Alzheimer's disease and driving: prediction and assessment of driving performance.
OBJECTIVE
To examine driving competence in a group of drivers diagnosed with probable Alzheimer's Disease (AD) in terms of a standardized open road evaluation and expert judgments. To examine the validity of a standardized medical examination, including administration of the Mini-Mental Status Exam (MMSE), and a standardized neuropsychological assessment as predictors of open road driving performance.


METHODS
A prospective investigation with consecutively referred subjects.


METHODS
Coorabel Driver Assessment Centre, Royal Rehabilitation Centre Sydney, Australia.


METHODS
Nineteen subjects with a diagnosis of probable AD.


METHODS
A standardized clinical medical examination, a standardized neuropsychological assessment, and a standardized open road driving evaluation. The driving evaluation provided a correct driving actions score. The outcome measure was the expert judges' rating of overall driving competence, which was termed the final on-road result.


RESULTS
Seven subjects passed the on-road driving evaluation, and 12 failed. MMSE was found to be a significant predictor of final on-road result. The physician's prediction, the neuropsychology test scores, and the neuropsychologist's prediction were not found to be significantly associated with the final on-road result. The on-road driving evaluation was a reliable test.


CONCLUSIONS
Inasmuch as all subjects except one were still driving and all wished to continue to drive, it is important to note that 63.2% of subjects failed the on-road evaluation. Conversely, 36.8% were judged safe to drive, suggesting that AD diagnosis alone may be insufficient criteria for cessation of driving. A standardized road test may be the only appropriate means of determining driving competence in people diagnosed with AD.
Fox
G K
GK
Rehabilitation Studies Unit, University of Sydney, Royal Rehabilitation Centre Sydney, Ryde, New South Wales, Australia.
Bowden
S C
SC
Bashford
G M
GM
Smith
D S
DS
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology* / Q000523:psychology; D001334:Automobile Driving; D005069:Evaluation Studies as Topic; D005544:Forecasting; D006801:Humans; D007600:Judgment; D008609:Mental Status Schedule; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010808:Physical Examination; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D015203:Reproducibility of Results