Driving and Alzheimer's disease: A neuropsychological screening battery for the elderly

ABSTRACT As life expectancy increases, there is a marked increase in the elderly population eager to continue driving. A large proportion of these elderly drive safely, however, patients with mild dementia are high-risk drivers. Objective: to identify the cognitive tests that best predict driving ability in subjects with mild dementia. Methods: 28 drivers with mild dementia and 28 healthy elderly subjects underwent an extensive cognitive assessment (NACC Uniform Data Set Neuropsychological Battery), completed an adapted On Road Driving Test (ORDT) and a Driving Simulator assessment. Results: drivers with mild dementia made more mistakes on the ORDT and had slower responses in the simulator tasks. Cognitive tests correlated strongly with on road and simulator driving performance. Age, the Digit Symbol Modalities Test and Boston Naming Test scores were the variables that best predicted performance on the ORDT and were included in a logistic regression model. Conclusion: the strong correlation between driving performance and performance on specific cognitive tests supports the importance of cognitive assessment as a useful tool for deciding whether patients with mild dementia can drive safely. The algorithm including these three variables could be used as a screening tool for the detection of unsafe driving in elderly subjects with cognitive decline.

摘要
随着人类预期寿命的延长，渴望继续驾驶的老年人口数量显著增长。其中绝大多数老年人能够安全驾驶，但轻度痴呆患者属于高风险驾驶人群。
研究目的：识别可最佳预测轻度痴呆患者驾驶能力的认知测试方法。
研究方法：招募28名轻度痴呆驾驶员与28名健康老年受试者，对其实施全面认知评估（采用国家阿尔茨海默病协调中心统一数据集神经心理成套测验，NACC Uniform Data Set Neuropsychological Battery），并完成改良版道路驾驶测试（On Road Driving Test, ORDT）与驾驶模拟器测评。
研究结果：轻度痴呆驾驶员在ORDT中出现的操作失误更多，且在模拟器任务中的反应速度更慢。认知测试成绩与道路驾驶及模拟器驾驶表现显著相关。年龄、数字符号模态测试（Digit Symbol Modalities Test）得分与波士顿命名测试（Boston Naming Test）得分是最佳预测ORDT表现的变量，上述变量被纳入逻辑回归模型。
研究结论：驾驶表现与特定认知测试成绩之间的强相关性，印证了认知评估可作为判断轻度痴呆患者能否安全驾驶的有效工具。包含上述三项变量的算法可作为筛查工具，用于识别存在认知衰退的老年受试者中的不安全驾驶行为。