Driving and Alzheimer's disease: A neuropsychological screening battery for the elderly

Crivelli, Lucía; Russo, María Julieta; Farez, Mauricio Franco; Bonetto, Mariana; Prado, Cecilia; Calandri, Ismael Luis; Campos, Jorge; Cohen, Gabriela; Méndez, Patricio Chrem; Sabe, Liliana Raquel; Allegri, Ricardo Francisco

doi:10.1590/1980-57642018dn13-030008

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 13 (3) • Jul-Sep 2019 • https://doi.org/10.1590/1980-57642018dn13-030008 copy

Driving and Alzheimer's disease: A neuropsychological screening battery for the elderly

CONDUÇÃO E DOENÇA DE ALZHEIMER: UMA BATERIA DE TRIAGEM NEUROPSICOLÓGICA PARA IDOSOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

As life expectancy increases, there is a marked increase in the elderly population eager to continue driving. A large proportion of these elderly drive safely, however, patients with mild dementia are high-risk drivers.

Objective:

to identify the cognitive tests that best predict driving ability in subjects with mild dementia.

Methods:

28 drivers with mild dementia and 28 healthy elderly subjects underwent an extensive cognitive assessment (NACC Uniform Data Set Neuropsychological Battery), completed an adapted On Road Driving Test (ORDT) and a Driving Simulator assessment.

Results:

drivers with mild dementia made more mistakes on the ORDT and had slower responses in the simulator tasks. Cognitive tests correlated strongly with on road and simulator driving performance. Age, the Digit Symbol Modalities Test and Boston Naming Test scores were the variables that best predicted performance on the ORDT and were included in a logistic regression model.

Conclusion:

the strong correlation between driving performance and performance on specific cognitive tests supports the importance of cognitive assessment as a useful tool for deciding whether patients with mild dementia can drive safely. The algorithm including these three variables could be used as a screening tool for the detection of unsafe driving in elderly subjects with cognitive decline.

Key words:
automobile driving; cognition; Alzheimer's disease; dementia

		NC (n=28)	Patients (n=28)	p
Demographic variables	Age	73.7±4.9	76±4.7	ns
	Gender (F:M)	12:16	6:22	ns
	Education (years)	14.7±3.3	12.9±4.4	ns
Cognitive assessment	MMSE	29 (28-30)	26 (20-30)	<0.0001
	Clock Drawing Test (mean, range)	3 (2-3)	3 (1-3)	ns
	Logical Memory Immediate Recall	24.5±6.6	10.3±6.4	<0.0001
	Logical Memory Delayed Recall	19.4±7.3	4.17±6.6	<0.0001
	Logical Memory Recognition Trial	16.25±2.3	7.1±5.1	<0.0001
	Digit Span Forwards	6.14±1	5.64±0.9	ns
	Digit Span Backwards	4.3±1	3.7±0.7	<0.001
	Semantic Verbal Fluency (animals)	20.8±6.2	13±4.9	<0.0001
	Semantic Verbal Fluency (vegetable)	13.7±3.9	8.1±3.7	<0.0001
	Phonologic verbal Fluency	15.8±4.6	11.3±4.2	<0.001
	TMT-A	36 (24-94)	57.5 (26-123)	<0.001
	TMT-B	81.5 (52-193)	161 (44-335)	<0.0001
	DSMT	39.5±11.6	26.75±10.3	<0.0001
	BNT (mean, range)	28.5 (20-30)	24.5 (9-30)	<0.0001
	RAVLT (trials 1-5)	37.2±8.5	21.7±8.8	<0.0001
	RAVLT Delayed Recall	7.1±3.2	1±2.5	<0.0001
	RAVLT Recognition trial	11.4±2.3	6.75±5.1	0.0001
	RAVLT intrusions (mean, range)	1.5 (0-8)	2 (0-13)	ns
	RAVLT false positives	1 (0-4)	1.5 (0-14)	ns
	ROCFT Copy	33.6±3.2	31.2±3.9	<0.01
	ROCFT Delayed Recall	15.7±6.9	3.9±5	<0.0001
	FAB (0-18)	16.2±1.2	14.4±2.1	<0.001
	GDS	2.2±1.9	2.5±2.4	ns
	NPIQ	1.25±1.7	4.5±2.9	<0.0001
	FAQ	1.7±4.3	7.2±6	<0.001
	FDS	1 (0-12)	8.5 (1-18)	<0.0001
	AANDQ Patient	19.3±4.6	19.3±5.9	ns
	AANDQ Caregiver	21 (10-34)	25 (14-41)	ns

	NC (n=28)	Patients (n=28)	p
On Road Driving Test ^* * Values are expressed in percentage of correct answers.
1. Remains controlled in the transit lane.	96.3	60.7	<0.01
2. Correctly determines the circulation lane	81.5	46.4	<0.01
3. Recognizes the direction to turn	93	36	<0.0001
4. Signals properly	44.4	32.1	ns
5. Turning Speed.	89	68	ns
6. Recovery after turning.	92.6	67.9	<0.05
7. Positioning of the vehicle before and after turning.	96.3	67.9	<0.05
8. Signals adequately.	44.4	39.3	ns
9. Look through the mirrors.	100	89.3	ns
10. Turns head to look.	88.9	92.9	ns
11. Is able to accelerate gently	92.6	78.6	ns
12. Is able to adjust or modify the speed according to the transit or the condition of the route.	81.5	50	<0.05
13. Is able to maintain a constant speed.	92.6	67.9	<0.05
14. Is able to stop gently.	96.3	75	<0.05
15. It is capable of maintaining strong, consistent braking.	100	75	<0.05
16. Capable of curbing in appropriate place.	100	75	<0.05
17. Follows and respects the rules of the road.	88.9	35.7	<0.0001
18. Thinks and plans in advance before turning.	96.3	32.1	<0.0001
19. Responds appropriately to any dangerous situations.	96.3	64.3	<0.01
20. Show courtesy to interact with other drivers.	100	79	<0.05
21. Drives carefully.	100	50	<0.0001
22. Maintains enough space between his car and others.	100	85.7	ns
23. Adequately responds to transit control mechanisms.	92.3	48.1	0.001
24. Is able to park at 45º.	77.8	92.9	ns
25. Is able to parallel park.	51.9	35.7	ns
26. Is able to park at 90º.	63	42.9	ns
27. Responds correctly to verbal instructions.	100	35.7	<0.0001
28. Understands verbal instructions.	92.6	25	<0.0001
29. Is able to learn and obey new orders.	88.9	28.6	<0.0001
30. Can enter the vehicle without help.	100	92.9	ns
31. Can exit the vehicle without help.	100	92.9	Ns
Traffic Signal Recognition Task ^* * Values are expressed in percentage of correct answers.
No Entry	74.1	32	<0.01
No U-turn	100	78.6	<0.05
No overtaking	92.6	67.9	<0.05
First Aid Post	100	89.3	ns
Curve	100	100	ns
Narrow bridge	88.9	64.3	ns
No parking	96	85.7	ns
Crossroads	96.3	85.7	ns
Narrow road ahead	85.2	57	<0.05
Pedestrian Crossing	92.6	57.1	<0.01
Driving Assessment-Global Scores ^ Values are expressed as mean±standard deviation with the exception of the Traffic Signal Recognition Task score and the Simulator Traffic Signal reaction task score.
ORDT Score	28.9±4.7	18.5±7.1	<0.0001
Traffic Signal Recognition Task score (tot signals, correctly identified, median range)	10 (7-10)	7.5 (2-10)	<0.0001
Simulator Brake Reaction score (feet)	48.5±7	57.3±16.8	<0.01
Simulator Traffic Signal reaction task score (% correct responses)	83%	49%	<0.0001

	Driving assessment		Simulator tasks
	ORDT	Signal recognition	Brake reaction time task	Traffic signal reaction task
Age	0.05	n.s.	<0.05	n.s.
Gender (F:M)	n.s	n.s.	n.s.	n.s.
Education (years)	n.s	n.s.	n.s.	n.s.
MMSE	<0.05	<0.001	n.s.	<0.001
Clock Drawing Test (mean, range)	n.s.	<0.01	n.s.	<0.01
Logical Memory Immediate Recall	<0.001	<0.001	n.s.	<0.001
Logical Memory Delayed Recall	<0.001	<0.01	n.s.	<0.001
Logical Memory Recognition Trial	<0.01	<0.001	n.s.	<0.001
Digit Span Forwards	n.s.	n.s.	n.s.	n.s.
Digit Span Backwards	n.s.	n.s.	n.s.	<0.01
Semantic Verbal Fluency (animals)	<0.01	<0.01	<0.05	<0.001
Semantic Verbal Fluency (vegetable)	<0.001	<0.01	n.s.	<0.001
Phonologic verbal Fluency	n.s.	n.s.	n.s.	<0.01
TMT-A	<0.01	n.s.	<0.05	<0.001
TMT-B	<0.01	<0.05	<0.01	<0.001
DSMT	<0.01	<0.01	n.s.	<0.001
BNT	<0.01	<0.001	n.s.	<0.001
RAVLT (trials 1-5)	<0.001	<0.001	n.s.	<0.001
RAVLT Delayed Recall	<0.01	<0.001	n.s.	<0.001
RAVLT Recognition trial	n.s	<0.01	n.s.	<0.001
RAVLT intrusions	n.s	n.s.	n.s.	n.s.
RAVLT false positives	<0.01	n.s.	n.s.	n.s.
ROCFT Copy	<0.001	<0.001	n.s.	<0.001
ROCFT Delayed Recall	n.s	n.s.	n.s.	n.s.
FAB (0-18)	<0.05	<0.01	n.s.	<0.001
GDS	n.s	n.s.	n.s.	n.s.
NPIQ	<0.01	<0.01	n.s.	<0.05
FAQ	<0.01	<0.05	n.s.	<0.01
FDS	<0.001	<0.01	<0.05	<0.001
AANDQ Patient	n.s	n.s	n.s.	n.s.
AANDQ Caregiver	n.s	n.s	n.s.	n.s.

		Performance prediction
		Failed (<1.5)	Approved (≥1.5)
On Road Driving Test	Failed (<38/46)	8	3
On Road Driving Test	Approved (≥38/46)	3	14

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Lucía Crivelli. FLENI, Montañeses 2325 (C1428AQK) - Buenos Aires - Argentina. E-mail: lcrivelli@fleni.org.ar