Validity of the mini-mental state examination and the montreal cognitive assessment in the prediction of driving test outcome.

OBJECTIVES: To evaluate the effectiveness of two cognitive screening measures, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in predicting driving test outcome for individuals with and without cognitive impairment. DESIGN: Retrospective cohort study. SETTING: A clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: Adult drivers who underwent assessment with the MMSE and MoCA as part of a comprehensive driving evaluation between 2010 and 2014 (N=92). MEASUREMENTS: MMSE and MoCA total scores were independent variables. The outcome measure was performance on a standardized road test. RESULTS: A preestablished diagnosis of cognitive impairment enhanced the validity of cognitive screening measures in the identification of at-risk drivers. In individuals with cognitive impairment there was a significant relationship between MoCA score and on-road outcome. Specifically, an individual was 1.36 times as likely to fail the road test with each 1-point decrease in MoCA score. No such relationship was detected in those without a diagnosis of cognitive impairment. CONCLUSION: For individuals who have not been diagnosed with cognitive impairment, neither the MMSE nor the MoCA can be reliably used as an indicator of driving risk, but for individuals with a preestablished diagnosis of cognitive impairment, the MoCA is a useful tool in this regard. A score on the MoCA of 18 or less should raise concerns about driving safety.

The driving competence of 90-year-old drivers: from a hospital-based driving clinic.

OBJECTIVES: To compare the performance on a standardized driving evaluation of a group of oldest old adults (age 90-97) against younger old adults (age 80-87) and examine whether the same cognitive variables and brake reaction time performance were associated with pass-fail status on a road test in both groups. Secondary objectives focused on an examination of the specific driving errors of both groups. METHODS: This retrospective cohort study was conducted in the setting of a clinical driving evaluation program at an academic medical center in the United States. In this study we examined the performance of 88 participants (27 age 90-97 and 61 age 80-87) who completed comprehensive driving evaluations between 1997 and 2011. The outcome variable was performance on a standardized road test. Measures included the Trail Making Test (TMT), the Mini Mental State Examination (MMSE), and brake reaction time (BRT). An exploratory analysis of the possible predictive value of specific MMSE subtests was also performed. RESULTS: Results indicate that the oldest old adults (90-97 years old) were at no greater driving risk than were a younger old (80-87 years old) cohort and made similar types and frequency of driving errors. TMT-B time was associated with pass-fail status in both groups. MMSE attention items discriminated between safe and unsafe younger old drivers, and MMSE orientation items were associated with pass-fail status in the oldest old cohort. CONCLUSION: Drivers age 90 and above were at no greater driving risk than those one decade younger. MMSE orientation questions may be useful to assist in identifying which oldest old drivers could benefit from a comprehensive driving evaluation including an on-road test.

The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver.

OBJECTIVES: To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview-based screening tool for health providers working with older drivers) in identifying at-risk older drivers. DESIGN: Retrospective cohort study. SETTING: Clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009. MEASUREMENTS: Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini-Mental State Examination, and brake reaction time. The outcome variable was performance on a 45-minute road test. RESULTS: Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant (P<.001). The domains most strongly associated with road test outcome were cognitive function (P<.001) and family concerns (P=.01). Scores of 9 or greater-on the 4Cs identified 84% of participants who were at risk for poor road test performance. CONCLUSION: The 4Cs, an interview based screening tool, may be a useful marker to identify at-risk older drivers.

DriveWise: an interdisciplinary hospital-based driving assessment program.

Health care professionals working with the elderly have opportunities through research and clinical practice to shape public policy affecting the older driver. This article describes DriveWise, an interdisciplinary hospital-based driving assessment program developed in response to clinical concerns about the driving safety of individuals with medical conditions. DriveWise clinicians use evidence-based, functional assessments to determine driving competence. In addition, the program was designed to meet the emotional needs of individuals whose driving safety has been called into question. To date, approximately 380 participants have been assessed through DriveWise. The following report details the DriveWise mission, DriveWise team members, and road test results. We continue to refine the assessment process to promote safety and support the dignity and independence of all participants. The DriveWise interdisciplinary approach to practice is a concrete example of how gerontological education across professions can have direct benefits to the older adult.

The use of the Color Trails Test in the assessment of driver competence: preliminary report of a culture-fair instrument.

Studies have shown that the Trail Making Test (TMT) predicts real-world driving performance in individuals who have cognitive deficits. However, because this test requires knowledge of the Latin alphabet, the TMT may not be appropriate for individuals who are illiterate or for those whom English is not their primary language. Because the Color Trails Test (CTT) is not influenced by knowledge of the alphabet, the CTT may be a culture-fair alternative to the TMT. To date, the utility of the CTT in the evaluation of driver competence has not been established. In the current study, individuals referred for a comprehensive driving assessment underwent testing with the TMT and CTT. The results suggest that the CTT and the TMT provide similar information regarding road-test outcome. Thus, the CTT may be a culture-fair alternative to the TMT in the assessment of driver competence.