Abstract
Objectives
Dementia increases the risk of unsafe driving, but this is less apparent in preclinical
stages such as mild cognitive impairment (MCI). There is, however, limited detailed
data on the patterns of driving errors associated with MCI. Here, we examined whether
drivers with MCI exhibited different on-road error profiles compared with cognitively
normal (CN) older drivers.
Design
Observational.
Setting and Participants
A total of 296 licensed older drivers [mean age 75.5 (SD = 6.2) years, 120 (40.5%)
women] recruited from the community.
Method
Participants completed a health and driving history survey, a neuropsychological test
battery, and an on-road driving assessment including driver-instructed and self-navigation
components. Driving assessors were blind to participant cognitive status. Participants
were categorized as safe or unsafe based on a validated on-road safety scale, and
as having MCI based on International Working Group diagnostic criteria. Proportion
of errors incurred as a function of error type and traffic context were compared across
safe and unsafe MCI and CN drivers.
Results
Compared with safe CN drivers (n = 225), safe MCI drivers (n = 45) showed a similar
pattern of errors in different traffic contexts. Compared with safe CN drivers, unsafe
CN drivers (n = 17) were more likely to make errors in observation, speed control,
lane position, and approach, and at stop/give-way signs, lane changes, and curved
driving. Unsafe MCI drivers (n = 9) had additional difficulties at intersections,
roundabouts, parking, straight driving, and under self-navigation conditions. A higher
proportion of unsafe MCI drivers had multidomain subtype [n = 6 (67%)] than safe MCI
drivers [n = 11 (25%)], odds ratio 6.2 (95% confidence interval, 1.4–29.6).
Conclusion and Implications
Among safe drivers, MCI and CN drivers exhibit similar on-road error profiles, suggesting
driver restrictions based on MCI status alone are unwarranted. However, formal evaluation
is recommended in such cases, as there is evidence drivers with multiple domains of
cognitive impairment may require additional interventions to support safe driving.
Keywords
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Article info
Publication history
Published online: July 19, 2020
Footnotes
The authors declare no conflicts of interest.
This study was funded by the National Health and Medical Research Council of Australia (NHMRC grant #1045024). Kaarin Anstey is funded by NHMRC Research Fellowship #1102694.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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