Association Between Unsafe Driving Performance and Cognitive-Perceptual Dysfunction in Older Drivers

Trait anger causes risky driving behavior by influencing executive function and hazard cognition

Drivers with a high level of trait anger feel more intensity of anger on road, contributing to more risky driving behavior and further increasing the probability of collisions. It seems that trait anger directly correlates with risky driving behavior, but how it works in detail remains unknown and previous research indicated executive function and hazard cognition may play a mediation role in it. Our research aims to explore the relationship among these variables and test if there is a multiple mediation model. We sampled 302 valid participants and used online questionnaires, containing trait anger scale (TAS), executive function index (EFI), hazard cognition scale (HCS; representing attitudes towards risky driving behavior), driver behavior questionnaire (DBQ), and self-reported traffic violations (e.g., accidents, penalty points, fines). Hierarchical multiple linear regression of DBQ results show trait anger is a medium but statistically significant predictor of risky driving behavior and drivers' attitude towards risky situations can significantly predict risky driving behavior at medium effect. But risky driving behavior cannot be predicted by executive function. Interestingly, opposing to prior research, zero-inflated Poisson regression analysis of self-reported traffic violations suggests trait anger negatively predicts accidents and fines in the zero-inflation model, and hazard cognition negatively predicts penalty points. Notably, the executive function negatively predicts penalty points and fines in the count model, which confirms our hypothetical direction. They all represent a small effect size in this nonlinear regression model. Path analysis suggested that trait anger influences risky driving behavior through executive function, and hazard cognition both separately and jointly. This study provides a theoretical framework for the transaction model of aggressive driving behavior and offers some possible interventions toward the effect of trait anger on risky driving behavior.

Lifestyle Matters: Effects of Habitual Physical Activity on Driving Skills in Older Age

Research on multitasking driving has suggested age-related deterioration in driving performance. It has been shown that physical and cognitive functioning, which are related to driving performance and decline with aging, are positively associated with physical activity behavior. This study aimed to explore whether driving performance decline becomes severe with advancing age and whether physical activity behavior modifies age-related deterioration in driving performance. A total of one hundred forty-one healthy adults were categorized into three groups based on their age; old-old (74.21 ± 2.33 years), young-old (66.53 ± 1.50 years), and young adults (23.25 ± 2.82 years). Participants completed a realistic multitasking driving task. Physical activity and cardiorespiratory fitness levels were evaluated. Older groups drove more slowly and laterally than young adults, and old-old adults drove slower than young-old ones across the whole driving course. Physical activity level did not interact with the aging effect on driving performance, whereas cardiovascular fitness interacted. Higher-fitness young-old and young adults drove faster than higher-fitness old-old adults. Higher-fitness old adults drove more laterally than higher-fitness young adults. The present study demonstrated a gradual decline in driving performance in old adults, and cardiorespiratory fitness interacted with the aging effect on driving performance. Future research on the interaction of aging and physical activity behavior on driving performance in different age groups is of great value and may help deepen our knowledge.

Comparison of older and middle-aged drivers' driving performance in a naturalistic setting

There is a concern in the public domain about driving safety among older drivers due the increase in age-associated medical conditions. It is not known how these medical changes impact driving performance and choice of driving environment. This study aimed to compare older drivers' (≥74 years) driving performance in a naturalistic setting to middle-aged drivers (35-64 years) on their chosen driving environment, and number, type and severity of errors. The effect of sex and perceived driving ability was also examined. Drivers' performance was studied using the electronic Driving Observation Schedule [eDOS]), a naturalistic observation approach. Fifty-three older (mean age = 80.6 years, 72% male) and 60 middle-aged (mean age = 50.0 years, 50% male) healthy drivers were recruited. Both groups made few driving errors that were mostly low-risk. Driving performance of older adults differed from middle-aged drivers; they drove on simpler routes (fewer intersections and lane changes) and made fewer errors. Findings are likely indicative of older drivers' use of adaptive strategies to maintain safe driving.

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

A Frontal Neuropsychological Profile in Fitness to Drive

Traffic accidents are a global concern due to the elevated mortality rates of both drivers and pedestrians. The World Health Organization declared 2011-2020 as the Decade of Action for Road Safety, endorsing initiatives to reduce traffic-related deaths. Yet, despite these incentives, fatal accidents still occur. Different studies have linked deficits in executive functions to risky driving attitudes and crashes. The present study focuses on demographic, cognitive and personality factors, related to the prefrontal cortex, that are characteristic of drivers prone to risky behavior behind the wheel. The penalty Points System was used to classify drivers as "safe", with no point loss over a two-year period, or "risky", with full point loss during the same interval. A neuropsychological assessment of prefrontal cognitive functions was carried out on each group to identify variables associated with safe and risky behavior. Neuropsychological indexes were obtained from a continuous performance task without cue (Simple Attention), a continuous performance task with cue (Conditioned Attention), the Tower of Hanoi test and the Neurologically-related Changes in Personality Inventory (NECHAPI). A Discriminant Analysis (DA) found that education level, reaction times in Simple and Conditioned Attention, learning errors in the Tower of Hanoi and vulnerability in the personality test, best predicted whether drivers were likely to be in the safe or risky group. Finally, a cross-validation analysis performed on the same sample correctly classified 87.5% of the drivers. These data suggest that prefrontal dysfunction contributes to risky behavior behind the wheel. The inclusion of cognitive programs to identify and train drivers with this propensity could reduce risky driving, and consequently, save lives on the road.

Driving scene-based driving errors in brain injury patients and their relevance to cognitive-perceptual function and functional activity level: A cross-sectional study

Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.

The psychomotor vigilance task: Role in the diagnosis of hepatic encephalopathy and relationship with driving ability

BACKGROUND & AIMS

Hepatic encephalopathy (HE) is a syndrome of decreased vigilance and has been associated with impaired driving ability. The aim of this study was to evaluate the psychomotor vigilance task (PVT), which is used to assess both vigilance and driving ability, in a group of patients with cirrhosis and varying degrees of HE.

METHODS

A total of 145 patients (120 males, 59 ± 10 years, model for end-stage liver disease [MELD] score 13 ± 5) underwent the PVT; a subgroup of 117 completed a driving questionnaire and a subgroup of 106 underwent the psychometric hepatic encephalopathy score (PHES) and an electroencephalogram (EEG), based on which, plus a clinical evaluation, they were classed as being unimpaired (n = 51), or as having minimal (n = 35), or mild overt HE (n = 20). All patients were followed up for an average of 13 ± 5 months in relation to the occurrence of accidents and/or traffic offences, HE-related hospitalisations and death. Sixty-six healthy volunteers evenly distributed by sex, age and education served as a reference cohort for the PVT.

RESULTS

Patients showed worse PVT performance compared with healthy volunteers, and PVT indices significantly correlated with MELD, ammonia levels, PHES and the EEG results. Significant associations were observed between neuropsychiatric performance/PVT indices and licence/driving status. PVT, PHES and EEG results all predicted HE-related hospitalisations and/or death over the follow-up period; none predicted accidents or traffic offences. However, individuals with the slowest reaction times and most lapses on the PVT were often not driving despite having a licence. When patients who had stopped driving for HE-related reasons (n = 6) were modelled as having an accident or fine over the subsequent 6 and 12 months, PVT was a predictor of accidents and traffic offences, even after correction for MELD and age.

CONCLUSIONS

The PVT is worthy of further study for the purposes of both HE and driving ability assessment.

LAY SUMMARY

Hepatic encephalopathy (HE) is a complication of advanced liver disease that can manifest as excessive sleepiness. Some patients with HE have been shown to have difficulty driving. Herein, we used a test called the Psychomotor Vigilance Task (PVT), which measures sleepiness and can also be used to assess driving competence. We showed that PVT performance is fairly stable in healthy individuals. We also showed that PVT performance parallels performance in tests which are commonly used in cirrhotic patients to measure HE. We suggest that this test is helpful in quantifying HE and identifying dangerous drivers among patients with cirrhosis.

Age-Related Differences in Pro-active Driving Behavior Revealed by EEG Measures

Healthy aging is associated with a decline in cognitive functions. This may become an issue when complex tasks have to be performed like driving a car in a demanding traffic situation. On the other hand, older people are able to compensate for age-related deficits, e.g., by deploying extra mental effort and other compensatory strategies. The present study investigated the interplay of age, task workload, and mental effort using EEG measures and a proactive driving task, in which 16 younger and 16 older participants had to keep a virtual car on track on a curvy road. Total oscillatory power and relative power in Theta and Alpha bands were analyzed, as well as event-related potentials (ERPs) to task-irrelevant regular and irregular sound stimuli. Steering variability and Theta power increased with increasing task load (i.e., with shaper bends of the road), while Alpha power decreased. This pattern of workload and mental effort was found in both age groups. However, only in the older group a relationship between steering variability and Theta power occurred: better steering performance was associated with higher Theta power, reflecting higher mental effort. Higher Theta power while driving was also associated with a stronger increase in reported subjective fatigue in the older group. In the younger group, lower steering variability came along with lower ERP responses to deviant sound stimuli, reflecting reduced processing of task-irrelevant environmental stimuli. In sum, better performance in proactive driving (i.e., more alert steering behavior) was associated with increased mental effort in the older group, and higher attentional focus on the task in the younger group, indicating age-specific strategies in the way younger and older drivers manage demanding (driving) tasks.

Default-mode network dynamics are restricted during high speed discrimination in healthy aging: Associations with neurocognitive status and simulated driving behavior

Numerous daily tasks, including car driving, require fine visuospatial tuning. One such visuospatial ability, speed discrimination, declines with aging but its neural underpinnings remain unknown. In this study, we use fMRI to explore the effect of aging during a high speed discrimination task and its neural underpinnings, along with a complete neuropsychological assessment and a simulated driving evaluation in order to examine how they interact with each other through a multivariate regression approach. Beyond confirming that high speed discrimination performance is diminished in the elderly, we found that this deficit might be partly due to a lack of modulation in the activity and connectivity of the default mode network (DMN) in this age group, as well as an over-recruitment of frontoparietal and cerebellar regions, possibly as a compensatory mechanism. In addition, younger adults tended to drive at faster speeds, a behavior that was associated to adequate DMN dynamics and executive functioning, an effect that seems to be lost in the elderly. In summary, these results reveal how age-related declines in fine visuospatial abilities, such as high speed discrimination, were distinctly mediated by DMN functioning, a mechanism also associated to speeding behavior in a driving simulator.

Influence of spine surgery on the ability to perform an emergency stop while driving a car

BACKGROUND

Spinal surgeries have strongly increased in number over the past decade. The question of when it is safe to resume driving is thereby one the most frequently asked questions that patients ask of their treating physician.

OBJECTIVE

The aim of this study was to assess braking performance before and after spine surgery.

METHODS

Reaction time, foot transfer time (together brake response time [BRT]), and brake force (BF) were evaluated in a drive simulator. A longitudinal patient cohort (n= 27) was tested preoperatively and at the first follow-up. A cross-sectional cohort (n= 27) was tested at > 1 year postoperatively. The values from these groups were compared with a healthy age-matched control group of 24 volunteers.

RESULTS

No significant improvement in BRT was seen in lumbar fusion three months postoperatively (p= 0.597); BF was even weaker than it was preoperatively (p= 0.044). In comparison to the control group (median BRT 479 ms), preoperative BRT was already impaired in lumbar fusion patients (median 560 ms), representing an increased braking distance of 2.25 m at 100 km/h.

CONCLUSION

Although most patients performed adequately, about one third presented critical braking performance. Risk factors for impaired braking may include scheduled multisegmental fusion surgery, female sex, and pain.

Assessing the use of immersive virtual reality, mouse and touchscreen in pointing and dragging-and-dropping tasks among young, middle-aged and older adults

This study assessed the use of an immersive virtual reality (VR), a mouse and a touchscreen for one-directional pointing, multi-directional pointing, and dragging-and-dropping tasks involving targets of smaller and larger widths by young (n = 18; 18-30 years), middle-aged (n = 18; 40-55 years) and older adults (n = 18; 65-75 years). A three-way, mixed-factorial design was used for data collection. The dependent variables were the movement time required and the error rate. Our main findings were that the participants took more time and made more errors in using the VR input interface than in using the mouse or the touchscreen. This pattern applied in all three age groups in all tasks, except for multi-directional pointing with a larger target width among the older group. Overall, older adults took longer to complete the tasks and made more errors than young or middle-aged adults. Larger target widths yielded shorter movement times and lower error rates in pointing tasks, but larger targets yielded higher rates of error in dragging-and-dropping tasks. Our study indicated that any other virtual environments that are similar to those we tested may be more suitable for displaying scenes than for manipulating objects that are small and require fine control. Although interacting with VR is relatively difficult, especially for older adults, there is still potential for older adults to adapt to that interface. Furthermore, adjusting the width of objects according to the type of manipulation required might be an effective way to promote performance.

Relationship Between Cognitive Perceptual Abilities and Accident and Penalty Histories Among Elderly Korean Drivers

OBJECTIVE

To investigate the relationship between cognitive perceptual abilities of elderly drivers based on the Cognitive Perceptual Assessment for Driving (CPAD) test and their accident and penalty histories.

METHODS

A total of 168 elderly drivers (aged ≥65 years) participated in the study. Participant data included CPAD scores and incidents of traffic accidents and penalties, attained from the Korea Road Traffic Authority and Korea National Police Agency, respectively.

RESULTS

Drivers' mean age was 70.25±4.1 years and the mean CPAD score was 52.75±4.72. Elderly drivers' age was negatively related to the CPAD score (p<0.001). The accident history group had marginally lower CPAD scores, as compared to the non-accident group (p=0.051). However, incidence rates for traffic fines did not differ significantly between the two groups. Additionally, the group that passed the CPAD test had experienced fewer traffic accidents (3.6%), as compared to the group that failed (10.6%). The older age group (12.0%) had also experienced more traffic accidents, as compared to the younger group (2.4%).

CONCLUSION

Overall, elderly drivers who experienced driving accidents had lower CPAD scores than those who did not, without statistical significance. Thus, driving-related cognitive abilities of elderly drivers with insufficient cognitive ability need to be further evaluated to prevent traffic accidents.

The association of physical activity, cognitive processes and automobile driving ability in older adults: A review of the literature

As the number of older adults in the United States grows, the number of automobile drivers over the age of 65 will also increase. Several cognitive processes necessary for automobile driving are vulnerable to age-related decline. These include declines in executive function, working memory, attention, and speed of information processing. The benefits of physical activity on physical, psychological and particular cognitive processes are well-documented; however few studies have explored the relationship between physical activity and driving ability in older adults or examined if cognitive processes mediate (or moderate) the effect of physical activity on driving ability. The purpose of this paper is to review the existing literature regarding physical activity, cognition and automobile driving. Recommendations for further research and utility of the findings to nursing and the health care team are provided.

Driving Trail Making Test part B: a variant of the TMT-B

[Purpose] The Trail Making Test part B (TMT-B) is used in evaluating driving abilities and includes testing for the executive function. A driving simulator version of this test (DTMT-B) was developed to measure drivers’ executive abilities in three-dimensional space. The purpose of the present study was to assess the validity of the DTMT-B for driving assessment. [Subjects] Thirty stroke patients and 65 healthy subjects were recruited. [Methods] Participants performed the TMT-B and DTMT-B. The DTMT-B was run on a driving simulator in which the individual performed a task on virtual roads connecting the lettered and numbered TMT-B points by simulated driving instead of connecting them with lines as in the paper or computerized TMT-B. Intra-class correlation coefficients (ICCs) were used to assess validities. Significant correlations were found between the TMT-B and DTMT-B. [Results] Participants performed the TMT-B and DTMT-B. Intra-class correlation coefficients (ICCs) were used to assess validities. Significant correlations were found between the TMT-B and DTMT-B. [Conclusion] The results suggest that the DTMT-B may be useful as part of driver screening assessment using a driving simulator for stroke patients and that it may also be used to assess the executive functions for healthy people.

Evaluation of older driver head functional range of motion using portable immersive virtual reality

BACKGROUND

The number of drivers over 65 years of age continues to increase. Although neck rotation range has been identified as a factor associated with self-reported crash history in older drivers, it was not consistently reported as indicators of older driver performance or crashes across previous studies. It is likely that drivers use neck and trunk rotation when driving, and therefore the functional range of motion (ROM) (i.e. overall rotation used during a task) of older drivers should be further examined.

OBJECTIVE

Evaluate older driver performance in an immersive virtual reality, simulated, dynamic driving blind spot target detection task.

METHODS

A cross-sectional laboratory study recruited twenty-six licensed drivers (14 young between 18 and 35 years, and 12 older between 65 to 75 years) from the local community. Participants were asked to detect targets by performing blind spot check movements while neck and trunk rotation was tracked. Functional ROM, target detection success, and time to detection were analyzed.

RESULTS

In addition to neck rotation, older and younger drivers on average rotated their trunks 9.96° and 18.04°, respectively. The younger drivers generally demonstrated 15.6° greater functional ROM (p<.001), were nearly twice as successful in target detection due to target location (p=.008), and had 0.46 s less target detection time (p=.016) than the older drivers.

CONCLUSION

Assessing older driver functional ROM may provide more comprehensive assessment of driving ability than neck ROM. Target detection success and time to detection may also be part of the aging process as these measures differed between driver groups.

The Effects of Hip and Spine Orthoses on Braking Parameters: A Simulated Study With Healthy Subjects

BACKGROUND

Although a person's fitness to drive has gained more attention over the past few years, investigations have focused mainly on postsurgical (eg, hip arthroplasty) driving performance. Few data are available on how orthoses affect the ability to perform an emergency stop.

OBJECTIVE

To determine whether common lumbar and hip orthoses impair driving performance by increasing brake response time and weakening brake force (BF).

DESIGN

Crossover repeated measures design.

SETTING

University hospital.

PARTICIPANTS

A crossover, repeated-measures design was used to test 30 healthy volunteers with and without each of the orthoses in random order.

METHODS

A custom-made simulator was created from a car cabin fitted with measurement equipment to record braking parameters under realistic spatial constraints.

MAIN OUTCOME MEASUREMENTS

Reaction time (RT), foot transfer time (FTT) (these 2 together: brake response time), and maximum BF.

RESULTS

Although spine orthoses lead to statistically significant increases in RT (Vertebradyn-Strong, P = .002; Horizon 637 LSO, P = .32; and SofTec Dorso, P = .013), this effect was not observed in hip orthoses, where instead FTT was prolonged (DynaCox and Hohmann-like orthosis, P < .001). BF was not significantly altered in any of the orthoses.

CONCLUSIONS

This study demonstrates that hip and spine orthoses lead to impaired driving performance. Depending on the type of immobilization, this effect mostly increases RT or FTT, lengthening total stopping distances by up to half a meter at 100 km/h. However, in the absence of an underlying pathological condition in individuals with orthoses, their braking performance should be sufficient to continue driving.

Age-dependent visual exploration during simulated day- and night driving on a motorway: a cross-sectional study

Background

Central and peripheral vision is needed for object detection. Previous research has shown that visual target detection is affected by age. In addition, light conditions also influence visual exploration. The aim of the study was to investigate the effects of age and different light conditions on visual exploration behavior and on driving performance during simulated driving.

Methods

A fixed-base simulator with 180 degree field of view was used to simulate a motorway route under daylight and night conditions to test 29 young subjects (25–40 years) and 27 older subjects (65–78 years). Drivers’ eye fixations were analyzed and assigned to regions of interests (ROI) such as street, road signs, car ahead, environment, rear view mirror, side mirror left, side mirror right, incoming car, parked car, road repair. In addition, lane-keeping and driving speed were analyzed as a measure of driving performance.

Results

Older drivers had longer fixations on the task relevant ROI, but had a lower frequency of checking mirrors when compared to younger drivers. In both age groups, night driving led to a less fixations on the mirror. At the performance level, older drivers showed more variation in driving speed and lane-keeping behavior, which was especially prominent at night. In younger drivers, night driving had no impact on driving speed or lane-keeping behavior.

Conclusions

Older drivers’ visual exploration behavior are more fixed on the task relevant ROI, especially at night, when driving performance becomes more heterogeneous than in younger drivers.

A participatory approach to develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment tool

The electric powered wheelchair (EPW) is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST) and Power Mobility Clinical Driving Assessment (PMCDA). Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user's current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools.

Evaluating the benefits of second-eye cataract surgery among the elderly

The aim of this systematic review was to synthesize and appraise the evidence of benefits of second-eye cataract extraction for visual function, patient-reported quality of life, falls, and driving ability among the elderly. We conducted a comprehensive search in MEDLINE using "surgery," "cataract extraction," "second eye," and "bilateral." Ten studies met the inclusion and quality criteria. We found "moderate" evidence supporting improvement in stereopsis, stereoacuity, and anisometropia over and above the benefits of first-eye surgery. We also found "moderate" evidence supporting improvement in visual acuity, contrast sensitivity, and self-reported visual functioning. Studies included in the review do not provide definitive evidence of second-eye surgery benefits on health-related quality of life, visual fields, falls prevention, and driving performance. However, the heterogeneity of outcome measures and the limited number of studies likely contributed to our findings. The findings have implications for clinicians and policymakers in the health-care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Using the community health assessment to screen for continued driving

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

A novel computer test to assess driving-relevant cognitive functions--a pilot study

BACKGROUND

The assessment of driving-relevant cognitive functions in older drivers is a difficult challenge as there is no clear-cut dividing line between normal cognition and impaired cognition and not all cognitive functions are equally important for driving.

METHODS

To support decision makers, the Bern Cognitive Screening Test (BCST) for older drivers was designed. It is a computer-assisted test battery assessing visuo-spatial attention, executive functions, eye-hand coordination, distance judgment, and speed regulation. Here we compare the performance in BCST with the performance in paper and pencil cognitive screening tests and the performance in the driving simulator testing of 41 safe drivers (without crash history) and 14 unsafe drivers (with crash history).

RESULTS

Safe drivers performed better than unsafe drivers in BCST (Mann-Whitney U test: U = 125.5; p = 0.001) and in the driving simulator (Student's t-test: t(44) = -2.64, p = 0.006). No clear group differences were found in paper and pencil screening tests (p > 0.05; ns). BCST was best at identifying older unsafe drivers (sensitivity 86%; specificity 61%) and was also better tolerated than the driving simulator test with fewer dropouts.

CONCLUSIONS

BCST is more accurate than paper and pencil screening tests, and better tolerated than driving simulator testing when assessing driving-relevant cognition in older drivers.

Systematic review of the evidence for Trails B cut-off scores in assessing fitness-to-drive

Background

Fitness-to-drive guidelines recommend employing the Trail Making B Test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test.

The objective of this study was to address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive.

Methods

Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer-reviewed journals.

Results

Forty-seven articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 133 seconds, 147 seconds, 180 seconds, and < 3 errors.

Conclusions

There is support for the previously published Trails B cut-offs of 3 minutes or 3 errors (the ‘3 or 3 rule’). Major methodological limitations of this body of research were uncovered including (1) lack of justification of sample size leaving studies open to Type II error (i.e., false negative findings), and (2) excessive focus on associations rather than clinically useful cut-off scores.

Cognitive deficits are associated with poorer simulated driving in older adults with heart failure

BACKGROUND

Cognitive impairment is prevalent in older adults with heart failure (HF) and associated with reduced functional independence. HF patients appear at risk for reduced driving ability, as past work in other medical samples has shown cognitive dysfunction to be an important contributor to driving performance. The current study examined whether cognitive dysfunction was independently associated with reduced driving simulation performance in a sample of HF patients.

METHODS

18 persons with HF (67.72; SD = 8.56 year) completed echocardiogram and a brief neuropsychological test battery assessing global cognitive function, attention/executive function, memory and motor function. All participants then completed the Kent Multidimensional Assessment Driving Simulation (K-MADS), a driving simulator scenario with good psychometric properties.

RESULTS

The sample exhibited an average Mini Mental State Examination (MMSE) score of 27.83 (SD = 2.09). Independent sample t-tests showed that HF patients performed worse than healthy adults on the driving simulation scenario. Finally, partial correlations showed worse attention/executive and motor function were independently associated with poorer driving simulation performance across several indices reflective of driving ability (i.e., centerline crossings, number of collisions, % of time over the speed limit, among others).

CONCLUSION

The current findings showed that reduced cognitive function was associated with poor simulated driving performance in older adults with HF. If replicated using behind-the-wheel testing, HF patients may be at elevated risk for unsafe driving and routine driving evaluations in this population may be warranted.

The impact of cognitive deficit on self-reported car crashes in ultra-octogenarian population: data of an Italian population-based study

OBJECTIVE

To examine the usefulness of specific neurocognitive tests for predicting the crash involvement in ultra-octogenarian population.

METHODS

A total of 800 subjects (mean age 82.4 + 3.1 years) underwent a battery of neuropsychological tests. Global intellectual functioning was assessed using the Mini Mental State Examination, mental flexibility and information processing speed were assessed using the Trail Making Test parts A and B (TMT-A and TMT-B), long-term memory was evaluated with the short story, and visuo-spatial skills were tested with Clock Drawing Test. One year after this evaluation, 343 (43%) participants have been interviewed by a telephone call to know if they were currently driving and if they had a car crash during this period.

RESULTS

Two hundred ninety-seven subjects had their driving license renewed and completed the follow-up 1 year after. Data shows that less than 11% of this group had a car crash during the first year of observation (Crash Involved). Older subjects involved in a car crash showed significant worse performances on TMT-B (TMT-B pathological Crash Involved vs. Noncrash Involved 47% vs. 27%; p = 0.02) and on short story (short story pathological Crash Involved vs. Noncrash Involved 19% vs. 5%; p = 0.02).

CONCLUSIONS

Trail Making test B and short story have been demonstrated to provide a predictive value of driving performance of older people. Therefore, we suggest that a simple and standardized battery of neuropsychological tests, lasting about 30 min and administered by an experienced staff, is a good diagnostic instrument for risk prevention of driving activity of older drivers.

Both texting and eating are associated with impaired simulated driving performance

OBJECTIVE

Distracted driving is a known contributor to traffic accidents, and many states have banned texting while driving. However, little is known about the potential accident risk of other common activities while driving, such as eating. The objective of the current study was to examine the adverse impact of eating/drinking behavior relative to texting and nondistracted behaviors on a simulated driving task.

METHODS

A total of 186 participants were recruited from undergraduate psychology courses over 2 semesters at Kent State University. We utilized the Kent Multidimensional Assessment Driving Simulation (K-MADS) to compare simulated driving performance among participants randomly assigned to texting (N = 45), eating (N = 45), and control (N = 96) conditions. Multivariate analyses of variance (MANOVA) were conducted to examine between-group differences on simulated driving indices.

RESULTS

MANOVA analyses indicated that groups differed in simulated driving performance, F(14, 366) = 7.70, P < .001. Both texting and eating produced impaired driving performance relative to controls, though these behaviors had approximately equal effect. Specifically, both texting and eating groups had more collisions, pedestrian strikes, and center line crossings than controls. In addition, the texting group had more road edge excursions than either eating or control participants and the eating group missed more stop signs than controls.

CONCLUSIONS

These findings suggest that both texting and eating are associated with poorer simulated driving performance. Future work is needed to determine whether these findings generalize to real-world driving and the development of strategies to reduce distracted driving.

Neural correlates of visual motion prediction

Predicting the trajectories of moving objects in our surroundings is important for many life scenarios, such as driving, walking, reaching, hunting and combat. We determined human subjects’ performance and task-related brain activity in a motion trajectory prediction task. The task required spatial and motion working memory as well as the ability to extrapolate motion information in time to predict future object locations. We showed that the neural circuits associated with motion prediction included frontal, parietal and insular cortex, as well as the thalamus and the visual cortex. Interestingly, deactivation of many of these regions seemed to be more closely related to task performance. The differential activity during motion prediction vs. direct observation was also correlated with task performance. The neural networks involved in our visual motion prediction task are significantly different from those that underlie visual motion memory and imagery. Our results set the stage for the examination of the effects of deficiencies in these networks, such as those caused by aging and mental disorders, on visual motion prediction and its consequences on mobility related daily activities.