On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

Abstract

Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These on-road driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for right- and left-sided strokes. Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R² = 0.60). ‘Lane changing' and ‘understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R² = 0.65). Divided attention was the main determinant of on-road scores in the total group (R² = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R² = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R² = 0.46). Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and left-sided strokes.

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“…To fully appreciate the impact of clinical factors identified in this study and others on driving [21,23], on-road driving assessors should be in close communication with the physician. Although our findings may be more clinically relevant to the stroke population seeking a comprehensive fitness-to-drive evaluation than previous studies that used stringent eligibility criteria [8,25,26], there are some limitations inherent to this type of design, including a number of missing data. As the physicians were chosen by the patients, we had no information about the physician's knowledge, experience and attitudes towards fitness-to-drive assessments.…”

Driving Fitness in Different Forms of Dementia: An Update

“…Overall, on‐road performance was reported to be significantly decreased in VaD patients: about 70% fail an on‐road test in early disease stages, compared to 11% of healthy drivers. Severe driving difficulties are also reported for patients having experienced a single stroke …”

Is it safe to drive after acute mild stroke? A preliminary report

“…There is a need to identify the driving behaviors that are characteristic of various subpopulations of stroke, including various stages (e.g., acute, chronic), severities, and location of stroke. Devos and colleagues [23] aimed to address this by determining whether left and right hemispheric lesions differentially impact on-road driving performance. Although there was no difference in overall score of the on-road test for right and left lesions, results suggested that the lateralization of stroke might influence the aspects of driving that contribute most to the overall driving performance score [23].…”