title: Can a novel web-based computer test predict poor simulated driving performance? a pilot study with healthy and cognitive-impaired participants.
abstract: BACKGROUND
  Driving a car is a complex instrumental activity of daily living and driving performance is very sensitive to cognitive impairment. The assessment of driving-relevant cognition in older drivers is challenging and requires reliable and valid tests with good sensitivity and specificity to predict safe driving. Driving simulators can be used to test fitness to drive. Several studies have found strong correlation between driving simulator performance and on-the-road driving. However, access to driving simulators is restricted to specialists and simulators are too expensive, large, and complex to allow easy access to older drivers or physicians advising them. An easily accessible, Web-based, cognitive screening test could offer a solution to this problem. The World Wide Web allows easy dissemination of the test software and implementation of the scoring algorithm on a central server, allowing generation of a dynamically growing database with normative values and ensures that all users have access to the same up-to-date normative values.
  
  
  OBJECTIVE
  In this pilot study, we present the novel Web-based Bern Cognitive Screening Test (wBCST) and investigate whether it can predict poor simulated driving performance in healthy and cognitive-impaired participants.
  
  
  METHODS
  The wBCST performance and simulated driving performance have been analyzed in 26 healthy younger and 44 healthy older participants as well as in 10 older participants with cognitive impairment. Correlations between the two tests were calculated. Also, simulated driving performance was used to group the participants into good performers (n=70) and poor performers (n=10). A receiver-operating characteristic analysis was calculated to determine sensitivity and specificity of the wBCST in predicting simulated driving performance.
  
  
  RESULTS
  The mean wBCST score of the participants with poor simulated driving performance was reduced by 52%, compared to participants with good simulated driving performance (P<.001). The area under the receiver-operating characteristic curve was 0.80 with a 95% confidence interval 0.68-0.92.
  
  
  CONCLUSIONS
  When selecting a 75% test score as the cutoff, the novel test has 83% sensitivity, 70% specificity, and 81% efficiency, which are good values for a screening test. Overall, in this pilot study, the novel Web-based computer test appears to be a promising tool for supporting clinicians in fitness-to-drive assessments of older drivers. The Web-based distribution and scoring on a central computer will facilitate further evaluation of the novel test setup. We expect that in the near future, Web-based computer tests will become a valid and reliable tool for clinicians, for example, when assessing fitness to drive in older drivers.
authors.affiliation: Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Nef
authors.forename: René M
authors.initials: RM
authors.lastname: Müri
authors.forename: Rahel
authors.initials: R
authors.lastname: Bieri
authors.forename: Michael
authors.initials: M
authors.lastname: Jäger
authors.forename: Nora
authors.initials: N
authors.lastname: Bethencourt
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tarnanas
authors.forename: Urs P
authors.initials: UP
authors.lastname: Mosimann
mesh_terms: D000328:Adult; D001334:Automobile Driving; D016022:Case-Control Studies; D003198:Computer Simulation; D006801:Humans; D020407:Internet; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
keywords: Web-based cognitive test; cognitive impairment; computer-based tests; driving simulation