Identifying Driving Impairment in Alzheimer Disease: A Comparison of Self and Observer Reports Versus Driving Evaluation

Abstract

This study examined the relationship between driving behaviors and awareness of deficit in patients with Alzheimer's disease (AD). Fifteen mildly impaired AD patients and 15 healthy elderly controls with valid drivers' licenses were administered a series of questionnaires concerning daily functioning and driving performance, and all 30 subjects were evaluated on a standardized road test. Self-report and caregiver/informant responses were compared with determine levels of discrepancy in ratings, while comparisons of AD and healthy elderly controls revealed group differences. Actual driving performance was considered the standard by which to determine accuracy of perceptions. Drivers with AD were rated as significantly worse than healthy elderly drivers on nine of 10 driving behaviors by an independent evaluator. AD patients' self-reports of driving ability were significantly better than the evaluator's ratings on seven of the 10 items, whereas the healthy elderly drivers rated themselves better than did the evaluator on one item. Although caregivers were likely to acknowledge a general concern with their AD patients' driving, they underreported specific driving problems when their ratings were compared with those of an independent evaluator. These findings have implications for the development of caregiver-based modifications of driving behavior.

Comparing Caregiver and Clinician Predictions of Fitness to Drive in People With Alzheimer’s Disease

“…The reason underlying the poor association between caregiver and objective ratings is unclear and was not empirically tested in this study. A number of reasons have been put forth to explain reporter bias in caregivers, including the desire to avoid interpersonal conflict or to deemphasize the progression of the disease because of reliance on the driver for transportation (Wild & Cotrell, 2003). In a study of 80 older drivers, 33% stated that their independence would be affected if their spouse stopped driving, even though they were all licensed drivers (Classen et al, 2012a).…”

“…Therefore, self-report and caregiver report measures that clinicians can use in the office to identify driving errors and risky behaviors are desirable. Several studies have found limited utility for self-report measures in AD because affected people experience reduced insight into their own cognitive deficits and denial of their reduced driving performance Cotrell & Wild, 1999;Dobbs, 1997;Hunt, Morris, Edwards, & Wilson, 1993;O'Neill et al, 1992;Wild & Cotrell, 2003). Families and caregivers often rely on input from physicians to make the final decision about driving cessation.…”

Performance in normal subjects on a novel battery of driving-related sensory-motor and cognitive tests

“…Gish, Decina, Lococo, & McKnight, 1998;Wild & Cotrell, 2003;Wilson & Smith, 1983) and associated with previous incidents of unsafe driving or on-road driving assessment outcome (e.g., Galski, Bruno, & Ehle, 1993;Mazer, Korner-Bitensky, & Sofer, 1998;McKnight & McKnight, 1999;Schanke & Sundet, 2000).…”

Anxiety of Alzheimer's disease patients before and after a standardized on‐road driving test

“…Specifically, the results of two recent studies demonstrated that both AD patients and their informants might overestimate the patient's driving abilities before the on-road driving test [37,38]. There exists a discrepancy between AD patients' and informants' ratings of patient driving ability and actual performance as rated by a professional driving instructor on the standardized on-road driving test.…”