title: Can we improve clinical prediction of at-risk older drivers?
abstract: OBJECTIVE
  To conduct a pilot study to evaluate the predictive value of the Montreal Cognitive Assessment test (MoCA) and a brief test of multiple object tracking (MOT) relative to other tests of cognition and attention in identifying at-risk older drivers, and to determine which combination of tests provided the best overall prediction.
  
  
  METHODS
  Forty-seven currently licensed drivers (58-95 years), primarily from a clinical driving evaluation program, participated. Their performance was measured on: (1) a screening test battery, comprising MoCA, MOT, Mini-Mental State Examination (MMSE), Trail-Making Test, visual acuity, contrast sensitivity, and Useful Field of View (UFOV) and (2) a standardized road test.
  
  
  RESULTS
  Eighteen participants were rated at-risk on the road test. UFOV subtest 2 was the best single predictor with an area under the curve (AUC) of .84. Neither MoCA nor MOT was a better predictor of the at-risk outcome than either MMSE or UFOV, respectively. The best four-test combination (MMSE, UFOV subtest 2, visual acuity and contrast sensitivity) was able to identify at-risk drivers with 95% specificity and 80% sensitivity (.91 AUC).
  
  
  CONCLUSIONS
  Although the best four-test combination was much better than a single test in identifying at-risk drivers, there is still much work to do in this field to establish test batteries that have both high sensitivity and specificity.
authors: Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. Electronic address: alex_bowers@meei.harvard.edu.
authors: Alex R
authors: AR
authors: Bowers
authors: R Julius
authors: RJ
authors: Anastasio
authors: Sarah S
authors: SS
authors: Sheldon
authors: Margaret G
authors: MG
authors: O'Connor
authors: Ann M
authors: AM
authors: Hollis
authors: Piers D
authors: PD
authors: Howe
authors: Todd S
authors: TS
authors: Horowitz
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D001333:Automobile Driver Examination; D001334:Automobile Driving / Q000706:statistics & numerical data*; D003071:Cognition; D015350:Contrast Sensitivity; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D014145:Trail Making Test; D014792:Visual Acuity; D058609:Visual Field Tests
keywords: Driving safety; Multiple object tracking; Visual attention
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