Older Adults with Mild Cognitive Impairments Show Less Driving Errors after a Multiple Sessions Simulator Training Program but Do Not Exhibit Long Term Retention

In-vehicle Sensing and Data Analysis for Older Drivers with Mild Cognitive Impairment

Driving is a complex daily activity indicating age and disease-related cognitive declines. Therefore, deficits in driving performance compared with ones without mild cognitive impairment (MCI) can reflect changes in cognitive functioning. There is increasing evidence that unobtrusive monitoring of older adults' driving performance in a daily-life setting may allow us to detect subtle early changes in cognition. The objectives of this paper include designing low-cost in-vehicle sensing hardware capable of obtaining high-precision positioning and telematics data, identifying important indicators for early changes in cognition, and detecting early-warning signs of cognitive impairment in a truly normal, day-to-day driving condition with machine learning approaches. Our statistical analysis comparing drivers with MCI to those without reveals that those with MCI exhibit smoother and safer driving patterns. This suggests that drivers with MCI are cognizant of their condition and tend to avoid erratic driving behaviors. Furthermore, our Random Forest models identified the number of night trips, number of trips, and education as the most influential factors in our data evaluation.

Occupational Therapy Interventions to Improve Driving Performance in Older People With Mild Cognitive Impairment or Early-Stage Dementia: A Systematic Review

IMPORTANCE

For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population.

OBJECTIVE

To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia.

DATA SOURCES

We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines.

FINDINGS

One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6-72.5 yr. One study evaluated a compensatory approach, whereas the others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects.

CONCLUSIONS AND RELEVANCE

Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measures and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients' abilities. Development of evidence and guidelines in this area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.

Driving exposure, patterns and safety critical events for older drivers with and without mild cognitive impairment: Findings from a naturalistic driving study

OBJECTIVE

The aim of the study is to compare driving exposure, patterns and factors associated with safety critical events between drivers with MCI and a comparison group without cognitive impairment.

DESIGN, SETTING, PARTICIPANTS

Naturalistic driving data using an in-vehicle monitoring device were collected from 36 older drivers with MCI and 35 older drivers without cognitive impairment over a two-week period in Western Australia.

MEASUREMENTS

Naturalistic driving exposure, patterns (eg. night-time trips, peak-hour trips) and safety critical events (harsh acceleration, harsh braking and harsh cornering).

RESULTS

Drivers with MCI had a lower number of safety critical events (mean = 7.20, SD = 11.44) compared to drivers without cognitive impairment (mean = 10.89, SD = 23.30) however, this was not statistically significantly. There were also no statistically significant differences between drivers with and without MCI for measures of driving exposure or any of the driving patterns including weekday trips, night-time trips and trips on highways/freeways. The results of the multivariable modelling found only binocular contrast sensitivity was associated with the rate of safety critical events. For every increase of 0.1 log units in contrast sensitivity (better contrast sensitivity) the rate of safety critical events significantly decreased by 30 % (IRR = 0.70, 95 % CI = 0.50-0.98, p = 0.04).

CONCLUSION

Drivers with MCI were found to have similar driving exposure and patterns compared to older drivers without cognitive impairment, however drivers with better contrast sensitivity experienced fewer safety critical events. Future research should consider a longitudinal study design with an extended driving monitoring period and a larger sample with a clinical diagnosis of MCI to assess changes in cognition and its impact on driving.

Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples

Background

Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population.

Objective

To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies.

Methods

Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease.

Results

Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants.

Conclusion

Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.

Are interventions effective at improving driving in older drivers?: A systematic review

Background

With the aging of the population, the number of older drivers is on the rise. This poses significant challenges for public health initiatives, as older drivers have a relatively higher risk for collisions. While many studies focus on developing screening tools to identify medically at-risk drivers, little research has been done to develop training programs or interventions to promote, maintain or enhance driving-related abilities among healthy individuals. The purpose of this systematic review is to synopsize the current literature on interventions that are tailored to improve driving in older healthy individuals by working on components of safe driving such as: self-awareness, knowledge, behaviour, skills and/or reducing crash/collision rates in healthy older drivers.

Methods

Relevant databases such as Scopus and PubMed databases were selected and searched for primary articles published in between January 2007 and December 2017. Articles were identified using MeSH search terms: (“safety” OR “education” OR “training” OR “driving” OR “simulator” OR “program” OR “countermeasures”) AND (“older drivers” OR “senior drivers” OR “aged drivers” OR “elderly drivers”). All retrieved abstracts were reviewed, and full texts printed if deemed relevant.

Results

Twenty-five (25) articles were classified according to: 1) Classroom settings; 2) Computer-based training for cognitive or visual processing; 3) Physical training; 4) In-simulator training; 5) On-road training; and 6) Mixed interventions. Results show that different types of approaches have been successful in improving specific driving skills and/or behaviours. However, there are clear discrepancies on how driving performance/behaviours are evaluated between studies, both in terms of methods or dependent variables, it is therefore difficult to make direct comparisons between these studies.

Conclusions

This review identified strong study projects, effective at improving older drivers’ performance and thus allowed to highlight potential interventions that can be used to maintain or improve older drivers’ safety behind the wheel. There is a need to further test these interventions by combining them and determining their effectiveness at improving driving performance.

Sensor-based systems for early detection of dementia (SENDA): a study protocol for a prospective cohort sequential study

Background

Dementia and cognitive decline are serious social and economic burdens. An increase in the population of older people, as well as longer lifespans mean that numbers of dementia cases are exponentially rising. Neuropathological changes associated with dementia are thought to appear before the clinical manifestation of cognitive symptoms, i.e., memory impairments. Further, some older adults (OA) experience cognitive decline before it can be objectively diagnosed. For optimal care of these patients, it is necessary to detect cognitive decline and dementia at an early stage. In this vein, motor, sensory, and neurophysiological declines could be promising factors if found to be present before the onset of cognitive impairment. Hence, the objective of the SENDA study is to develop a multi-dimensional sensor-based instrument that allows early detection of cognitive decline or dementia in OA with the help of cognitive, sensory, motor, and neurophysiological parameters before its clinical manifestation.

Methods/design

In the cohort sequential study, participants are assigned to one of three study groups depending on their cognitive status: 1. cognitively healthy individuals (CHI), 2. subjectively cognitively impaired persons (SCI), or 3. (possible) mildly cognitively impaired persons (pMCI, MCI). All groups take part in the same cognitive (e.g., executive function tests), motor (e.g., gait analyses, balance tests), sensory (e.g., vibration perception threshold test, proprioception tests), and neurophysiological (e.g., electroencephalograms) measurements. Depending on the time at which participants are included into the study, all measurements are repeated up to four times in intervals of 8 months within 3 years to identify associations with cognitive changes over time.

Discussion

This study aims to detect possible motor, sensory, neurophysiological, and cognitive predictors to develop an early screening tool for dementia and its pre-stages in OA. Thus, affected persons could receive optimal health care at an earlier time point to maintain their health resources.

Trial status

The study is ongoing. The recruitment of participants will be continued until May 2020.

Driving difficulties as reported by older drivers with mild cognitive impairment and without neurological impairment

Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment. Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs. Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations. Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers' fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.

Naturalistic Driving Study Investigating Self-Regulation Behavior in Early Alzheimer's Disease: A Pilot Study

BACKGROUND

Because cognitive processes decline in the earliest stages of Alzheimer's disease (AD), the driving abilities are often affected. The naturalistic driving approach is relevant to study the driving habits and behaviors in normal or critical situations in a familiar environment of participants.

OBJECTIVE

This pilot study analyzed in-car video recordings of naturalistic driving in patients with early-stage AD and in healthy controls, with a special focus on tactical self-regulation behavior.

METHODS

Twenty patients with early-stage AD (Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria), and 21 healthy older adults were included in the study. Data collection equipment was installed in their personal vehicles. Two expert psychologists assessed driving performance using a specially designed Naturalistic Driving Assessment Scale (NaDAS), paying particular attention to tactical self-regulation behavior, and they recorded all critical safety events.

RESULTS

Poorer driving performance was observed among AD drivers: their tactical self-regulation behavior was of lower quality. AD patients had also twice as many critical events as healthy drivers and three times more "unaware" critical events.

CONCLUSION

This pilot study used a naturalistic approach to accurately show that AD drivers have poorer tactical self-regulation behavior than healthy older drivers. Future deployment of assistance systems in vehicles should specifically target tactical self-regulation components.