Driving practice effects for older drivers with mild cognitive impairment: A preliminary study.

BACKGROUND: Older drivers with mild cognitive impairment (MCI) often show declining driving performance. Evidence is lacking regarding whether their driving skills can be improved after practice. AIMS/OBJECTIVES: To compare the practice effects of older drivers with MCI and drivers with normal cognition in an unfamiliar, standardized driving course with three practices. MATERIALS AND METHODS: Single-blind two-group observational design. Twelve drivers with confirmed MCI as the experimental group and ten with normal cognition (NC) as the control, all ≥ 55 years old. The primary outcome was to assess the practice effects, measured with an in-car global-positioning-system mobile application to compare the speed and directional control of a complex manoeuvre after practices. Secondary outcomes were to assess the pass/fail rate and mistakes observed for the 3rd/final on-road driving practice. No instructions were given during practice. Descriptive statistics and the Mann-Whitney U test were used for data analysis. RESULTS: No significant inter-group difference in the pass/fail rate and number of mistakes. Some MCI drivers performed better in the speed and directional control of the S-Bend manoeuvre after practices. CONCLUSIONS: The driving performance of drivers with MCI may improve with practice. SIGNIFICANCE: Older drivers with MCI may potentially benefit from driver retraining. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT04648735).

High-Ecological Cognitive Intervention to Improve Cognitive Skills and Cognitive-Functional Performance for Older Adults With Mild Cognitive Impairment.

IMPORTANCE: Evidence of the effectiveness of cognitive activity and preparatory tasks in improving the cognitive skills and functional performance of people with cognitive decline is limited. OBJECTIVE: To examine the efficacy of a high-ecological cognitive intervention. DESIGN: Quasi-experimental, pretest-posttest design with nonequivalent control. SETTING: Community. PARTICIPANTS: Older adults with mild cognitive impairment from two senior centers. INTERVENTION: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention using simulated everyday cognitive tasks (experimental group) and of nutrition education (active control group). Outcomes and Measures: Cognitive skills were measured with the Color Trails Test (CTT), the Contextual Memory Test (CMT; Immediate Recall [CMT-Im] and Delayed Recall [CMT-De] tasks), and the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span subtest (Digits Forward and Digits Backward). Cognitive-functional performance was measured with the Rivermead Behavioural Memory Test-Third Edition (RBMT-3; Immediate Recall [RBMT-3-Im] and Delayed Recall [RBMT-3-De] tasks) and the Cognitive Failures Questionnaire (CFQ). RESULTS: Thirty-seven participants (M age = 70.84 yr; 70.3% women) met the inclusion criteria for analysis (20 participants in the intervention group, 17 participants in the control group). Multivariate linear regression showed that the intervention group improved significantly more than the control group on the CTT, CMT-Im, and RBMT-3-Im but not on the CMT-De, RBMT-3-De, and CFQ. CONCLUSIONS AND RELEVANCE: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention improved attention, executive function, immediate memory, and objective cognitive-functional performance with immediate-memory task demands. What This Article Adds: Carefully designed and structured simulated everyday cognitive tasks can be used as a cognitive training agent to improve both cognitive skills and objective cognitive-functional performance. The effectiveness of group-based cognitive interventions depends on the skills of occupational therapy practitioners in activity analysis and grading.