1
|
Babulal GM, Chen L, Murphy SA, Carr DB, Morris JC. Predicting Driving Cessation Among Cognitively Normal Older Drivers: The Role of Alzheimer Disease Biomarkers and Clinical Assessments. Neurology 2024; 102:e209426. [PMID: 38776513 DOI: 10.1212/wnl.0000000000209426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES With the aging US population and increasing incidence of Alzheimer disease (AD), understanding factors contributing to driving cessation among older adults is crucial for clinicians. Driving is integral for maintaining independence and functional mobility, but the risk factors for driving cessation, particularly in the context of normal aging and preclinical AD, are not well understood. We studied a well-characterized community cohort to examine factors associated with driving cessation. METHODS This prospective, longitudinal observation study enrolled participants from the Knight Alzheimer Disease Research Center and The DRIVES Project. Participants were enrolled if they were aged 65 years or older, drove weekly, and were cognitively normal (Clinical Dementia Rating [CDR] = 0) at baseline. Participants underwent annual clinical, neurologic, and neuropsychological assessments, including β-amyloid PET imaging and CSF (Aβ42, total tau [t-Tau], and phosphorylated tau [p-Tau]) collection every 2-3 years. The primary outcome was time from baseline visit to driving cessation, accounting for death as a competing risk. The cumulative incidence function of driving cessation was estimated for each biomarker. The Fine and Gray subdistribution hazard model was used to examine the association between time to driving cessation and biomarkers adjusting for clinical and demographic covariates. RESULTS Among the 283 participants included in this study, there was a mean follow-up of 5.62 years. Driving cessation (8%) was associated with older age, female sex, progression to symptomatic AD (CDR ≥0.5), and poorer performance on a preclinical Alzheimer cognitive composite (PACC) score. Aβ PET imaging did not independently predict driving cessation, whereas CSF biomarkers, specifically t-Tau/Aβ42 (hazard ratio [HR] 2.82, 95% CI 1.23-6.44, p = 0.014) and p-Tau/Aβ42 (HR 2.91, 95% CI 1.28-6.59, p = 0.012) ratios, were independent predictors in the simple model adjusting for age, education, and sex. However, in the full model, progression to cognitive impairment based on the CDR and PACC score across each model was associated with a higher risk of driving cessation, whereas AD biomarkers were not statistically significant. DISCUSSION Female sex, CDR progression, and neuropsychological measures of cognitive functioning obtained in the clinic were strongly associated with future driving cessation. The results emphasize the need for early planning and conversations about driving retirement in the context of cognitive decline and the immense value of clinical measures in determining functional outcomes.
Collapse
Affiliation(s)
- Ganesh M Babulal
- From the Department of Neurology (G.M.B., S.A.M., J.C.M.), Division of Biostatistics (L.C.), and Department of Medicine (D.B.C.), Washington University School of Medicine, St. Louis, MO
| | - Ling Chen
- From the Department of Neurology (G.M.B., S.A.M., J.C.M.), Division of Biostatistics (L.C.), and Department of Medicine (D.B.C.), Washington University School of Medicine, St. Louis, MO
| | - Samantha A Murphy
- From the Department of Neurology (G.M.B., S.A.M., J.C.M.), Division of Biostatistics (L.C.), and Department of Medicine (D.B.C.), Washington University School of Medicine, St. Louis, MO
| | - David B Carr
- From the Department of Neurology (G.M.B., S.A.M., J.C.M.), Division of Biostatistics (L.C.), and Department of Medicine (D.B.C.), Washington University School of Medicine, St. Louis, MO
| | - John C Morris
- From the Department of Neurology (G.M.B., S.A.M., J.C.M.), Division of Biostatistics (L.C.), and Department of Medicine (D.B.C.), Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
2
|
Babulal GM, Chen L, Carr DB, Johnson AM, Shimony JS, Doherty J, Murphy S, Walker A, Domash H, Hornbeck R, Keefe S, Flores S, Raji CA, Morris JC, Ances BM, Benzinger TLS. Cortical atrophy and leukoaraiosis, imaging markers of cerebrovascular small vessel disease, are associated with driving behavior changes among cognitively normal older adults. J Neurol Sci 2023; 448:120616. [PMID: 36989588 PMCID: PMC10106438 DOI: 10.1016/j.jns.2023.120616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) as measured by cortical atrophy and white matter hyperintensities [leukoaraiosis], captured via magnetic resonance imaging (MRI) are increasing in prevalence due to the growth of the aging population and an increase in cardiovascular risk factors in the population. CSVD impacts cognitive function and mobility, but it is unclear if it affects complex, functional activities like driving. METHODS In a cohort of 163 cognitively normal, community-dwelling older adults (age ≥ 65), we compared naturalistic driving behavior with mild/moderate leukoaraiosis, cortical atrophy, or their combined rating in a clinical composite termed, aging-related changes to those without any, over a two-and-a-half-year period. RESULTS Older drivers with mild or moderate cortical atrophy and aging-related changes (composite) experienced a greater decrease in the number of monthly trips which was due to a decrease in the number of trips made within a one-to-five-mile diameter from their residence. Older drivers with CSVD experience a larger reduction in daily driving behaviors than drivers without CSVD, which may serve as an early neurobehavioral marker for functional decline. CONCLUSIONS As CSVD markers, leukoaraiosis and cortical atrophy are standard MRI metrics that are widely available and can be used for screening individuals at higher risk for driving safety risk and decline in community mobility.
Collapse
Affiliation(s)
- Ganesh M Babulal
- Department of Neurology, Washington University in St. Louis, MO, USA; Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA; Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa; Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, MO, USA
| | - David B Carr
- Department of Medicine, Division of Geriatrics & Nutritional Sciences, Washington University in St. Louis, MO, USA
| | - Ann M Johnson
- Center for Clinical Studies, Washington University in St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Jason Doherty
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Samantha Murphy
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Alexis Walker
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Hailee Domash
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Russ Hornbeck
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Sarah Keefe
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Shaney Flores
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - Cyrus A Raji
- Department of Neurology, Washington University in St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, MO, USA; Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO, USA; Hope Center for Neurological Disorders, Washington University in St. Louis, MO 63110, USA
| |
Collapse
|
3
|
Krasniuk S, Crizzle AM, Toxopeus R, Mychael D, Prince N. Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment. Can J Occup Ther 2023; 90:44-54. [PMID: 35950229 PMCID: PMC9923206 DOI: 10.1177/00084174221117708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) can predict on-road outcomes in drivers with cognitive impairment (CI); however, studies have not included drivers referred for comprehensive driving evaluations (CDEs), who typically have more severe CI. Purpose. We determined the predictive ability of Trails B and UFOV on pass/fail on-road outcomes in drivers with CI (Montreal Cognitive Assessment <26) referred for CDEs. Method. Retrospective data collection from two driving assessments centers (N = 100, mean age = 76.2 ± 8.8 years). Findings. The Trails B (area under the curve [AUC] = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) predicted pass/fail outcomes. A cut-point ≥467 ms on UFOV subtest 3 better-predicted pass/fail outcomes with 78.9% sensitivity and 73.5% specificity. In comparison, a cut-point ≥3.58 min on Trails B had lower sensitivity (73.7%) and specificity (61.8%). Implications. The UFOV subtest 3 may be more useful than the Trails B for predicting pass/fail outcomes in drivers with more severe CI referred for CDEs.
Collapse
Affiliation(s)
| | - Alexander M. Crizzle
- Alexander Crizzle, School of Public Health,
University of Saskatchewan, Saskatoon, SK, Canada.
| | | | | | | |
Collapse
|
4
|
Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
Collapse
Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
| |
Collapse
|