The longitudinal impact of cognitive speed of processing training on driving mobility.

PURPOSE: To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers. DESIGN AND METHODS: Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period. RESULTS: Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving difficulty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving difficulty. IMPLICATIONS: Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults.

Do older drivers at-risk for crashes modify their driving over time?

Five-year driving habit trajectories among older adults (n = 645) at-risk for crashes were examined. Performance measures included Useful Field of View (UFOV). Motor-Free Visual Perception Test, Rapid Walk, and Foot Tap. Self-report measures included demographics and the Driving Habits Questionnaire. Longitudinal random-effects models revealed that drivers at-risk for subsequent crashes, based upon UFOV, regulated their driving more than the lower-risk participants. Restricted driving was present at baseline for the at-risk group and was observed in longitudinal trajectories that controlled for baseline differences. Results indicate that persons at-risk for subsequent crashes increasingly limit their driving over time. Despite this self-regulation, a larger sample of such older drivers was twice as likely to incur subsequent at-fault crashes. Results suggest that self-regulation among older drivers at-risk for crashes is an insufficient compensatory approach to eliminating increased crash risk. UFOV is a registered trademark of Visual Awareness, Inc.

What predicts changes in useful field of view test performance?

The Useful Field of View Test (UFOV) has been used as an examination of age-related changes in visual processing and cognition and as an indicator of everyday performance outcomes, particularly driving, for over 20 years. How UFOV performance changes with age and what may impact such changes have not previously been investigated longitudinally. Predictors of change in UFOV performance over a 5-year period among control group participants (N=690) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study were examined. Random effects models were estimated with 4-subtest-total UFOV as the outcome and with baseline age, education, gender, race, visual acuity, depressive symptoms, mental status, and self-rated health, as well as attrition, as predictors. UFOV performance generally followed a curvilinear pattern, improving and then declining over time. Only increased age was consistently related to greater declines in UFOV performance over time. UFOV and Digit Symbol Substitution subtest, a standard measure of cognitive speed, had similar trajectories of change. The implications of these results are discussed.

Predictors of falling in older Maryland drivers: a structural-equation model.

Falls can impair health and reduce quality of life among older adults. Although many factors are related to falling, few analyses examine causal models of this behavior. In this study, factors associated with falling were explored simultaneously using structural-equation modeling. A variety of cognitive, physical-performance, and health measures were administered to 694 older adult drivers from the state of Maryland. The observed and latent variables of age, cognitive ability, physical functioning, health, and falling behavior were used to create a causal model. The model revealed that being older was associated with declines in cognition, and such cognitive declines predicted increased falling. Similarly, poorer health was related to poorer physical functioning, which, in turn, also predicted increased falling. This model indicates that in addition to existing fall-prevention interventions aimed at improving physical functioning, interventions to improve cognition and health might also be effective. It is speculated that fear of falling, which often results in reduced mobility among older adults, might account for the lack of a direct relationship between age and falling. This hypothesis should be examined in further research.

The useful field of view test: normative data for older adults.

The Useful Field of View test (UFOV) is increasingly used in clinical and rehabilitation settings. To date there have been no normative data for adjusted performance comparisons across demographically-similar, elderly peers. This study examined demographic and cognitive influences on the UFOV in a sample of 2759 participants (65-94 years of age). Performance was found to differ by age and education. Regression analyses examined the relative contributions of age, education, mental status, vision, and health to UFOV performance. All of these factors were found to significantly contribute to UFOV performance, with age accounting for the most variance and education accounting for the least. Normative tables for the UFOV by age and education are provided. These norms will allow researchers and clinicians to compare UFOV performance with similar peers and may help in identifying elderly persons who would benefit from speed of processing training.

Development and evaluation of home-based speed-of-processing training for older adults.

OBJECTIVES: To develop technical parameters for a videotape-based speed-of-processing training protocol, to evaluate the feasibility of self-administration (experiment 1), and to evaluate the protocol's effectiveness (experiment 2). DESIGN: A feasibility study (experiment 1) and a pre-post, 4-arm, nonrandomized controlled trial (experiment 2). SETTING: University research center. PARTICIPANTS: A population-based sample (37 men, 47 women; age range, 65-94y) (experiment 1). A population-based sample (age > or =65y) with no prior exposure to the Useful Field of View assessment or speed-of-processing training, no dementia or life-limiting illness, a Mini-Mental State Examination score of greater than 24, corrected far visual acuity of greater than or equal to 20/40, contrast sensitivity of greater than or equal to 1.50 log(10), and deficient processing speed (experiment 2). For experiment 2, 8 of 189 eligible people declined to participate. The final sample for this experiment included 100 men and 81 women (age range, 65-91y). INTERVENTIONS: Eight to ten 1-hour cognitive training sessions. MAIN OUTCOME MEASURE: Posttraining gains in processing speed. RESULTS: Self-administration was feasible. Subjects who underwent home-based training improved their processing speed significantly more than either control group (F(3,146)=16.16, P<.001). Their gains were 74% as great as the gains of those who underwent trainer-facilitated speed-of-processing training. CONCLUSIONS: People can improve their processing speed at home using readily available technology. Future research should explore the relation of these improvements to driving performance.

Predictors of driving exposure and avoidance in a field study of older drivers from the state of Maryland.

Using structural equation modeling techniques, this study examines causal models of driving avoidance and exposure among older adults. Prior studies have revealed that past incidence of falls, Useful Field of View (UFOV) test performance, and Trails Making test performance are predictive of subsequent motor vehicle crash involvement [Owsley, C., Ball, K., McGwin Jr., G., Sloane, M.E., Roenker, D.L., White, M.F., Overley, E.T., 1998. Visual processing impairment and risk of motor vehicle crash among older adults. J. Am. Med. Assoc. 279 (14), 1083-1088; Sims, R.V., McGwin, G., Pulley, L., Roseman, J.M., 2001. Mobility impairments in crash-involved older drivers. J. Aging Health 13 (3), 430-438; Stutts, J.C., 1998. Do older drivers with visual nd cognitive impairments drive less? J. Am. Geriatr. Soc. 46, 854-861]. Data analyses used these indices, along with age, health, measures of physical functioning, and additional measures of cognitive functioning, to examine driving exposure and avoidance behaviors. A field sample of 4,234 drivers, 55 years of age and older, were recruited from the Maryland Motor Vehicles Administration after renewing their driver's licenses. A performance-based assessment, which included the Gross Impairment Screening battery and task 2 of the UFOV test, was completed by participants. A sub-sample of participants (n=815) were interviewed by telephone about their health and mobility 3-6 months following the initial assessment at a renewal center. In addition to age and gender, latent variables for health status, physical functioning, cognitive functioning, driving exposure, and driving avoidance were created. Direct and indirect causal paths were specified. Age, gender, health status, and cognitive functioning had direct effects on both driving exposure and driving avoidance; physical functioning did not have a direct effect on driving exposure or avoidance. The implications of these findings are discussed as they relate to designing interventions to promote mobility.

Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting?

OBJECTIVES: To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision (MVC) involvement in a cohort of older drivers. DESIGN: Prospective cohort study. SETTING: Motor Vehicle Administration (MVA) field sites in Maryland. PARTICIPANTS: Of the 4,173 older drivers invited to participate in the study, 2,114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1,910 individuals recruited through MVA field sites. MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOV) subtest 2; a Mobility Questionnaire; and MVC occurrence. RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 140 degrees visual field), age, sex, history of falls, and poorer cognitive performance, as measured using Trails B, MVPT, and UFOV subtest 2, were predictive of future at-fault MVC involvement. After adjusting for annual mileage, participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC, those who made four or more errors on the MVPT were 2.10 times as likely to crash, those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash, and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC. Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs. CONCLUSION: Performance-based cognitive measures are predictive of future at-fault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High-risk older drivers can be identified through brief, performance-based measures administered in a MVA setting.

The effects of physical activity and sedentary behavior on cognitive health in older adults.

Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.

Cumulative meta-analysis of the relationship between useful field of view and driving performance in older adults: current and future implications.

PURPOSE: Driving is a complex behavior that requires the utilization of a wide range of individual abilities. Identifying assessments that not only capture individual differences, but also are related to older adults' driving performance would be beneficial. This investigation examines the relationship between the Useful Field of View (UFOV) assessment and objective measures of retrospective or concurrent driving performance, including state-recorded accidents, on-road driving, and driving simulator performance. METHOD: The PubMed and PsycINFO databases were searched to retrieve eight studies that reported bivariate relationships between UFOV and these objective driving measures. Cumulative meta-analysis techniques were used to combine the effect sizes in an attempt to determine whether the strength of the relationship was stable across studies and to assess whether a sufficient number of studies have been conducted to validate the relationship between UFOV and driving performance. RESULTS: A within-group homogeneity of effect sizes test revealed that the samples could be thought of as being drawn from the same population, Q [7] = 11.29, p (one-tailed) = 0.13. Therefore, the effect sizes of eight studies were combined for the present cumulative meta-analysis. The weighted mean effect size across the studies revealed a large effect (Cohen's d = 0.945), with poorer UFOV performance associated with negative driving outcomes. This relationship was robust across multiple indices of driving performance and several research laboratories. CONCLUSIONS: This convergence of evidence across numerous studies using different methodologies confirms the importance of the UFOV assessment as a valid and reliable index of driving performance and safety. Recent prospective studies have confirmed a relationship between UFOV performance and future crashes, further supporting the use of this instrument as a potential screening measure for at-risk older drivers.

Reliability and validity of useful field of view test scores as administered by personal computer.

The Useful Field of View test (UFOV(1)) is a measure of processing speed that predicts driving performance and other functional abilities in older adults. In comparison to a number of other visual and cognitive measures, the UFOV measure has consistently been found to be the strongest predictor of motor vehicle crashes of older adults. This measure has valuable applications in that computerized, performance-based measures that are predictive of crashes in the elderly population can provide an objective criterion for determining the need for driver restriction or rehabilitation. Administration of the UFOV test has evolved from the standard version (administered via touch-screen with the Visual Attention Analyzer) to two briefer versions, which are administered on a personal desktop computer (PC) using either a touch screen or mouse response option. These new versions of the test are briefer and require less specialized equipment, making the test more portable and practical for use in clinical settings. This study examined the reliability and validity of the scores from these two new versions. Results indicate that test-retest reliabilities of the scores from the UFOV PC versions are high (r's= 0 .884 for mouse and 0.735 for touch), and performance on both PC versions correlates well with performance on the standard version (r's = 0.658 for mouse and 0.746 for touch). Furthermore, scores were highly correlated (r = 0.916) when participants used either a touch screen or a mouse to input responses. In conclusion, the reliability and validity coefficients are of sufficient magnitude to make the touch and mouse PC versions of the UFOV practical for use in clinical evaluations.

Sensory and cognitive factors influencing functional ability in older adults.

BACKGROUND: Age-related sensory and cognitive impairments have been related to functional performance in older adults. With regard to cognitive abilities, processing speed in particular may be strongly related to older adults' abilities to perform everyday tasks. Identifying and comparing cognitive correlates of functional performance is particularly important in order to design interventions to promote independence and prevent functional disability. OBJECTIVE: The present study examined the relative importance of cognitive (specifically, speeded and nonspeeded) and sensory factors in relation to older adults' functional abilities. Functional abilities included measures of mobility and performance of everyday activities. METHODS: A cross-sectional study design was employed. Five hundred and thirty adults between the ages of 62 and 94 completed measures of sensory, cognitive (including processing speed, attention, memory, intelligence) and functional abilities. RESULTS: Overall, functional performance was most strongly associated with cognitive speed performance, but nonspeeded cognitive and sensory abilities also accounted for significant amounts of variance in functional performance. Age explained a small but statistically significant amount of additional variance in some functional abilities, but no additional variance in self-reported mobility measures. CONCLUSION: These findings point to the potential impact of multifaceted training programs, targeting both sensory and cognitive abilities for maintaining functional abilities.

Speed-of-processing and driving simulator training result in improved driving performance.

Useful field of view, a measure of processing speed and spatial attention, can be improved with training. We evaluated the effects of this improvement on older adults' driving performance. Elderly adults participated in a speed-of-processing training program (N = 48), a traditional driver training program performed in a driving simulator (N = 22), or a low-risk reference group (N = 25). Before training, immediately after training or an equivalent time delay, and after an 18-month delay each participant was evaluated in a driving simulator and completed a 14-mile (22.5-km) open-road driving evaluation. Speed-of-processing training, but not simulator training, improved a specific measure of useful field of view (UFOV), transferred to some simulator measures, and resulted in fewer dangerous maneuvers during the driving evaluation. The simulator-trained group improved on two driving performance measures: turning into the correct lane and proper signal use. Similar effects were not observed in the speed-of-processing training or low-risk reference groups. The persistence of these effects over an 18-month test interval was also evaluated. Actual or potential applications of this research include driver assessment and/or training programs and cognitive intervention programs for older adults.

Transfer of a speed of processing intervention to near and far cognitive functions.

BACKGROUND: Evidence establishing the potential for modification of cognitive functioning in later adulthood has begun to accumulate. OBJECTIVE: The primary goal of the current study was to evaluate, among older adults, the extent to which standardized speed of processing training transfers to similar and dissimilar speeded cognitive measures as well as to other domains of cognitive functioning. METHODS: Ninety-seven older adults (mean age 73.71 years) were administered a battery of cognitive tests assessing intelligence, memory, attention, verbal fluency, visual-perceptual ability, speed of processing, and functional abilities. Forty-four of the participants received ten 1-hour sessions of speed of processing training. The remainder of participants were in a no-contact control group. Approximately 6 weeks after the pretraining assessment, all participants repeated the same battery of tests. RESULTS: The results revealed training effects for some speed of processing measures, including performance of instrumental activities of daily living, but no transfer to other domains of cognitive functioning. CONCLUSION: Speed of processing training may enhance the speed at which older adults can perform instrumental activities of daily living.