Five-year change scores in old age for six neuropsychological tests and normative data for the Useful Field of View (UFOV) test: The influence of physical health.

INTRODUCTION: Neuropsychological assessment of cognitive change over time is often conducted in clinical settings, but whether neuropsychological change scores are influenced by physical health has, as far as we know, not been examined previously. METHOD: In a sample of 153 older Swedish adults (age range, 72-86 years), we evaluated the influence of common age-related diseases, terminal decline pathology, age, education, and gender, to provide (a) preliminary test-specific regression weights and 90% confidence intervals to assess significant change in performance after five years on tests of visual scanning, mental shifting, visual spatial ability, memory, reaction time, and selective attention, and (b) normative data for the Useful Field of View test (UFOV) from a single testing occasion. RESULTS: Multiple regression analyses showed that test-retest changes were affected by physical health for mental shifting, visual spatial ability, memory, and reaction time, by age for mental shifting and visual reaction time, by education for visual spatial ability, and by Age × Education for auditory reaction time. Gender did not affect any of the change scores. The overall average of variance explained was 2.5%: up to 8.1% for physical health, 4.4% for age, and 3.6% for education. The UFOV scores were mostly influenced by age, but also by physical health and education. CONCLUSIONS: The findings indicate that considering the influence of health on normative change scores in old age in addition to demographic factors leads to more accurate predictions of whether true change has occurred.

Assessment and Reporting of Driving Fitness in Patients with Dementia in Clinical Practice: Data from SveDem, the Swedish Dementia Registry.

BACKGROUND: Driving constitutes a very important aspect of daily life and is dependent on cognitive functions such as attention, visuo-spatial skills and memory, which are often compromised in dementia. Therefore, the driving fitness of patients with dementia needs to be addressed by physicians and those that are deemed unfit should not be allowed to continue driving. OBJECTIVE: We aimed at investigating to what extent physicians assess driving fitness in dementia patients and determinant factors for revoking of their licenses. METHODS: This study includes 15113 patients with newly diagnosed dementia and driver's license registered in the Swedish Dementia Registry (SveDem). The main outcomes were reporting to the licensing authority and making an agreement about driving eligibility with the patients. RESULTS: Physicians had not taken any action in 16% of dementia patients, whereas 9% were reported to the authority to have their licenses revoked. Males (OR = 3.04), those with an MMSE score between 20-24 (OR = 1.35) and 10-19 (OR = 1.50), patients with frontotemporal (OR = 3.09) and vascular dementia (OR = 1.26) were more likely to be reported to the authority. CONCLUSION: For the majority of patients with dementia, driving fitness was assessed. Nevertheless, physicians did not address the issue in a sizeable proportion of dementia patients. Type of dementia, cognitive status, age, sex and burden of comorbidities are independent factors associated with the assessment of driving fitness in patients with dementia. Increased knowledge on how these factors relate to road safety may pave the way for more specific guidelines addressing the issue of driving in patients with dementia.

Health-adjusted neuropsychological test norms based on 463 older Swedish car drivers.

There is a need for improved normative information in particular for older persons. The present study provides neuropsychological test norms on seven cognitive tests used in a sample representing the general older driving population, when uncontrolled and controlled for physical health. A group of 463 healthy Swedish car drivers, aged 65 to 84 years, participated in a medical and neuropsychological examination. The latter included tests of visual scanning, mental shifting, visual spatial function, memory, reaction time, selective attention, and simultaneous capacity. Hierarchical regression analyses demonstrated that, when uncontrolled for health, old age was associated with significant impairment on all seven tests. Education was associated with a significant advantage for all tests except most reaction time subtests. Women outperformed men on selective attention. Controlling for health did not consistently change the associations with education, but generally weakened those with age, indicating rises in normative scores of up to 0.36 SD (residual). In terms of variance explained, impaired health predicted on average 2.5%, age 2.9%, education 2.1% and gender 0.1%. It was concluded (1) that individual regression-based predictions of expected values have the advantage of allowing control for the impact of health on normative scores in addition to the adjustment for various demographic and performance-related variables and (2) that health-adjusted norms have the potential to classify functional status more accurately, to the extent that these norms diverge from norms uncontrolled for physical health.

Older drivers: On-road and off-road test results.

Eighty-five volunteer drivers, 65-85 years old, without cognitive impairments impacting on their driving were examined, in order to investigate driving errors characteristic for older drivers. In addition, any relationships between cognitive off-road and on-road tests results, the latter being the gold standard, were identified. Performance measurements included Trail Making Test (TMT), Nordic Stroke Driver Screening Assessment (NorSDSA), Useful Field of View (UFOV), self-rating driving performance and the two on-road protocols P-Drive and ROA. Some of the older drivers displayed questionable driving behaviour. In total, 21% of the participants failed the on-road assessment. Some of the specific errors were more serious than others. The most common driving errors embraced speed; exceeding the speed limit or not controlling the speed. Correlations with the P-Drive protocol were established for NorSDSA total score (weak), UFOV subtest 2 (weak), and UFOV subtest 3 (moderate). Correlations with the ROA protocol were established for UFOV subtest 2 (weak) and UFOV subtest 3 (weak). P-Drive and self ratings correlated weakly, whereas no correlation between self ratings and the ROA protocol was found. The results suggest that specific problems or errors seen in an older person's driving can actually be "normal driving behaviours".

P-drive on-road: internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders.

The aim of this study was to determine internal scale validity and reliability of P-Drive on-road by observing driving performance among people with neurological disorders. The study comprised a consecutive sample of 205 persons with stroke, dementia, or mild cognitive impairment who were remitted for and performed a standardized test in real traffic. Their driving abilities were evaluated with a new assessment tool, P-Drive on-road. Aspects of validity and reliability of the tool were analyzed using a Rasch rating scale model. The results indicated that the rating scale functioned as intended and a principal component analysis indicated that the items formed a unidimensional scale. Acceptable levels of person response validity were found and the scale was also able to distinguish between the abilities of the drivers with a person separation reliability of 0.90. The results indicate that P-Drive on-road is valid and reliable for producing a linear measure of driving ability in people with stroke, dementia and mild cognitive impairment, and has the potential to become a clinically useful assessment tool for on-road driving tests.

The Nordic stroke driver screening assessment as predictor for the outcome of an on-road test.

The use of the cognitive test battery Nordic Stroke Driver Screening Assessment (NorSDSA) has increased, sometimes as a stand-alone test to evaluate fitness to drive, also for non-stroke patients such as patients suffering from cognitive deficits/dementia, approaches that may be questioned. The objective of the study was to determine whether the NorSDSA could predict an on-road test result, for large sets of stroke (n=74) and cognitive deficits/dementia participants (n=116), respectively. The percentage of correctly classified was 62% for the stroke group and 50% for the cognitive deficits/dementia group. A discriminant analysis with pass/fail on the on-road test as grouping variable could classify 62% of the stroke participants and the cognitive deficit/dementia participants. Hence, the NorSDSA could not predict the outcome of the on-road test. Therefore, NorSDSA should not be used as a stand-alone test to determine the fitness to drive of individual participants. Also, its use with participants suffering from cognitive deficits/dementia appears to be less successful than for clients with stroke.

Lived experience of driving ability following stroke.

PURPOSE: This study describes and expands our understanding of the lived-experience of driving ability after stroke in the context of being under a driving evaluation. METHOD: Four men with stroke were interviewed on three occasions. The interviews were open-ended, taped and transcribed verbatim, and analysed using Karlsson's Empirical, Phenomenological and Psychological method. FINDINGS: The findings revealed five main characteristics expressed in the participants' lived experiences: (1) the meaning of driving remained throughout life; (2) being questioned and advised not to drive--an untenable situation; (3) being out of control and violated by the driving evaluation; (4) driving safely (as usual) during the on-road test; and (5) perceiving consequences in everyday living. CONCLUSION: The findings indicate that driving is important and taken for granted even after stroke. To lose the ability to drive was unexpected and aroused strong feelings and reactions. The present study contributes to a deeper understanding of how people with stroke experience their driving ability and the evaluation process, which can be integrated in clinical procedures to help improve information, emotional support and clinical procedures.

A Swedish survey of occupational therapists' involvement and performance in driving assessments.

The purpose of this study was to examine the extent to which occupational therapists (OTs) are involved in driving assessments in Sweden and how these assessments are performed. A questionnaire was sent to 154 geriatric, rehabilitation, and neurological clinics, and additionally directly to 19 OTs who had purchased a test battery specifically used for driving assessments. The response rate was 60%. Of those responding, 57% reported being involved in fitness-to-drive assessments. However, such assessments were carried out in various manners and diverse methods were used, ranging from unstandardized activity assessments to a test developed specifically for driving assessments. Only 19% used on-road driving tests as a complement to the clinical assessments. Apart from the lack of appropriate methods, the respondents said that they did not have sufficient knowledge to perform driving assessments and expressed a need for further education. In the future it seems necessary for OTs in Sweden to undergo specialized training and perform the assessments on a regular basis to maintain a high level of competence as driving assessors.