It is premature to test older drivers with the SIMARD-MD

Bédard, Michel; Marshall, Shawn; Man-Son-Hing, Malcolm; Weaver, Bruce; Gélinas, Isabelle; Korner‐Bitensky, Nicol; Mazer, Barbara; Naglie, Gary; Porter, Michelle M.; Rapoport, Mark J.; Tuokko, Holly; Vrkljan, Brenda

doi:10.1016/j.aap.2013.04.001

Cited by 12 publications

(14 citation statements)

References 24 publications

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“…This perspective aligns with the literature indicating that measures of global cognitive functioning lack specificity and, thus, should not be used in isolation to identify at-risk drivers. 18,22,47 The results presented here emphasize the importance of tailoring protocols aimed at identifying medically at-risk drivers to assess the deficits associated with a particular disease category as well as those factors that directly relate to driving safety.…”

Section: Discussionmentioning

confidence: 92%

“…19,20 Although these recommendations are indeed based on research evidence, for example, the study by Roy and Molnar, 21 both sets of guidelines indicate that none of these tests have high enough sensitivity and specificity to be relied upon as a sole predictor of driving ability, an opinion that has been echoed by many experts in the field. 22,23 Driving is a complex and multifactorial behavior that draws upon multiple physical, sensory, and cognitive processes and is impacted by personal and environmental characteristics. Anstey and colleagues 24 sought to develop an evidence-based model to identify the factors that enable driving safety among all older adults, and through an extensive search of the scientific literature, they identified cognitive, visual, and physical factors as contributing to driving safety.…”

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confidence: 99%

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Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Yamin

Stinchcombe

Gagnon

2015

Am J Alzheimers Dis Other Demen

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This study sought to predict driving performance of drivers with Alzheimer's disease (AD) using measures of attention, visual processing, and global cognition. Simulated driving performance of individuals with mild AD (n = 20) was contrasted with performance of a group of healthy controls (n = 21). Performance on measures of global cognitive function and specific tests of attention and visual processing were examined in relation to simulated driving performance. Strong associations were observed between measures of attention, notably the Test of Everyday Attention (sustained attention; r = -.651, P = .002) and the Useful Field of View (r = .563, P = .010), and driving performance among drivers with mild AD. The Visual Object and Space Perception Test-object was significantly correlated with the occurrence of crashes (r = .652, P = .002). Tests of global cognition did not correlate with simulated driving outcomes. The results suggest that professionals exercise caution when extrapolating driving performance based on global cognitive indicators.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Yamin

Stinchcombe

Gagnon

2015

Am J Alzheimers Dis Other Demen

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“…Bédard et al (20) recently published a review of the SIMARD MD comparing its score to other cognitive measures and found that patients with a post-secondary education scored higher on the SIMARD MD, suggesting an educational bias. Similarly they found scores were significantly lower for older patients, suggesting a bias towards age, as well.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly they found scores were significantly lower for older patients, suggesting a bias towards age, as well. (20) …”

Section: Introductionmentioning

confidence: 99%

Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment

et al. 2014

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BackgroundThe assessment of fitness to drive in patients with cognitive impairment is complex. The SIMARD MD was developed to assist with assessing fitness to drive. This study compares the clinical decision made by a geriatrician regarding driving with the SIMARD MD score.MethodsPatients with a diagnosis of mild dementia or mild cognitive impairment, who had a SIMARD MD test, were included in the sample. A retrospective chart review was completed to gather diagnosis, driving status, and cognitive and functional information.ResultsSixty-three patients were identified and 57 met the inclusion criteria. The mean age was 77.1 years (SD 8.9). The most common diagnosis was Alzheimer’s disease in 22 (38.6%) patients. The mean MMSE score was 24.9 (SD 3.34) and the mean MoCA was 19.9 (SD 3.58). The mean SIMARD MD score was 37.2 (SD 19.54). Twenty-four patients had a SIMARD MD score ≤ 30, twenty-eight between 31–70, and five scored > 70. The SIMARD MD scores did not differ significantly compared to the clinical decision (ANOVA p value = 0.14).ConclusionsThere was no association between the SIMARD MD scores and the geriatricians’ clinical decision regarding fitness to drive in persons with mild dementia or mild cognitive impairment.

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“…It is possible, using two cut points rather than one, to achieve higher sensitivity and specificity. However, this results in a very large "gray area," necessitating that a large number of drivers undergo comprehensive testing (Bédard et al, 2013). Hence, there is not, at present, a single tool that provides sufficient precision to make decisions regarding fitness-to-drive (Gamache, 2010).…”

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confidence: 99%

Consensus Statements for Screening and Assessment Tools

Bédard¹,

Dickerson

2014

Occupational Therapy In Health Care

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Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.

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It is premature to test older drivers with the SIMARD-MD

Abstract: Background: A new tool, the SIMARD-MD, has been proposed to help physicians identify

Cited by 12 publications

References 24 publications

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment

Consensus Statements for Screening and Assessment Tools

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