Pilot study of a new road test to assess cognitive fitness to drive

Abstract

The Traffic Injury Research Foundation (TIRF) developed and evaluated a new road test, called the Enhanced Road Test (ERT), to assess a driver’s cognitive fitness to drive for the Ministry of Transportation in Ontario, Canada (MTO). The ERT was designed to flag individuals for potential cognitive impairment, but was not meant to indicate, or assess the level of impairment. Practical feasibility for implementation of the ERT was determined in a pilot study as well as its ability to differentiate drivers with and without cognitive impairment. The research design included both process and outcome evaluation components. The qualitative process evaluation was conducted using surveys administered to participant drivers (N = 70) and feedback obtained from driver examiners involved in the pilot (N = 3). The quantitative outcome evaluation used an experimental design to administer the ERT to a sample of drivers with (N = 42), and without (N = 28), mild cognitive impairment. Regression analysis was conducted and scoring functions of the ERT were compared through a Receiver Operating Characteristic (ROC) curve analysis.Survey results revealed that drivers did not raise specific concerns about the ERT and that examiners believed more training on driving behaviours associated with cognitive impairment and some scoresheet formatting changes would be beneficial. ROC Area Under the Curve (AUC) results revealed that some components of the ERT were better at identifying individuals whose driving skills declined. These components are the adjust-control, route finding and divided attention tasks. Two final scoring schemes for the ERT are proposed as well as several recommendations for its possible implementation.