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• Drivers with preclinical Alzheimer disease drive more slowly compared to drivers without. • Road diets decrease speed variance between older drivers. • Attentional control partially mediates observed differences in driving speed. The driving populace of the United States is aging. The prevalence of Alzheimer disease (AD) will increase in the coming decades. Road diets (that is, the reallocation of one or more lanes of car traffic to other uses) have been proposed as a modification to increase pedestrian safety, particularly for older adults. In contrast, we considered the impacts of road diets on aging drivers, and on those with early pathological accumulation of AD. We observed naturalistic driving data for 60 cognitively normal older drivers (Age Range = 62–87 years, Median = 75 years) driving across three road segments located in the St. Louis metropolitan area, Missouri, United States. We used neuroimaging and lumbar puncture derived biomarker data to determine which of the drivers had preclinical AD. Since previous AD studies identified a variety of changes in driving behavior among older drivers with preclinical AD, we examined driving speed before and after lane repurposing. We found that drivers with preclinical AD drove at lower speeds compared to those without preclinical AD prior to road diet implementation. After lanes were repurposed, there was no statistical difference in the speed between older drivers with and without preclinical AD. We evaluated cognitive performance and found that attentional control had a mediating effect on driver speed, suggesting that an individual's ability to focus on a specific task and filter out distractions was associated with faster driving. Driving speed after lane repurposing is not mediated by attentional control, suggesting that road diets are impervious to individual driver capacity. We conclude that lane repurposing has potential as an important mobility infrastructure solution that could enhance older driver safety and facilitate aging in place. [ABSTRACT FROM AUTHOR]

Objectives To model the relative contributions of driver data and clinical judgments to clinical ratings of driver capability for a state licensing authority and to compare ratings with on-road test results. Design Retrospective, logistic regression. Setting Missouri Driver License Bureau. Participants Adults aged 60 and older (N = 652; 52% male) evaluated by a physician of their choosing and a portion subsequently road tested (n = 286). Measurements Clinical data from an evidence-based physician statement (Form 1528). A three-level rating (likely capable, unclear, not capable) was collapsed into two outcomes (0 likely capable; 1 unclear, not capable) as the dependent variable. Independent variables (predictors) were age, sex, driving exposure, recent crash or police action, number of medical conditions, medication side effects, driver insight, and disease functional severity rating for driving. Results Three variables in the model (Nagelkerke coefficient of determination = 0.64; P < .001) were significant in the expected direction: disease functional severity for driving (odds ratio (OR = 6.65), insight (OR = 2.35), and age (OR = 1.06). Proportionately more drivers rated likely capable (73%) passed the road test than those rated unclear or not capable (62%). Conclusion Judgments of disease severity, decrements in driver insight, and older age influenced clinician ratings of driving capability. Correspondence of physician ratings to on-road test outcomes was imperfect, highlighting the complexities in translation of clinical judgments to on-road performance. Both means of assessment have important and additive roles in driver licensing. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the clinical utility of the Trail-Making Tests (TMTs) as screens for impaired road-test performance. DESIGN: Secondary analyses of three data sets from previously published studies of impaired driving in older adults using comparable road test designs and outcome measures. SETTING: Two academic driving specialty clinics. PARTICIPANTS: Older drivers (N = 392; 303 with cognitive impairment, 89 controls) from Rhode Island and Missouri. MEASUREMENTS: Standard operating characteristics were evaluated for the TMT Part A (TMT-A) and Part B (TMT-B), as well as optimal upper and lower test cut-points that could be useful in defining groups of drivers with indeterminate likelihood of impaired driving who would most benefit from further screening or on-road testing. RESULTS: Discrimination remained high (>70%) when cut-points for the TMTs derived from Rhode Island data were applied to Missouri data, but calibration was poor (all P < .01). TMT-A provided the best utility for determining a range of scores (68-90 seconds) for which additional road testing would be indicated in general practice settings. A high frequency of cognitively impaired participants unable to perform the TMT-B test within the allotted time limited the utility of the test (>25%). Mere inability to complete the test in a reasonable time frame (e.g., TMT-A > 48 seconds or TMT-B > 108 seconds) may still be a useful tool in separating unsafe from safe or marginal drivers in such samples. CONCLUSION: The TMTs (particularly TMT-A) may be useful as screens for driving impairment in older drivers in general practice settings, where most people are still safe drivers, but more-precise screening measures need to be analyzed critically in a variety of clinical settings for testing cognitively impaired older drivers. [ABSTRACT FROM AUTHOR]

Objectives To differentiate driving errors in persons with dementia who fail a performance- based road test from errors in persons who pass. Design Cross-sectional. Setting Community. Participants Active drivers diagnosed with dementia (n = 60) and older adult controls (n = 32). Measurement All participants completed a standardized clinical and on-road driving assessment. The outcome variable was the number and types of driving errors according to the Record of Driving Errors ( RODE), a standardized tool to record driving errors. Results Sixty-two percent (n = 37) of individuals with dementia and 3% (n = 1) of controls failed the road test. Based on the RODE, individuals with dementia made twice as many driving errors as healthy controls. Within the dementia sample, individuals who failed the road test had more difficulties driving straight and making left and right turns than during lane changes. Dangerous actions occurred most often while driving straight and making left turns. Specific driving behaviors associated with road test failure in the sample with dementia included difficulties in lane positioning and usage, stopping the vehicle appropriately, attention, decision-making, and following rules of the road. Informants of participants with dementia who failed the road test reported more impairment with cognitive functioning on the Assessing Dementia 8 Screening Interview ( AD8). Conclusion This report highlights the driving errors most common in people with dementia who fail a road test. The finding that most of the dangerous actions in the sample with dementia occurred while driving straight condition is novel. Driving on straight roads has not been considered a condition of 'high challenge' in prior driving studies in individuals with dementia. This finding has potential implications for future interventions related to vehicle instrumentation and driving recommendations for people with dementia. [ABSTRACT FROM AUTHOR]

The Record of Driving Errors (RODE) is a novel standardized tool designed to quantitatively document the specific types of driving errors that occur during a standardized performance-based road test. The purpose of this study was to determine interrater reliability between two occupational therapy driver rehabilitation specialists who quantitatively scored specific driving errors using the RODE in a sample of older adults diagnosed with dementia (n = 24). Intraclass correlation coefficients of major driving error and intervention categories indicated almost perfect agreement between raters. Using raters with adequate training and similar professional backgrounds, it is possible to have good interraterreliability using the RODE on a standardizedroad test. [ABSTRACT FROM AUTHOR]

This study investigated reasons why older adults ( n = 689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer’s disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n = 187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness. [ABSTRACT FROM AUTHOR]

Objectives To develop a screening battery for office-based clinicians that would assist with the prediction of impaired driving performance and deciding who should proceed to road testing in a sample of adults with cognitive or visual deficits. Design Prospective observational study. Setting Driving evaluation clinic at a Veterans Affairs Medical Center ( VAMC) in St. Louis, Missouri. Participants Seventy-seven individuals aged 23 to 91 with diagnoses of cognitive or visual impairment or both referred to an occupational therapy based driving clinic by VAMC providers because of concerns regarding driving safety. Measurements Predictor variables included tests of visual and cognitive functioning and activities of daily living. The major outcome was pass or fail on a standardized performance-based on-road driving test. Results Thirty percent of the referrals failed the road test. The best predictors of driving performance were the Trail- Making Test Part A and the Mazes Test from the Neuropsychological Assessment Battery. Conclusion Measures of visual search, psychomotor speed, and executive functioning accurately predicted road test performance in a significant number of participants. These brief tests may assist clinicians in deciding who should proceed with a road test in a driver rehabilitation clinic or perhaps to whom it should be recommended to cease driving. [ABSTRACT FROM AUTHOR]

Objectives To develop a cognitive and functional screening battery for the on-road performance of older drivers with dementia. Design Prospective observational study. Setting On-road driving evaluation clinic at an academic rehabilitation center. Participants Ninety-nine older people with dementia (63% male, mean age 74.2 ± 9), referred by community physicians to an occupational therapy driving clinic. Measurements The outcome variable was pass or fail on the modified Washington University Road Test. Predictor measures were tests of visual, motor, and cognitive functioning, selected for their empirical or conceptual relationship to the complex task of driving safely. Results Sixty-five (65%) participants failed the on-road driving test. The best predictive model, with an overall accuracy of up to 85% when participants were blinded, included the Eight-item Informant Interview to Differentiate Aging and Dementia, Clock Drawing Test score, and time to complete the Snellgrove Maze Test or Trail Making Test Part A. Visual and motor functioning were not associated with road test failure. Conclusion A screening battery that could be performed in less than 10 minutes predicted with good accuracy failure rate for the on-road driving test in this sample of older drivers with dementia. A probability of failure calculator is provided from a logistic regression model that may be useful for clinicians in their decision to refer impaired older adults for further testing. More studies are needed in larger community-based samples, along with discussions with patients, families, and clinicians, with regard to acceptable levels of test uncertainty. [ABSTRACT FROM AUTHOR]

In this study, we examined confidence and face validity or client acceptability of tests used in a Veterans Affairs Medical Center driving clinic. The clinic used evidence-based off-road tests and adopted the Washington University Road Test (WURT) as a performance-based on-road examination. Forty-three clients consented to participate in the study; most were male with an average age of 78.2 years (standard deviation5 12.6). In general, a trend existed toward higher client acceptability of tests adopted from the Neuropsychological Assessment Battery (Stern & White, 2003) and the WURT than of other off-road measures. Confidence decreased after administration of the psychometric test battery, yet it increased after the on-road evaluations despite a 47% failure rate in the sample. Additional study is needed on test acceptability because it may have the potential to increase understanding, compliance, or both with driving recommendations. Additional research is also needed to examine client confidence levels and their potential impact on performance during the driving evaluation process. [ABSTRACT FROM AUTHOR]

The article discusses a study on whether deconditioned older adults referred from internal medicine units in the Rehabilitation Institute of Saint Louis acute center in Missouri benefited from inpatient rehabilitation services. The Functional Independence Measure (FIM) was used to assess the change in patients' functional status. It notes the presence of depression in majority of subjects. It found that an inpatient rehabilitation service demonstrated significant improvement in FIM scores.

Objective: Although returning to driving is a major concern for many survivors of stroke, predicting who will return to driving after a stroke is often difficult for rehabilitation professionals. The primary aim of this study was to identify patient factors present at admission to an inpatient rehabilitation hospital that can be used to identify which patients who have had acute stroke will and will not return to driving. Design: After comparing returners and nonreturners on demographic and clinical characteristics, a logistic regression model with return to driving as the outcome variable was built using the backward stepwise method. Results: Thirty-one percent (48/156) of the patients who had been driving before their stroke returned to driving 6 mos after stroke. The final regression model, using Functional Independence Measure cognition and lower extremity Motricity Index scores, predicted the driving outcome with an accuracy of 75% (107/143). Conclusions: Patients with lower Functional Independence Measure cognition and lower extremity Motricity Index scores at admission to inpatient rehabilitation are less likely to return to driving at 6 mos. This model could be used by rehabilitation professionals to help counsel patients and their families and focus treatment goals. [ABSTRACT FROM AUTHOR]