum. Conclusions The findings found in this study represent the first evidence that the presence of TD in patients with MCI is associated with loss of gray matter in those brain regions that have been documented to be responsible for orientation in both neuropsychological and neuroimaging studies.
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Affiliation(s)
- Tae-Sung Lim
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
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Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74:1316-24. [PMID: 20385882 DOI: 10.1212/wnl.0b013e3181da3b0f] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the evidence regarding the usefulness of patient demographic characteristics, driving history, and cognitive testing in predicting driving capability among patients with dementia and to determine the efficacy of driving risk reduction strategies. METHODS Systematic review of the literature using the American Academy of Neurology's evidence-based methods. RECOMMENDATIONS For patients with dementia, consider the following characteristics useful for identifying patients at increased risk for unsafe driving: the Clinical Dementia Rating scale (Level A), a caregiver's rating of a patient's driving ability as marginal or unsafe (Level B), a history of crashes or traffic citations (Level C), reduced driving mileage or self-reported situational avoidance (Level C), Mini-Mental State Examination scores of 24 or less (Level C), and aggressive or impulsive personality characteristics (Level C). Consider the following characteristics not useful for identifying patients at increased risk for unsafe driving: a patient's self-rating of safe driving ability (Level A) and lack of situational avoidance (Level C). There is insufficient evidence to support or refute the benefit of neuropsychological testing, after controlling for the presence and severity of dementia, or interventional strategies for drivers with dementia (Level U).
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Affiliation(s)
- D J Iverson
- Humboldt Neurological Medical Group, Inc., Eureka, CA, USA
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Abstract
Driving is a complex activity that always becomes impaired at some point in older adults with degenerative dementia. Over time, disruption of the visual processing circuits of the brain that link the occipital and prefrontal regions, particularly in the right hemisphere, leads to increasing degrees of driving impairment that ultimately preclude safe driving. Neuropsychological tests of visuospatial ability, executive function and attention that tap into the integrity of these brain regions provide the clinician with important information regarding the need for a formal determination of driving competence. Enhancement of cognitive function in these domains through anti-dementia therapy and exercise may partially mitigate risk; however, all drivers with dementia must ultimately retire from driving when dementia becomes moderately severe, and often in earlier stages of the illness. Future efforts to improve screening tests for hazardous driving and to develop interventions to help prolong the time that drivers with mild dementia can continue to drive safely are needed for our increasingly aged and mobile population.
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Affiliation(s)
- Brian R Ott
- Department of Neurology, Warren Alpert Medical School of Brown University, RI, USA and The Alzheimer’s Disease & Memory, Disorders Center, Rhode Island Hospital, RI, USA, Tel.: +1 401 444 6440, Fax: +1 401 444 6858,
| | - Lori A Daiello
- Department of Neurology, Warren Alpert Medical School of Brown University, RI, USA and The Alzheimer’s Disease & Memory, Disorders Center, Rhode Island Hospital, RI, USA, Tel.: +1 401 444 6440, Fax: +1 401 444 6858,
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Alexandersen A, Dalen K, Brønnick K. Prediction of driving ability after inconclusive neuropsychological investigation. Brain Inj 2009; 23:313-21. [DOI: 10.1080/02699050902788428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stern RA, D'Ambrosio LA, Mohyde M, Carruth A, Tracton-Bishop B, Hunter JC, Daneshvar DH, Coughlin JF. At the crossroads: development and evaluation of a dementia caregiver group intervention to assist in driving cessation. GERONTOLOGY & GERIATRICS EDUCATION 2008; 29:363-382. [PMID: 19064472 PMCID: PMC2679525 DOI: 10.1080/02701960802497936] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Deciding when an individual with dementia must reduce or stop driving can be a stressful issue for family caregivers. The purpose of this study was to develop a group intervention to assist these caregivers with driving issues and to provide a preliminary evaluation of the comparative effectiveness of this At the Crossroads intervention. Participants were randomized to one of three arms: (1) active intervention (four 2-hour manualized educational/support group meetings; n = 31); (2) written materials only (participants received written materials after a pretest; n = 23); and (3)control (participants received written materials after a posttest; n = 12).Participants were administered a battery of self-report and interview-based questionnaires at baseline and again 2 months later. At follow-up, the active intervention group scored significantly better than both other groups on key outcome variables, including self-efficacy, communication, and preparedness. The At the Crossroads caregiver intervention appears to effectively provide education and support needed for caregivers to address driving-related issues with their loved ones.
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Affiliation(s)
- Robert A Stern
- Department of Neurology, Alzheimer's Disease Clinical and Research Program, Boston University School of Medicine, Boston, MA 02118-2526, USA.
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Meuser TM, Carr DB, Berg-Weger M, Niewoehner P, Morris JC. Driving and dementia in older adults: Implementation and evaluation of a continuing education project. THE GERONTOLOGIST 2007; 46:680-7. [PMID: 17050760 DOI: 10.1093/geront/46.5.680] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We aimed to develop and evaluate a multimedia workshop curriculum to educate physicians and other health professionals about (a) driving-related assessment in older adults with dementia, and (b) strategies to encourage driving retirement for impaired individuals. DESIGN AND METHODS A curriculum developed by the Older Drivers Project of the American Medical Association was expanded for presentation by a multidisciplinary team. One pilot and seven test workshops were offered. A program evaluation method-testing knowledge, confidence, attitudes, and practice behaviors-was employed at four points in time: T1 (Time 1; pretest focusing on the previous 12 months), T2 (Time 2; same-day post-test), T3 (Time 3; post-test at 3 months), and T4 (Time 4; post-test at 12 months). RESULTS At T1, participants (N = 147) expressed high agreement that an assessment of driving ability is an important issue in clinical dementia care, but they reported low knowledge of assessment strategies, resources, and state reporting requirements. Modest gains in knowledge and confidence were demonstrated at both T3 (n = 93) and T4 (n = 63). In addition, the frequency of driving-related practice behaviors (i.e., incorporation of driving-related questions into clinical evaluation, chart documentation, reporting of impaired drivers) had increased significantly by T3 and T4. IMPLICATIONS The results indicate that a focused workshop curriculum, with practical and immediate applications to care, can motivate measurable changes in clinical practice. Once they are informed, health professionals can address issues of driving ability in older patients with dementia and, with the support of available resources, encourage impaired individuals to retire from driving for the safety of everyone on the road.
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Affiliation(s)
- Thomas M Meuser
- Director of Education, Alzheimer's Disease Research Center, Washington University School of Medicine, 4488 Forest Park Avenue, Suite 130, St. Louis, MO 63108, USA.
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Lovell RK, Russell KJ. Developing referral and reassessment criteria for drivers with dementia. Aust Occup Ther J 2005. [DOI: 10.1111/j.1440-1630.2005.00454.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Adler G, Rottunda S, Dysken M. The older driver with dementia: an updated literature review. JOURNAL OF SAFETY RESEARCH 2005; 36:399-407. [PMID: 16226768 DOI: 10.1016/j.jsr.2005.07.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 06/03/2005] [Accepted: 07/15/2005] [Indexed: 05/04/2023]
Abstract
INTRODUCTION At some point during their illness, drivers with dementia pose a public safety risk. METHOD To address the issue of determining driving competence in drivers with dementia, the authors reviewed 11 studies. RESULTS When comparing different driving assessments, the authors found that while road tests, simulators, and neuropsychological tests are important, each has limitations. CONCLUSION Neuropsychological tests that highlighted visual spatial skills, attention, and reaction time provided the most meaningful correlations with driving performance. Furthermore, the authors recommend that patients with MMSE scores of 24 or less have a driving evaluation, and that driving evaluations be repeated at six month intervals or more frequently if a noticeable decline is observed. IMPACT Because many older adults with dementia continue to drive, competence must be addressed.
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Affiliation(s)
- Geri Adler
- College of Social Work, University of South Carolina, Columbus, SC 29208, USA.
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Zuin D, Ortiz H, Boromei D, Lopez OL. Motor vehicle crashes and abnormal driving behaviours in patients with dementia in Mendoza, Argentina. Eur J Neurol 2002; 9:29-34. [PMID: 11784373 DOI: 10.1046/j.1468-1331.2002.00296.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies conducted in industrialized countries have shown that elderly demented subjects have increased risk of car accidents. However, there is no information about the effect of dementia on driving habits in non-industrialized countries. The number of motor vehicle crashes (MVC) and abnormal driving behaviours (ADB) (e.g. not recognizing traffic lights, driving in the middle of the road, etc.) were assessed with a semi-structured interview in 56 demented subjects and 31 elderly controls, all of whom were active drivers, at the Regional Registry of Dementia in Mendoza. Detailed neurological, psychiatric and neuropsychological examinations were also conducted on each subject. The presence of dementia and sex (male) predicted ADB, MVC and number of MVC (two or more). Among demented patients, ADB and MVC were associated with sex (male) and number of MVC was associated with sex (male) and Blessed Dementia Rating Scale for activities of daily living scores. Neither ADB, MCV, or number of MVC were associated with education level, or with cognitive or psychiatric measures. These findings showed that in developing countries, dementia has a significant contribution to MVC and ADB, as occurs in industrialized nations. Consequently, legislation to curb the risk of accidents caused by demented patients should be implemented. Furthermore, physicians must encourage demented patients (or their families) to discontinue driving, even those with mild dementia syndrome.
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Affiliation(s)
- D Zuin
- Centro de Estudios de la Memoria, Mendoza, Argentina
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Affiliation(s)
- D Kuhn
- Mather Institute on Aging, Evanston, Illinois, USA
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