Computerized Maze Navigation and On-Road Performance by Drivers With Dementia

Abstract

This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests. Parameters measured for mazes included errors, planning time, drawing time, and total time. Within 2 weeks, subjects were examined by a professional driving instructor on a standardized road test modeled after the Washington University Road Test. Road test total score was significantly correlated with total time across the 5 mazes. This maze score was significant for both Alzheimer disease subjects and control subjects. One maze in particular, requiring less than 2 minutes to complete, was highly correlated with driving performance. For the standard neuropsychological tests, highest correlations were seen with Trail Making A (TrailsA) and the Hopkins Verbal Learning Tests Trial 1 (HVLT1). Multiple regression models for road test score using stepwise subtraction of maze and neuropsychological test variables revealed significant independent contributions for total maze time, HVLT1, and TrailsA for the entire group; total maze time and HVLT1 for Alzheimer disease subjects; and TrailsA for normal subjects. As a visual analog of driving, a brief computerized test of maze navigation time compares well to standard neuropsychological tests of psychomotor speed, scanning, attention, and working memory as a predictor of driving performance by persons with early Alzheimer disease and normal elders. Measurement of maze task performance appears to be useful in the assessment of older drivers at risk for hazardous driving.

The Addenbrooke's Cognitive Examination Revised as a potential screening test for elderly drivers

“…For instance, two meta-analyses of the literature, one of persons with dementia (Reger et al, 2004) and one of older adults without a dementia diagnosis (Mathias and Lucas, 2009), provided support for the utility of tests of visuospatial abilities and visual attention, respectively, in predicting real-world driving ability. Tests of executive functions have also shown promise in predicting on-road (Ott et al, 2008;Whelihan et al, 2005) and crash involvement (Daigneault et al, 2002), although executive functioning has not been examined as extensively as other neurocognitive domains. Nevertheless, neuropsychological test scores do not correlate entirely with functional outcomes (Sadek and van Gorp, 2010), and current investigations attempt to conclude the most effective assessment methods for detecting driving deficits (Morgan and Heaton, 2009).…”

Predicting Road Test Performance in Drivers With Stroke

“…Recent reviews have found that similar tests of visuospatial skill, psychomotor speed, and attention are predictive of driving ability in stroke survivors (Devos et al, 2011;Marshall et al, 2007), providing convergent validation for our approach. Furthermore, studies in older adults with cognitive impairment have reported utility for these types of tests (Ott et al, in press) and for both handdrawn (Snellgrove, 2005) and computerized mazes (Ott et al, 2008;Staplin, Gish, Lococo, Joyce, & Sifrit, 2013). Therefore, further development of such tests is indicated.…”

The Roles and Performance of Professional Driving Instructors in Novice Driver Education

“…However, the majority of these articles were related to medical fields, including studies of occupational therapist driver assessors or associations between driving and illnesses such as dementia; stroke; Parkinson's disease; visual impairment; neurological conditions; orthopaedic issues; sleep problems; attention deficit hyperactivity disorder (ADHD); autism spectrum disorder (ASD); Down's syndrome; and the effect of drugs, medications and alcohol. [20][21][22][23][24][25][26][27][28] The subject population was often composed of older drivers, with the articles focusing on their fitness to drive. Critically, even if PDIs were involved in some articles, they were not the main subjects but were instead contributors, for instance in upholding the research design or its validity and reliability.…”