Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review.
OBJECTIVE
To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia.


METHODS
A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles.


METHODS
English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included.


METHODS
Two reviewers.


METHODS
The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating.


RESULTS
Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores.


CONCLUSIONS
Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies.
Molnar
Frank J
FJ
Canadian Institutes of Health Research Institute of Aging CanDRIVE New Emerging Team, Elisabeth-Bruyère Research Institute, Ottawa, Canada. fmolnar@ottawahospital.on.ca
Patel
Akhilesh
A
Marshall
Shawn C
SC
Man-Son-Hing
Malcolm
M
Wilson
Keith G
KG
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D001334:Automobile Driving / Q000592:standards*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis*; D006801:Humans; D009483:Neuropsychological Tests; D009819:Office Visits; D011594:Psychometrics