Papers That Might Change Your Practice: Review Of The Introduction of a New Screening Tool for the Identification of Cognitively Impaired Medically At-Risk Drivers

2010 was the first year of publication for the peer-reviewed journal where the paper appeared. There is no Journal Citation Reports impact factor for the Journal of Primary Care & Community Health, and it is not indexed on MEDLINE. Both authors are on faculty at the University of Alberta and have previously published on this topic. Dr. Dobbs is well known for her work on driving. The paper starts by noting the importance of motor vehicle crashes (MVCs) and identifying those 65+ as high-risk drivers (when MVC rates are expressed per kilometer driven). The authors feel this is due to the high prevalence of medical conditions among older persons. Cognitive impairment is high-lighted as being particularly important. Most would agree that a diagnosis of mild cognitive impairment or dementia should not in itself be sufficient grounds to lose driving privileges,(2) but to date no brief cognitive test has shown sufficient sensitivity and specificity to justify its use as the sole determinant of driving safety. The authors conclude that there is a need for an instrument to screen for “cognitive impairment relevant to driving.” There are limitations to the literature review provided. It focuses solely on the use of cognitive instruments for the detection of concerns about driving. Information on the global severity (or functional impact) of cognitive impairment, the personality and behavior of the driver, his or her driving history (e.g., history of MVCs or citations), and whether concerns have been raised by the family should also be considered. Recent recommendations on the assessment of driving risk are not referenced—for example, the authors quote from the Canadian Medical Association 2000 guide on determining medical fitness to operate a motor vehicle but not the 2006 one.(2) While there is room for improvement, clinicians already have approaches to the assessment of driving risk among those with impaired cognition, and over time persons with a dementia do give up driving.(3) Research Question Stated goals of the study are “…to develop and validate a brief, scientifically based, easy-to-administer, easy-to-score, paper and pencil screening tool to be used in the primary care setting for the identification of individuals at risk for declines in driving competence due to cognitive impairment with or without dementia…[and] introduce dual cut-points to identify those who would very likely pass or fail a driving assessment, leaving those who fall between the cut-points to be referred for a driving assessment to determine competency.”