title: The mini-mental state examination, clinical factors, and motor vehicle crash risk.
abstract: OBJECTIVE
  To examine the association between Mini-Mental State Examination (MMSE) score and motor vehicle crash (MVC) risk in a large cohort of community-dwelling participants with cardiovascular disease (CVD) or diabetes mellitus.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Participants enrolled in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease clinical trial, which included individuals aged 55 and older with CVD or diabetes mellitus.
  
  
  METHODS
  Totally 17,538 frequent drivers (defined as driving at least once per week) who had completed a baseline MMSE.
  
  
  METHODS
  Involvement in a MVC as the driver.
  
  
  RESULTS
  Baseline MMSE score was divided into four categories: 30, 27-29, 24-26, and <24. The median MMSE score was 29 (interquartile range 27-30), and 726 (4.1%) has a MMSE score of less than 24 at baseline. After a mean follow-up of 4.5 years, 1,068 (6.1%) participants were drivers in a MVC. Lower scores were not associated with future MVCs (MMSE score 29-27, hazard ratio (HR)=1.06, 95% confidence interval (CI)=0.93-1.22); MMSE score 26-24, HR=0.96, 95% CI=0.78-1.19; MMSE score<24, HR=0.72, 95% CI=0.50-1.05) on multivariable analysis. A MVC within the previous 2 years (HR=2.68, 95% CI=2.29-3.13) was the strongest predictor of future MVCs. Other clinical factors associated with greater MVC risk were depression, falls within the previous year, sleep apnea, and lower baseline systolic blood pressure.
  
  
  CONCLUSIONS
  In a population of frequent drivers, the MMSE does not predict MVCs. Other clinical factors have a stronger association with MVC risk.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Joseph
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Donnell
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.forename: Jackie
authors.initials: J
authors.lastname: Bosch
authors.forename: Rasha
authors.initials: R
authors.lastname: Khatib
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001334:Automobile Driving; D001562:Benzimidazoles / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D003704:Dementia / Q000150:complications / Q000175:diagnosis*; D048909:Diabetes Complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017257:Ramipril / Q000627:therapeutic use; D012306:Risk; D000077333:Telmisartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D017257:Ramipril; D000077333:Telmisartan
keywords: cognitive function; motor vehicle crashes