Assessment of Drivers with Alzheimer’s Disease in High Demand Driving Situations: Coping with Intersections in a Driving Simulator

Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer’s disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a comprehensive evaluation scheme to assess simulated driving performance at intersections. The evaluation scheme captured all types of errors that could occur during preparation (i.e., prior to the intersection), execution (i.e., during the intersection), and recovery (i.e., after the intersection). Using the evaluation scheme, intersection behaviour in a driving simulator among 17 drivers with mild AD was compared to that of 21 healthy controls. The results indicated that across all types of intersections, mild AD drivers exhibited a greater number of errors relative to controls. Drivers with mild AD made the most errors during the preparation period leading up to the intersection. These findings present a novel approach to analyzing intersection behaviour and contribute to the growing body of research on dementia and driving.

[1]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[2]  B. Reisberg,et al.  The Global Deterioration Scale for assessment of primary degenerative dementia. , 1982, The American journal of psychiatry.

[3]  M. Folstein,et al.  Population-based norms for the Mini-Mental State Examination by age and educational level. , 1993, JAMA.

[4]  J. Hodges,et al.  The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer’s disease: relationship to episodic and semantic memory impairment , 2000, Neuropsychologia.

[5]  M. Rizzo,et al.  Simulated Car Crashes at Intersections in Drivers With Alzheimer Disease , 2001, Alzheimer disease and associated disorders.

[6]  B. Freund,et al.  Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities. , 2002, The Gerontologist.

[7]  J. Enns,et al.  Paying attention behind the wheel: a framework for studying the role of attention in driving , 2004 .

[8]  David B. Hogan,et al.  Family Physicians’ Attitudes and Practices Regarding Assessments of Medical Fitness to Drive in Older Persons , 2007, Journal of General Internal Medicine.

[9]  Michel Bédard,et al.  Visual Attention and Older Drivers: The Contribution of Inhibition of Return to Safe Driving , 2006, Experimental aging research.

[10]  S. Marshall The Role of Reduced Fitness to Drive Due to Medical Impairments in Explaining Crashes Involving Older Drivers , 2008, Traffic injury prevention.

[11]  Michelle M. Porter,et al.  Predicting Driving Performance in Older Adults: We Are Not There Yet! , 2008, Traffic injury prevention.

[12]  Neville A. Stanton,et al.  Human error taxonomies applied to driving: A generic driver error taxonomy and its implications for intelligent transport systems , 2009 .

[13]  Bruce Weaver,et al.  Assessment of driving performance using a simulator protocol: validity and reproducibility. , 2010, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[14]  Arne Stinchcombe,et al.  Fluctuating Attentional Demand in a Simulated Driving Assessment: The Roles of Age and Driving Complexity , 2011, Traffic injury prevention.

[15]  Sherrilene Classen,et al.  MMSE as a predictor of on-road driving performance in community dwelling older drivers. , 2012, Accident; analysis and prevention.

[16]  Mark Vollrath,et al.  What does the driver look at? The influence of intersection characteristics on attention allocation and driving behavior. , 2012, Accident; analysis and prevention.

[17]  M M Porter,et al.  Development and evaluation of a driving observation schedule (DOS) to study everyday driving performance of older drivers. , 2013, Accident; analysis and prevention.

[18]  Shawn Marshall,et al.  It is premature to test older drivers with the SIMARD-MD. , 2013, Accident; analysis and prevention.

[19]  Lutz Jäncke,et al.  The drive-wise project: driving simulator training increases real driving performance in healthy older drivers , 2014, Front. Aging Neurosci..

[20]  H. Dawes,et al.  Utility of the MOCA as a cognitive predictor for fitness to drive , 2015, Journal of Neurology, Neurosurgery & Psychiatry.

[21]  Michel Bédard,et al.  Managing Safety and Mobility Needs of Older Drivers , 2015 .

[22]  D. O’Neill,et al.  Mobility and safety issues in drivers with dementia , 2015, International Psychogeriatrics.

[23]  Nazan Aksan,et al.  Cognitive functioning differentially predicts different dimensions of older drivers' on-road safety. , 2015, Accident; analysis and prevention.

[24]  S. Kreisel,et al.  Advice for Elderly Drivers in a German Memory Clinic: A Case Report on Medical, Ethical and Legal Consequences , 2016, Geriatrics.

[25]  A. Dickerson Chapter 11 – Driving and Community Mobility as an Instrumental Activity of Daily Living , 2016 .

[26]  S. Gagnon,et al.  Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease , 2016, American journal of Alzheimer's disease and other dementias.

[27]  B. Winblad,et al.  Assessment and Reporting of Driving Fitness in Patients with Dementia in Clinical Practice: Data from SveDem, the Swedish Dementia Registry , 2016, Journal of Alzheimer's disease : JAD.