title: How effective is the Trail Making Test (Parts A and B) in identifying cognitively impaired drivers?
abstract: BACKGROUND
  the medical community plays an important role in identifying drivers who may no longer be competent to drive due to illnesses such as dementia. Several office-based cognitive screening tools are currently used by the medical community, e.g. Mini-Mental State Examination, Trail Making Test (TMT), to assist in the identification of cognitively impaired (CI) at-risk drivers. However, the predictive validity of these tools is questionable.
  
  
  OBJECTIVE
  to examine the predictive power of the TMT for on-road driving performance.
  
  
  METHODS
  data from a prospective sample of CI and healthy older drivers were collected. TMT-A and -B (time and errors) served as predictor variables, with pass/fail on a scientifically based on-road assessment used as the criterion variable. Receiver operating characteristic (ROC) curve analysis was used to assess overall 'diagnostic' accuracy of TMT-A and -B for driving competency. Cut points from previous studies/guidelines were used to assess predictive power.
  
  
  RESULTS
  a total of 134 older drivers (mean age = 75.30; SD = 7.83) participated: 87 healthy controls and 47 CI individuals. All predictor variables, with the exception of TMT-A errors, were significantly correlated with driving outcome. However, results from ROC curve analyses indicated that only TMT-A and -B total time had moderate discriminative abilities. Results also indicate that the power of the TMT is the lowest where physicians need it most (e.g. identifying CI patients whose driving skills have declined to an unsafe level).
  
  
  CONCLUSIONS
  TMT-A and -B outcomes are most likely to be inaccurate in those whose driving competency has declined to an unsafe level, resulting in risks to both individual and public safety.
authors.affiliation: Family Medicine, University of Alberta, 205 8215 112 Street, Edmonton, Alberta, Canada T6G 2C8. bdobbs@ualberta.ca
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Dobbs
authors.forename: Simran S
authors.initials: SS
authors.lastname: Shergill
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001333:Automobile Driver Examination; D001334:Automobile Driving / Q000523:psychology*; D016022:Case-Control Studies; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D009048:Motor Skills; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013647:Task Performance and Analysis; D013997:Time Factors; D014145:Trail Making Test
keywords: automobile driving; dementia; mild cognitive impairment; older people; primary health care; screening tools