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 Tests that look at many cognitive skills instead of just one may be
most helpful, however, according to researchers who reviewed
findings in this area.
People with dementia have up to eight times the odds of being in a
car accident compared with other seniors. But in the early stages of
the condition, people with a dementia diagnosis can often drive
safely, the study team writes in the Journal of The American
Geriatrics Society.
“Simply having a diagnosis of dementia does not mean that the
individual should have to give up their license, however due to the
progressive nature of the disease, they will eventually need to stop
driving,” lead author Joanne Bennett, a doctoral candidate at
Macquarie University in Sydney, Australia, told Reuters Health by
email.
“As a result, their driving will need to be constantly monitored and
reviewed by both loved ones and health professionals,” Bennett said.
Dementia is an incurable condition that can be caused by various
diseases, the most common being Alzheimer’s disease. Dementia
affects memory and other thinking skills and can impact motor
functions necessary for driving.
To determine how well cognitive tests predict driving ability,
Bennett and her colleagues analyzed data from 28 studies examining
cognitive tests and driving performance among people with dementia.
Half of the studies used on-road tests to determine driving ability.
Most of the rest relied on reports from caregivers.
The cognitive tests tended to focus on attention and concentration,
ability to see objects, memory, language and general mental status.
Some tests also looked at executive functioning, a measure of
reasoning and problem-solving.
Overall, the links between tests of a single cognitive function and
driving ability were inconsistent. The researchers found that single
cognitive tests predicted the driving ability of people with
dementia only 46 percent of the time.
People who performed badly on tests of mental status, executive
functioning and attention and concentration also did poorly on
driving tests just over half of the time.
The other cognitive skills were linked to safe driving less than
half of the time, with memory and language proving to be least
relevant to driving skills.
In contrast, in six studies researchers incorporated multiple tests
to measure a variety of cognitive skills. Such batteries of tests
consistently predicted whether or not a person was able to drive
safely.
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But only two of these studies offered cutoff scores that a doctor
might be able use to determine if a patient can safely drive, the
researchers note.
“As it stands, apart from on-road tests, which can be quite
expensive for the client, there is no consensus on an objective
assessment that can be used as an alternative,” Bennett said.
Her team is working to develop a collection of tests that could
assess the safety of drivers with dementia, she said.
“With an aging population, we will have an increasing number of
drivers who have cognitive impairment and dementia,” said Kaarin
Anstey, Director of the Center for Research on Ageing, Health and
Wellbeing in Australia.
“There are red flags that show when adults are unsafe to drive,”
Antsey, who was not involved in the study, said by email.
Eye impairments are common in dementia, and can result in people
being unable to read signs or see pedestrians, she noted.
“Lack of orientation (e.g. driving up the wrong side of the road or
inability to maintain lane position) are key indicators that driving
has deteriorated to a point when it is unsafe,” Antsey added.
Bennett said that forgetting how to locate familiar places, failing
to observe traffic signs, making slow or poor decisions in traffic
and driving at an inappropriate speed may also be important warning
signs.
“When monitoring driving performance, loved ones should be looking
for patterns of poor performance, and not basing their decisions on
‘one off’ events,” Bennett advised.
SOURCE: bit.ly/1Pui9gS Journal of the American Geriatric Society,
online June 2, 2016.
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