A 2.5-Year Longitudinal Assessment of Naturalistic Driving in Preclinical Alzheimer’s Disease

Abstract

Background: Emerging evidence shows that cognitively normal older adults with preclinical Alzheimer’s disease (AD) make more errors and are more likely to receive a marginal/fail rating on a standardized road test compared to older adults without preclinical AD, but the extent to which preclinical AD impacts everyday driving behavior is unknown. Objective: To examine self-reported and naturalistic longitudinal driving behavior among persons with and without preclinical AD. Method: We prospectively followed cognitively normal drivers (aged 65 + years) with (n = 10) and without preclinical AD (n = 10) for 2.5 years. Preclinical AD was assessed using amyloid positron emission tomography (PET) with Pittsburgh Compound B. The Driving Habits Questionnaire assessed self-reported driving outcomes. Naturalistic driving was captured using a commercial GPS data logger plugged into the on-board diagnostics II port of each participant’s vehicle. Data were sampled every 30 seconds and all instances of speeding, hard braking, and sudden acceleration were recorded. Results: Preclinical AD participants went to fewer places/unique destinations, traveled fewer days, and took fewer trips than participants without preclinical AD. The preclinical AD group reported a smaller driving space, greater dependence on other drivers, and more difficulty driving due to vision difficulties. Persons with preclinical AD had fewer trips with any aggression and showed a greater decline across the 2.5-year follow-up period in the number of days driving per month and the number of trips between 1–5 miles. Conclusion: Changes in driving occur even during the preclinical stage of AD.

The Road to Recovery: A Pilot Study of Driving Behaviors Following Antibody-Mediated Encephalitis

“…Detection of these changes may identify individuals at-risk for brain pathology that may compromise driving ability. In a longitudinal study measuring objective driving behaviors in older CN community-dwelling adults, drivers with early (i.e., "preclinical") brain changes related to Alzheimer disease exhibited decreased driving space and exposure and had a lower number of trips with "aggressive behaviors" (especially hard braking and sudden acceleration) than their Alzheimer disease-free counterparts (15). In contrast to patients with neurodegenerative diseases, the cognitive and motor deficits associated with AME may resolve with time from treatment.…”

“…Patients were enrolled from January to October 2017 within prospective studies permitting longitudinal collection and monitoring of clinical symptoms and signs in recovering AME patients. Written informed consent was obtained from all individuals or their delegates, allowing the collection of relevant clinical information and installation and remote monitoring of driving behaviors using a commercial-off-the-shelf GPS data logger together with naturalistic driving methodology (15,16)-termed the Driving Real World In-Vehicle Evaluation System [DRIVES (17)]. The Washington University School of Medicine Institutional Review Board approved all study procedures.…”

“…Safe driving requires integration of higher-order cognitive and motor functions, drawing upon heteromodal (association) and unimodal (sensory/motor) cortices and relying heavily on sound judgment and decision-making. Accordingly, changes in driving behavior may provide a real-world correlate for changes in higher-order function associated with neurological diseases (14,15). Recovering AME patients may experience greater risks following the return to driving due to persistent frontal-executive and memory dysfunction (7,8).…”

A Systematic Review Examining Associations between Cardiovascular Conditions and Driving Outcomes among Older Drivers

“…However, this generalizability to daily driving behavior is limited and only naturalistic data can provide insight into a driver's native environment. The lack of studies employing naturalistic driving methodologies to measure everyday driving in CVD is partially surprising given their increasing use in studies of healthy older adults and those with preclinical and symptomatic AD [7,[48][49][50]. A reason for this finding may be due to the ascent in technological development with in vivo vehicle tracking, data acquisition and transmission has only occurred in the past decade, while road tests and driving simulators have been a mainstay of driving outcome assessment for over 30 years.…”

Evaluation of Naturalistic Driving Behavior Using In-Vehicle Monitoring Technology in Preclinical and Early Alzheimer’s Disease

“…Using naturalistic methodology, real world driving behavior appears to change even in the preclinical phase of the disease with amyloid positive older adults driving to fewer places/unique destinations, traveling fewer days, and taking fewer trips compared to amyloid negative same-aged peers. Furthermore, those with preclinical AD had fewer trips with any aggressive behaviors and showed a greater decline across a 2.5-year follow-up period in the number of days driving per month and number of trips taken (Roe et al, 2019).…”