title: Assessing executive function in relation to fitness to drive: a review of tools and their ability to predict safe driving.
abstract: OBJECTIVE
  The assessment of executive functions is an integral component in determining fitness to drive. A structured review was conducted to identify assessment tools used to measure executive function in relation to driving and to describe these tools according to: (i) specific executive function components assessed; (ii) the tool's validity in predicting safe driving; and (iii) clinical utility.
  
  
  METHODS
  Sixty-nine articles were reviewed, identifying 53 executive function tools/assessments used in driving research. Each tool was critically appraised and the findings were compiled in a Driving Executive Function Tool Guide.
  
  
  RESULTS
  Among the 53 tools, there were 27 general assessments of cognition, 19 driving-specific and seven activities of daily living/instrumental activities of daily living assessments. No single tool measured all executive function components: working memory was the most common (n = 20/53). Several tools demonstrated strong predictive validity and clinical utility. For example, tools, such as the Trail Making Test and the Maze Task, have the shortest administration time (i.e. often less than 10 minutes) and the most easily accessible method of administration (i.e. pen and paper or verbal). Driving-specific tools range from short questionnaires, such as the 10-minute Manchester Driving Behaviour Questionnaire, to more complex tools requiring about 45 minutes to administer. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY: The appropriateness of a tool depends on the individual being assessed and on practical constraints of the clinical context. The Driving Executive Function Tool Guide provides useful information that should facilitate decision-making and selection of appropriate executive function tools in relation to driving.
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Asimakopulos
authors.forename: Zachary
authors.initials: Z
authors.lastname: Boychuck
authors.forename: Diana
authors.initials: D
authors.lastname: Sondergaard
authors.forename: Valérie
authors.initials: V
authors.lastname: Poulin
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ménard
authors.forename: Nicol
authors.initials: N
authors.lastname: Korner-Bitensky
mesh_terms: D000367:Age Factors; D001334:Automobile Driving; D003657:Decision Making; D004185:Disability Evaluation; D056344:Executive Function; D006801:Humans; D009788:Occupational Therapy / Q000379:methods*; D015203:Reproducibility of Results