The utility of the Montreal Cognitive Assessment in predicting need for fitness to drive evaluations in older adults

Abstract

ObjectivesWith age, older adults (≥65 years) become increasingly vulnerable to cognitive disorders that may impair driving ability. Health practitioners are often tasked with screening older drivers and may recommend fitness to drive (FTD) evaluations for those potentially needing driving rehabilitation or cessation. Here, we examine whether the Montreal Cognitive Assessment (MoCA), which mainly tests cognitive ability, may identify older adults who might benefit from FTD testing. Methods/design264 older drivers (≥65 years), recruited from three primary care clinics, completed the MoCA and FTD evaluation. We compared literature-based MoCA cut-points (≥26 and < 26, respectively) and sensitivity analysis-determined MoCA cut-points to participant demographic and health characteristics as related to their ability to predict FTD score. ResultsMedian age was 73, 89% were White, and 54% were male. Most (83%) had abnormal (fail or conditional pass) FTD test outcomes. Overall, 57% had abnormal literature-based MoCA scores. For participants with abnormal MoCA scores (<26), increasing 4-m Gait Speed test scores (OR = 11.81) and age (OR = 1.05) increased odds of abnormal FTD test scores. For those with normal MoCA scores (26–30), self-reported excellent health status versus fair health decreased likelihood of abnormal FTD test scores (OR = 0.33) while being female increased likelihood (OR = 2.93). Sensitivity analysis determined a separate abnormal MoCA score cutoff (<28); 81% had abnormal MoCA scores and were more likely to have abnormal FTD scores with increasing age (OR = 1.07). Those with normal MoCA scores (28–30) experienced increased likelihood of abnormal FTD scores when female (OR = 4.97) and decreased likelihood when they were able to follow road signs (OR = 0.12). DiscussionMoCA may be valuable when identifying those who might benefit from FTD evaluations among those with both normal and abnormal cognitive function, especially when accounting for factors like gait speed, age, and gender. Future research should further explore these factors' roles in predicting abnormal FTD test outcomes.