Clinician assessment of the driving competence of patients with dementia.
OBJECTIVE
To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia.


METHODS
Observational study of a cross-section of drivers with mild dementia based on chart review by clinicians with varying types of expertise and experience.


METHODS
Outpatient dementia clinic.


METHODS
Fifty dementia subjects from a longitudinal study of driving and dementia.


METHODS
Each clinician reviewed information from the clinic charts and the first study visit. The clinician then rated the drivers as safe, marginal, or unsafe. A professional driving instructor compared these ratings with total driving scores on a standardized road test and categorical ratings of driving competence. Clinicians also completed a visual analog scale assessment of variables that led to their determinations of driving competence.


RESULTS
Accuracy of clinician ratings ranged from 62% to 78% for the instructor's global rating of safe versus marginal or unsafe. In general, there was moderate accuracy and interrater reliability. Accuracy could have been improved in the least-accurate raters by greater attention to dementia duration and severity ratings, as well as less reliance on the history and physical examination. The most accurate predictors were clinicians specially trained in dementia assessment, who were not necessarily the most experienced in their years of clinical experience.


CONCLUSIONS
Although a clinician may be able to identify many potentially hazardous drivers, accuracy is insufficient to suggest that a clinician's assessment alone is adequate to determine driving competence in those with mild dementia.
Ott
Brian R
BR
Department of Clinical Neurosciences, Brown University, Providence, Rhode Island, USA. Brian_Ott@mhri.org
Anthony
David
D
Papandonatos
George D
GD
D'Abreu
Anelyssa
A
Burock
Jeffrey
J
Curtin
Alicia
A
Wu
Chuang-Kuo
CK
Morris
John C
JC
D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology; D001334:Automobile Driving; D003704:Dementia / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D016743:Mental Competency; D010820:Physicians