Abstract
Cognitive impairment is a significant risk factor for hazardous driving among older drivers with Alzheimer’s dementia, but little is known about how the driving behavior of mildly symptomatic compares with those in the preclinical, asymptomatic phase of Alzheimer’s disease (AD). This study utilized two in-car technologies to characterize driving behavior in symptomatic and preclinical AD. The goals of this pilot study were to (1) describe unsafe driving behaviors in individuals with symptomatic early AD using G-force triggered video capture and (2) compare the driving habits of these symptomatic AD drivers to two groups of cognitively normal drivers, those with and those without evidence of cerebral amyloidosis (CN/A+ and CN/A−) using a global positioning system (GPS) datalogger. Thirty-three drivers (aged 60+ years) were studied over 3 months. G-force triggered video events captured instances of near-misses/collisions, traffic violations, risky driver conduct, and driving fundamentals. GPS data were sampled every 30 s and all instances of speeding, hard braking, and sudden acceleration were recorded. For the early AD participants, video capture identified driving unbelted, late response, driving too fast for conditions, traffic violations, poor judgment, and not scanning intersections as the most frequently occurring safety errors. When evaluating driving using the GPS datalogger, hard breaking events occurred most frequently on a per trip basis across all three groups. The CN/A+ group had the lowest event rate across all three event types with lower instances of speeding. Slower psychomotor speed (Trail Making Part A) was associated with fewer speeding events, more hard acceleration events, and more overall events. GPS tracked instances of speeding were correlated with total number of video-captured near-collisions/collisions and driving fundamentals. Results demonstrate the utility of electronic monitoring to identify potentially unsafe driving events in symptomatic and preclinical AD. Results suggest that drivers with preclinical AD may compensate for early, subtle cognitive changes by driving more slowly and cautiously than healthy older drivers or those with cognitive impairment. Self-regulatory changes in driving behavior appear to occur in the preclinical phase of AD, but safety concerns may not arise until symptoms of cognitive impairment emerge and the ability to self-monitor declines.
Highlights
Older drivers with cognitive impairment are at high risk for unsafe driving, carrying a relative crash risk of 2–5 times higher compared to matched controls (Marshall, 2008)
Summing across event types, driving events occurred in one in five trips taken by cognitively normal (CN)/A− or early Alzheimer’s disease (AD) drivers vs. one in eight trips taken by CN/A+
When only considering trips in which adverse driving events occurred, repeat events in the same trip were only common for speeding, with 0.9 more speeding events per trip on average in the CN/A− and early AD groups compared to the amyloid positive group (4.3 vs. 3.4 speeding events)
Summary
Older drivers with cognitive impairment are at high risk for unsafe driving, carrying a relative crash risk of 2–5 times higher compared to matched controls (Marshall, 2008). Individuals with AD are at increased risk for failing a road test with disease progression (Duchek et al, 2003; Ott et al, 2008), make more safety errors when driving in their own environment compared to cognitively normal older adults (Davis et al, 2012), and are at greater risk for crashes (Drachman and Swearer, 1993) Despite their increased risk, drivers with AD continue to drive during their disease course but may modify their behavior by reducing driving in complex situations (Festa et al, 2013; Molnar et al, 2013). This includes driving without passengers, during daytime hours, good weather, light traffic, and residential rather than commercial environments. Festa et al (2013) Despite behavioral modification, most drivers with AD eventually need to cease driving due to progressive cognitive and functional decline (Connors et al, 2018)
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