The doctor's dilemma: The ageing driver and dementia

O’Neill, Desmond

doi:10.1002/gps.930070412

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…This point of view implies the necessity of individual assessment of driving competence in medically or cognitively impaired individuals. O'Neill (1992) agreed with Drachman stating that the most challenging finding of these reports was that a significant minority of patients with dementia are reported to show no deterioration in driving skills. These figures provide strong support for Drachman's assertion that dementia should not be an automatic indication for prevention of driving.…”

Section: Introductionsupporting

confidence: 80%

“…Furthermore, not all accidents are reported to the police or insurance authorities. Several authors have argued for the use of on-road driving tests to assess actual driving performance (e.g., Odenheimer et al, 1994;O'Neill, 1992). In terms of road safety, dangerous driving performance and the occurrence of near-crashes or traffic conflicts are important factors to evaluate.…”

Section: Introductionmentioning

confidence: 99%

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Fitness to drive in older drivers with cognitive impairment

Withaar

Brouwer

Zomeren³

2000

J Int Neuropsychol Soc

110

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This paper is a literature review on assessment of fitness to drive in older drivers with cognitive impairment. Early studies on dementia and driving generally failed to distinguish between safe and unsafe drivers on the basis of cognitive test performance. Predictive studies demonstrated that cognitively impaired persons as a group perform significantly worse than controls on both neuropsychological and driving measures. A high prevalence of cognitive impairment was found in groups of older drivers involved in traffic accidents and crashes. However, a large range in neuropsychological test scores has been found. Low to moderate correlations could be established between neuropsychological test results and on-road driving performance, making it difficult to discriminate between cognitively impaired subjects who are fit or unfit to drive. The review concludes with a discussion of methodological difficulties in the field of dementia and driving, including participant selection, the choice of neuropsychological tests, and the operationalization of driving performance. (JINS, 2000, 6, 480-490.)

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Section: Introductionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Fitness to drive in older drivers with cognitive impairment

Withaar

Brouwer

Zomeren³

2000

J Int Neuropsychol Soc

110

View full text Add to dashboard Cite

show abstract

“…The development of cutoff scores was examined, with only five of the 30 studies using some form of discrimination 16 57 No Rebok 1994 17 10 No Harvey 1995 18 13 No Trobe 1996-A 20 42 No Trobe 1996-B 20 118 No Shua-Haim 1996 21 41 No Fox 1997 22 19 No Bieliaukas 1998 23 35 65 Yes analysis to determine whether participants fell into safe or unsafe driver categories on the basis of performance on the cognitive measures. Of these, three studies provided predictive equations with cutoff scores.…”

Section: Associations Between Cognitive Test Scores and Driving Perfomentioning

confidence: 99%

Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review

Bennett

Chekaluk

Batchelor

2016

J American Geriatrics Society

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Evidence has shown that although all individuals with dementia will eventually need to stop driving, most can continue to drive safely early in the disease. Fitness to drive needs to be monitored, and the use of cognitive testing to determine driver safety has been suggested. This review is the first to examine cognitive test results pertaining only to individuals with dementia. The aim was to examine the relationship between cognitive tests and driving to determine whether a cognitive assessment can be implemented as a tool to examine driver safety. A systematic review of 28 studies investigating the relationship between cognitive functioning and driving in individuals with dementia was conducted. The results of this review demonstrated a lack of consistency in the findings, with some studies showing a relationship between cognitive testing and driving performance for individuals with dementia, whereas others did not. Results relating to individual cognitive tests and measures confined to a single cognitive domain were variable and not consistently associated with driving performance. Studies consistently found that composite batteries predicted driving performance. The findings from this review support the use of composite batteries comprising multiple individual tests from different cognitive domains in predicting driving performance for individuals with dementia. Scores on individual tests or tests of a single cognitive domain did not predict driver safety. The composite batteries that researchers have examined are not clinically usable because they lack the ability to discriminate sufficiently between safe and unsafe drivers. Researchers need to develop a reliable, valid composite battery that can correctly determine driver safety in individuals with dementia.

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“…In contrast, Drachman 6 has suggested that limitation of driving privileges should be based on demonstration of impaired driving competence rather than on clinical diagnosis such as AD. O'Neill 7 points out that studies such as Friedland et al 2 and Lucas‐Blaustein et al 5 show a substantial minority of patients with AD suffer no deterioration in driving skills, thus supporting Drachman's 6 view that a diagnosis of AD alone is not sufficient to preclude driving. Cessation of driving has been associated with lower Mini‐Mental Status Examination (MMSE) scores 4, 5, 8 ; however, the MMSE did not distinguish those AD patients who had crashes from those who had not 2, 3, 5 .…”

mentioning

confidence: 96%

Alzheimer's Disease and Driving: Prediction and Assessment of Driving Performance

Fox

Bowden

Bashford

et al. 1997

J American Geriatrics Society

155

107

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Inasmuch as all subjects except one were still driving and all wished to continue to drive, it is important to note that 63.2% of subjects failed the on-road evaluation. Conversely, 36.8% were judged safe to drive, suggesting that AD diagnosis alone may be insufficient criteria for cessation of driving. A standardized road test may be the only appropriate means of determining driving competence in people diagnosed with AD.

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The doctor's dilemma: The ageing driver and dementia

Cited by 10 publications

References 24 publications

Fitness to drive in older drivers with cognitive impairment

Fitness to drive in older drivers with cognitive impairment

Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review

Alzheimer's Disease and Driving: Prediction and Assessment of Driving Performance

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