title: Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review.
abstract: 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.
authors.affiliation: Canadian Institutes of Health Research Institute of Aging CanDRIVE New Emerging Team, Elisabeth-Bruyère Research Institute, Ottawa, Canada. fmolnar@ottawahospital.on.ca
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Molnar
authors.forename: Akhilesh
authors.initials: A
authors.lastname: Patel
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Marshall
authors.forename: Malcolm
authors.initials: M
authors.lastname: Man-Son-Hing
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
mesh_terms: 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