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

Abstract

a b s t r a c tConsiderable research has shown that neuropsychological tests are predictive of real-world driving ability. The Mini-Mental State Examination (MMSE) is a brief cognitive test that has been commonly used in the assessment of older drivers. However, this test has inherent problems that limit its validity to evaluate cognitive abilities related to driving and to screen for driving impairments in non-demented people. Therefore, it is useful to test new screening instruments that may predict potential unsafe drivers who require an in-depth neuropsychological assessment in a specialised centre. To date, the utility of the Addenbrooke's Cognitive Examination Revised (ACE-R) as an indicator of driving ability has not been established. In the current study, fifty older drivers (mean age = 73.1 years) who were referred for a psychological assessment, the protocol of which included the ACE-R, underwent an on-road driving test. Using linear discriminant analyses, the results highlighted the higher classification accuracy of the ACE-R compared to the MMSE score, particularly for detecting unsafe drivers. Measures of visuospatial and executive functions, which are not incorporated in the MMSE score, had an incremental value in the prediction of driving ability. This emerging brief cognitive test may warrant additional study for use in the fitness to drive assessment of older adults.

Validation of the Chinese Version of Addenbrooke's Cognitive Examination-Revised for Screening Mild Alzheimer's Disease and Mild Cognitive Impairment

“…Addenbrooke's Cognitive Examination-Revised (ACE-R) is a brief cognitive test revised by Mioshi et al [9] in 2006, and, by contrast, recent series of studies recommended ACE-R as a superior tool for screening for early dementia and a-MCI in normal populations as well as for discriminating different types of dementias [10,11]. At present, ACE-R has been translated into many languages and has been validated in different clinical sites in the UK, Australia, Spain, Greece, Germany, Italy, Portugal, Japan, and Korea [5,12,13,14,15,16,17,18,19,20]. However, the psychometric properties of the Chinese version have not yet been examined.…”

Contributo da avaliação psicológica no exame clínico de condutores com doença neurológica e psiquiátrica: revisão teórica

“…Neste sentido, e com maior interesse e atualidade para a avaliação médica de condutores, o Addenbrooke's Cognitive Examination Revised 120,121 (ACE-R), igualmente um teste de rastreio cognitivo mais completo do que o MMSE (incorporando o pró-prio MMSE e tarefas de avaliação das funç ões executivas e visuo-espaciais), poderá corresponder a um potencial método de avaliação para identificação de condutores de risco. Os dados de investigação comprovam que o ACE-R apresenta uma eficiência classificatória superior na deteção de condutores inaptos na condução, e sugerem a utilidade deste indicador para fundamentar um pedido de referenciação para uma avaliação psicológica especializada 122 . Em consonância com estes resultados, é sugestivo que o Montreal Cognitive Assessment 123,124 (MoCA), um instrumento breve de avaliação cognitiva global que examina diferentes domínios, incluindo as funç ões executivas e capacidades visuo-espaciais, também possa constituir um teste com boas capacidades preditivas do desempenho de condução, mas são necessários estudos de validade que permitam suportar esta hipótese.…”

Cognitive basis about risk level classifications for the self-assessment of older drivers

“…Almost half of all drivers are older, and their accident rate has continued to increase2, 3 ) . Therefore, recently, elderly driving experts have committed to the screening of at-risk older drivers to prevent accidents4 ) .…”

“…In particular, cognitive functions have been reported as a key screening element in the elderly driver due to characteristics of the aging process7 ) . Therefore, cognitive assessment is used as a driving screening tool for older drivers4 ) . The commonly used cognitive tests include the Trail Making Test (TMT), Montreal Cognitive Assessment (MOCA), Useful Field of View (UFOV), Mini Mental State Examination (MMSE), and Clock Drawing Test (CDT)8,9,10 ) .…”