The trail making test as a screening instrument for driving performance in older drivers; a translational research

Abstract

BackgroundIn many countries, primary care physicians determine whether or not older drivers are fit to drive. Little, however, is known regarding the effects of cognitive decline on driving performance and the means to detect it. This study explores to what extent the trail making test (TMT) can provide indications to clinicians about their older patients’ on-road driving performance in the context of cognitive decline.MethodsThis translational study was nested within a cohort study and an exploratory psychophysics study. The target population of interest was constituted of older drivers in the absence of important cognitive or physical disorders. We therefore recruited and tested 404 home-dwelling drivers, aged 70 years or more and in possession of valid drivers’ licenses, who volunteered to participate in a driving refresher course. Forty-five drivers also agreed to undergo further testing at our lab. On-road driving performance was evaluated by instructors during a 45 minute validated open-road circuit. Drivers were classified as either being excellent, good, moderate, or poor depending on their score on a standardized evaluation of on-road driving performance.ResultsThe area under the receiver operator curve for detecting poorly performing drivers was 0.668 (CI95% 0.558 to 0.778) for the TMT-A, and 0.662 (CI95% 0.542 to 0.783) for the TMT-B. TMT was related to contrast sensitivity, motion direction, orientation discrimination, working memory, verbal fluency, and literacy. Older patients with a TMT-A ≥ 54 seconds or a TMT-B ≥ 150 seconds have a threefold (CI95% 1.3 to 7.0) increased risk of performing poorly during the on-road evaluation. TMT had a sensitivity of 63.6%, a specificity of 64.9%, a positive predictive value of 9.5%, and a negative predictive value of 96.9%.ConclusionIn screening settings, the TMT would have clinicians uselessly consider driving cessation in nine drivers out of ten. Given the important negative impact this could have on older drivers, this study confirms the TMT not to be specific enough for clinicians to justify driving cessation without complementary investigations on driving behaviors.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-123) contains supplementary material, which is available to authorized users.

Differential Contributions of Selective Attention and Sensory Integration to Driving Performance in Healthy Aging and Alzheimer’s Disease

“…First, the association in healthy elderly between visual search and driving was found only with the standardized but not the naturalistic driving assessment. The relationship between search and standardized road test performance is consistent with previous studies indicating significant relationships between attentional functioning and driving in structured assessment environments (Carr, Barco, Wallendorf, Snellgrove, & Ott, 2011; Dobbs & Shergill, 2013; Papandonatos et al, 2015; Vaucher et al, 2014). Naturalistic driving has been explored much less often in the literature, perhaps because older drivers tend to compensate for their cognitive and visual diminutions by limiting their driving to familiar streets, avoiding complex driving situations (e.g., high traffic), and reducing night driving (Baldock, Mathias, McLean, & Berndt, 2006; Carr, Duchek, & Morris, 2000; Festa et al, 2013; Lesikar, Gallo, Rebok, & Keyl, 2002; Ott et al, 2008).…”

Effects of ketamine on psychomotor, sensory and cognitive functions relevant for driving ability

“…Trailmaking B, a task commonly used to evaluate executive functions in various clinical situations, is a well-studied predictor of unsafe driving [139][140][141] and participant performance is significantly altered by ketamine administration. Moreover, the Wisconsin Card Sorting Test, [143][144][145].…”

Associations of Near-Miss Traffic Incidents with Attention and Executive Function among Older Japanese Drivers

“…However, this was not consistent with an association between TMT-A/-B scores and driving skills. The results of studies investigating the relationship between TMT-A and -B scores and driving outcomes suggested low-to-moderate correlations [12, 22, 23], while some of them showed no relationship [24, 25]. Thus, this association should be investigated further using prospective observation or intervention.…”

“…Attention and executive function may play an important role in ensuring safe driving as they involve paying attention to complex information and making an instantaneous judgment during driving. Particularly, attention and executive measures such as the Trail Making Test (TMT) may be useful to screen for driving impairment in older drivers [11, 12]. …”