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Stout SH, Babulal GM, Ma C, Carr DB, Head DM, Grant EA, Williams MM, Holtzman DM, Fagan AM, Morris JC, Roe CM. Driving cessation over a 24-year period: Dementia severity and cerebrospinal fluid biomarkers. Alzheimers Dement 2018; 14:610-616. [PMID: 29328928 PMCID: PMC5938126 DOI: 10.1016/j.jalz.2017.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/25/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION With 36 million older adult U.S. drivers, safety is a critical concern, particularly among those with dementia. It is unclear at what stage of Alzheimer's disease (AD) older adults stop driving and whether preclinical AD affects driving cessation. METHODS Time to driving cessation was examined based on Clinical Dementia Rating (CDR) and AD cerebrospinal fluid biomarkers. 1795 older adults followed up to 24 years received CDR ratings. A subset (591) had cerebrospinal fluid biomarker measurements and was followed up to 17 years. Differences in CDR and biomarker groups as predictors of time to driving cessation were analyzed using Kaplan-Meier curves and Cox proportional models. RESULTS Higher CDR scores and more abnormal biomarker measurements predicted a shorter time to driving cessation. DISCUSSION Higher levels of AD biomarkers, including among individuals with preclinical AD, lead to earlier driving cessation. Negative functional outcomes of preclinical AD show a nonbenign phase of the disease.
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Affiliation(s)
- Sarah H Stout
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ganesh M Babulal
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Chunyu Ma
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - David B Carr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA; The Rehabilitation Institute of St. Louis, St. Louis, MO, USA
| | - Denise M Head
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychology and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth A Grant
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - David M Holtzman
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne M Fagan
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA; Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine M Roe
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Adler G, Rottunda S, Bauer M, Kuskowski M. Driving cessation and AD: Issues congronting patients and family. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331750001500401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study surveyed older drivers with Alzheimer's disease (AD), collaterals familiar with the patient's driving, and a control group for the purpose of obtaining information about driving habits and plans for driving cessation. Drivers with dementia are at a greater risk for getting lost and having crashes than other older drivers. Family members are concerned about crashes to the extent that they are trying to prevent the AD driver from driving. Despite their concerns, many AD drivers and their families have not made plans for driving cessation. These results can assist health care professionals in developing approaches to assist AD drivers and their families as they make the transition to non-driving status.
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Affiliation(s)
| | - Susan Rottunda
- Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Mary Bauer
- Clinical Program, Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Michael Kuskowski
- Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota
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Devlin A, McGillivray JA. Self-regulation of older drivers with cognitive impairment: a systematic review. Australas J Ageing 2014; 33:74-80. [PMID: 24521006 DOI: 10.1111/ajag.12061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive decline contributes significantly to the safety risk of older drivers. Some drivers may be able to compensate for the increased crash risk by avoiding complex driving situations or restricting their driving. OBJECTIVE AND METHOD A comprehensive English-language systematic review was conducted to determine the level of evidence for older adult drivers with cognitive impairment engaging in self-regulation. RESULTS Twelve studies were included in the review. The majority of studies investigated driver avoidance, followed by driver restriction. Few studies ascertained the reasons for changing driving behaviour. CONCLUSIONS The evidence supports the view that drivers with cognitive impairment do restrict their driving and avoid complex driving situations. However, it remains to be determined whether the drivers who engage in self-regulation have insight into their own driving abilities or whether external factors result in self-regulation of driving behaviour.
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Affiliation(s)
- Anna Devlin
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
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Marquardt G, Johnston D, Black BS, Morrison A, Rosenblatt A, Lyketsos CG, Samus QM. Association of the spatial layout of the home and ADL abilities among older adults with dementia. Am J Alzheimers Dis Other Demen 2011; 26:51-7. [PMID: 21282278 PMCID: PMC3143576 DOI: 10.1177/1533317510387584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the relationship between architectural space syntax measures describing the spatial layout of a home and activities of daily living (ADL) among people with dementia. We visited the homes of 82 participants in a dementia care comparative effectiveness clinical trial and measured the space syntax variables intelligibility and convexity along with several clinical variables, including ADLs. In regression models, we estimated the cross-sectional association between space syntax measures and ADLs. Higher convexity was associated with worse performance of basic but not instrumental ADLs (adjusted β =19.2, P = .02). Intelligibility was not associated with ADLs. These results imply that enclosed rooms with a clearly legible meaning and function might be better memorized and associated with the spatial layout of the home resulting in better basic ADL performance. These results warrant further research on space syntax measures in the home environment of people with dementia, including longitudinal study, which we are pursuing.
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Arai A, Mizuno Y, Arai Y. Differences in perceptions regarding driving between young and old drivers and non-drivers in Japan. Int J Geriatr Psychiatry 2010; 25:1239-45. [PMID: 21086536 DOI: 10.1002/gps.2457] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The issue of driving cessation for dementia patients is one of the urgent public health priorities in Japan and is often complicated, with family or social barriers yet to be sufficiently addressed. Because the possibility of dementia or family caregiving can befall anyone, we focused on the disparity in people's perceptions of driving as possible barriers. The present study aimed to assess perceptions of driving among the general public and examine differences in perceptions based on age and driving status. METHODS A survey was conducted in a sample of the general public aged 40 and over in Japan. Respondents were 1010 people who received a self-administered questionnaire that included questions regarding perceptions about driving and sociodemographic factors. RESULTS The drivers that participated in this study tended to highly agree that 'driving is a "right" which we all deserve', compared with the non-drivers. The most common reason for reluctance to stop driving among drivers was the possible loss of personal mobility. Apart from transportation, older drivers were more likely than younger drivers to value the qualitative aspects of driving, for example, driving was viewed as 'a motivating factor in my life'. CONCLUSIONS These disparities in the general public's perceptions about driving may be possible family or social barriers to driving cessation in the case of drivers with dementia. Our findings also suggest that when addressing the need for driving retirement, not only mobility but also the qualitative aspects of driving be paid more attention.
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Affiliation(s)
- Asuna Arai
- Department of Gerontological Policy, National Institute for Longevity Sciences, National Center for Geriatrics and Gerontology, Aichi, Japan
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van Hoof J, Kort HSM, van Waarde H, Blom MM. Environmental interventions and the design of homes for older adults with dementia: an overview. Am J Alzheimers Dis Other Demen 2010; 25:202-32. [PMID: 20150655 PMCID: PMC10845627 DOI: 10.1177/1533317509358885] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
In Western societies, the vast majority of people with dementia live at home and wish to remain doing so for as long as possible. Aging in place can be facilitated through a variety of environmental interventions, including home modifications. This article provides an overview of existing design principles and design goals, and environmental interventions implemented at home, based on literature study and additional focus group sessions. There is a multitude of design principles, design goals, and environmental interventions available to assist with activities of daily living and functions, although few systematic studies have been conducted on the efficacy of these goals and interventions. The own home seems to be a largely ignored territory in research and government policies, which implies that many problems concerning aging in place and environmental interventions for dementia are not adequately dealt with.
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Affiliation(s)
- J van Hoof
- Hogeschool Utrecht University of Applied Sciences, Faculty of Health Care, Research Centre for Innovation in Health Care, Research Group Demand Driven Care, Utrecht, Netherlands.
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Perkinson MA, Berg-Weger ML, Carr DB, Meuser TM, Palmer JL, Buckles VD, Powlishta KK, Foley DJ, Morris JC. Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders. THE GERONTOLOGIST 2006; 45:676-85. [PMID: 16199403 DOI: 10.1093/geront/45.5.676] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Although driving by persons with Alzheimer's disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. DESIGN AND METHODS We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. RESULTS With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. IMPLICATIONS Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety.
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Affiliation(s)
- Margaret A Perkinson
- Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63108, USA
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Wild K, Cotrell V. Identifying driving impairment in Alzheimer disease: a comparison of self and observer reports versus driving evaluation. Alzheimer Dis Assoc Disord 2003; 17:27-34. [PMID: 12621317 DOI: 10.1097/00002093-200301000-00004] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the relationship between driving behaviors and awareness of deficit in patients with Alzheimer's disease (AD). Fifteen mildly impaired AD patients and 15 healthy elderly controls with valid drivers' licenses were administered a series of questionnaires concerning daily functioning and driving performance, and all 30 subjects were evaluated on a standardized road test. Self-report and caregiver/informant responses were compared with determine levels of discrepancy in ratings, while comparisons of AD and healthy elderly controls revealed group differences. Actual driving performance was considered the standard by which to determine accuracy of perceptions. Drivers with AD were rated as significantly worse than healthy elderly drivers on nine of 10 driving behaviors by an independent evaluator. AD patients' self-reports of driving ability were significantly better than the evaluator's ratings on seven of the 10 items, whereas the healthy elderly drivers rated themselves better than did the evaluator on one item. Although caregivers were likely to acknowledge a general concern with their AD patients' driving, they underreported specific driving problems when their ratings were compared with those of an independent evaluator. These findings have implications for the development of caregiver-based modifications of driving behavior.
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Affiliation(s)
- Katherine Wild
- Department of Neurology, Oregon Health Sciences University, Portland 97201, USA
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