Older Drivers At Risk

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Early Alzheimer’s Disease Impairs Cognitive Flexibility While Driving     Progress in Evidence-Based Assessment and Training    October 2013

Older Drivers At Risk

Today, older drivers are keeping their licenses longer and are driving more miles than in the past. They crash less often than decades past, however, per mile travelled, fatal crash rates increase noticeably starting at age 70 and are the highest among drivers among drivers 85 and older. Following these data, scientists are now developing more sophisticated techniques to understand what kind of “cognitive” deterioration contributes to crash risk.  Over a decade of research shows that early onset Alzheimer’s in older adults is primarily characterized by memory deficits, but also by a variety of impairments in attention, judgment, reasoning and executive function. It is estimated that one third of drivers with dementia continue to drive after receiving the dementia diagnosis. Studies show that these drivers are at a greater risk of crashes compared to cognitively healthy drivers of the same age.

The Driving Task & Attention Shifting

Driving is an extremely complex task that relies on intact cognitive abilities ─ planning, organization, and most importantly, the ability to switch between cognitive tasks (flexibility).  Driving is dynamic, the scene changes rapidly, and a driver must shift attention from what is not relevant to what is relevant on a second-by-second basis. That is one reason why practical exercises on attention-shifting are integral to the AlertDriver course. Apparently, attention-shifting is compromised by early Alzheimer’s.

Simulator Assessment of Driving & Attention Shifting

Newly released research compared patients with early Alzheimer’s disease (10) with healthy age- and education-matched controls (29) on their performance on neuropsychological tests and in a driving simulator (Etienne et al. 2013). Both groups drove the simulator over an 11–14 km easy course (no intersections, interactions or curves) for 3 sessions. The first 2 driving sessions required a simple verbal response when signs of different shapes or colors appeared on one side of the road. In session 3, the drivers had to recognize different sign shapes and colors alternating on both sides of the road. In other words, attention shifting was required in session 3, but not in 1 or 2. Drivers regulated their own speed. The simulator recorded mean reaction time between the target’s appearance and the participant’s answer, the errors, and the mean vehicle speed.

Early Alzheimer’s Driving Impairment

The early Alzheimer’s participants were impaired in their cognitive flexibility. They reacted more slowly to the simple targets, and they made significantly more errors in session 3 requiring them to shift their attention to signs on both sides of the road. The groups did not differ on vehicle speed on the simple tasks (sessions 1, 2). However, the Alzheimer’s participants drove more slowly when required to do the more complicated task in session 3. They engaged in adaptive behavior (going slower) in order to get more time to process the signal information.

Cognitive Inflexibility On The Road

In the simulator and on the road, the inflexibility could present challenges in high-traffic conditions, when a driver faces a sharp increase in visual cues in the driving scene. In similar on-the-road studies, early Alzheimer’s patients made more critical driving errors, such as slowing and inappropriate braking. In addition, the proportion of multiple vehicle crashes at intersections increases markedly starting at age 70-74.

Evidence-Based Assessment & Training

Cognitive flexibility in the context of a driving simulation appears to be a “measurable” criterion for safe driving. Consistently, much of the AlertDriver curriculum focuses on more flexible scanning, hazard detection and anticipation skills that can be practiced on the road. Progress in both assessment and evidence-based training hold some potential to make the roads safer for older drivers.

Reference Etienne V, Marin-Lamellet C, Laurent B. (2013) Mental flexibility impairment in drivers with early Alzheimer's disease: A simulator-based study. IATSS Res. 2013; 37(1), 16-20.

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Alert driver’s motto is “Fine Tune Your Attention – Save Lives.” Alert Driver has been working in the North Carolina court system for a decade. We have proven effectiveness with drivers of all ages. An AlertDriver goal is to change normative attitudes about attentive driving, and it seems to be working. See our white papers at AlertDriver.com. Our material is relevant and timely; we post reflective chat on 12 safety-related questions DAILY, keeping the material fresh. The chat questions are used by some families and friends as the basis for ongoing safety discussions. Alert Driver is not typical driver education. It focuses on the causes of motor vehicle crashes and how to prevent them, not on rules and regulations. If you would like a free demonstration of our program, please provide your name and email address to devon@alertdriver.com or call 919 408-0745.