title: Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting.
abstract: OBJECTIVE
  To examine the sensitivity and specificity of the Assessment of Driving-Related Skills (ADReS), a clinical tool recommended by the American Medical Association for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition.
  
  
  METHODS
  Cross-sectional observation study.
  
  
  METHODS
  Memory assessment outpatient clinic of a university hospital.
  
  
  METHODS
  Drivers with normal cognition (n = 47) and cognitive impairment (n = 75).
  
  
  METHODS
  A neurologist completed the ADReS during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on-road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score.
  
  
  RESULTS
  In this sample of currently active older drivers with and without cognitive impairment, measures of cognition-particularly the Trail-Making Test Part B-were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADReS had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve (AUC) of 0.57. A logistic regression model that incorporated computerized maze task and Mini-Mental State Examination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80.
  
  
  CONCLUSIONS
  In its present form, the ADReS has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADReS are needed for general office practice.
authors.affiliation: Department of Neurology, Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, Rhode Island 02903, USA. BOtt@lifespan.org
authors.forename: Brian R
authors.initials: BR
authors.lastname: Ott
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Davis
authors.forename: George D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: Scott
authors.initials: S
authors.lastname: Hewitt
authors.forename: Elena K
authors.initials: EK
authors.lastname: Festa
authors.forename: William C
authors.initials: WC
authors.lastname: Heindel
authors.forename: Carol A
authors.initials: CA
authors.lastname: Snellgrove
authors.forename: David B
authors.initials: DB
authors.lastname: Carr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001333:Automobile Driver Examination; D001334:Automobile Driving / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012237:Rhode Island; D012680:Sensitivity and Specificity
keywords: ADReS; aging; assessment; cognition; driving