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Pharmacopsychiatry 2017; 50(05): 203-210
DOI: 10.1055/s-0043-113571
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Executive Dysfunctions Predict Self-Restricted Driving Habits in Elderly People with or without Alzheimer’s Dementia

Ilsemarie Kurzthaler
1   Medical University of Innsbruck, Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Austria
,
Georg Kemmler
1   Medical University of Innsbruck, Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Austria
,
Michaela Defrancesco
1   Medical University of Innsbruck, Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Austria
,
Bernadette Moser
1   Medical University of Innsbruck, Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Austria
,
Wolfgang W. Fleischhacker
1   Medical University of Innsbruck, Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Austria
,
Elisabeth M. Weiss
2   Department of Psychology, Biological Psychology Unit, University of Graz, 8010 Graz, Austria
› Author Affiliations
Further Information

Publication History

received 01 February 2017
revised 03 June 2017

accepted 07 June 2017

Publication Date:
22 June 2017 (online)

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Abstract

Introduction The purpose of this study was to elucidate the impact of specific cognitive functions on self-restricted driving habits in healthy elderly drivers and patients suffering from mild cognitive impairment (MCI) and Alzheimer’s dementia (AD).

Method Our study population included 35 cognitively healthy controls, 10 MCI patients, and 16 patients with AD. All participants completed a neuropsychological examination and a self-reported questionnaire assessing driving habits and patterns.

Results In challenging driving conditions, patients with MCI or AD showed significantly more driving self-restriction than healthy subjects (effect size d=1.06, p=0.007). Ordinal regression analysis across the entire group revealed that deficits in executive functions and reaction had a higher impact on driving restriction (p=0.002) than deficits in memory functions (p=0.570). Additionally, our data showed that 40% of patients with mild to moderate AD still drive in challenging conditions.

Discussion Our results illustrate that elderly individuals use self-imposed driving restrictions as compensatory strategies. These restrictions increase with cognitive decline mainly in the field of executive functions, but they do not change once patients convert from MCI to AD.

Key words

driving - mild cognitive impairment - Alzheimer’s disease
 

  • References

  • 1 Dobbs BM. Aging baby boomers–a blessing or challenge for driver licensing authorities. Traffic Inj Prev 2008; 9: 379-386
    CrossrefPubMedGoogle Scholar
  • 2 Kamenoff I. Assessing elderly people to drive – practical considerations. Aust Fam Physician. 2008; 37: 727,729-732
    PubMedGoogle Scholar
  • 3 Rabitt P, Carmicheal A, Jones S. et al. When and why older drivers give up driving. Basingstoke: AA Foundation for Road Safety Research; 1996. Accessed at http://wwwroadsafetyfoundationorg/library-homepage/library-items/when-and-whyolder-drivers-give-up-drivingaspx
    Google Scholar
  • 4 Bartley M, O’Neill D. Transportation and driving in longitudinal studies on ageing. Age Ageing. 2010; 39: 631-636
    CrossrefPubMedGoogle Scholar
  • 5 O’Connor ML, Edwards JD, Waters MP. et al. Mediators of the association between driving cessation and mortality among older adults. J Aging Health. 2013; 25: 249S-269S
    CrossrefPubMedGoogle Scholar
  • 6 Taylor BD, Tripodes S. The effects of driving cessation on the elderly with dementia and their caregivers. Accid Anal Prev 2001; 33: 519-528
    CrossrefPubMedGoogle Scholar
  • 7 Marottoli RA, Mendes de Leon CF, Glass TA. et al. Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly. J Am Geriatr Soc. 1997; 45: 202-206
    CrossrefPubMedGoogle Scholar
  • 8 Lundqvist A, Alinder J, Alm H. et al. Neuropsychological aspects of driving after brain lesion: simulator study and on-road driving. Appl Neuropsychol. 1997; 4: 220-230
    CrossrefPubMedGoogle Scholar
  • 9 Stutts JC, Wilkins JW. On-road driving evaluations: a potential tool for helping older adults drive safely longer. J Safety Res. 2003; 34: 431-439
    CrossrefPubMedGoogle Scholar
  • 10 Anstey KJ, Wood J, Lord S. et al. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev. 2005; 25: 45-65
    CrossrefPubMedGoogle Scholar
  • 11 Galski T, Bruno RL, Ehle HT. Driving after cerebral damage: a model with implications for evaluation. Am J Occup Ther. 1992; 46: 324-332
    CrossrefPubMedGoogle Scholar
  • 12 Smither JW, Walker AG. Are the characteristics of narrative comments related to improvement in multirater feedback ratings over time?. J Appl Psychol 2004; 89: 575-581
    CrossrefPubMedGoogle Scholar
  • 13 Waller PF. The older driver. Hum Factors. 1991; 33: 499-505
    CrossrefPubMedGoogle Scholar
  • 14 O’Connor ML, Edwards JD, Small BJ. et al. Patterns of level and change in self-reported driving behaviors among older adults: who self-regulates?. J Gerontol B Psychol Sci Soc Sci 2012; 67: 437-446
    CrossrefPubMedGoogle Scholar
  • 15 Aksan N, Dawson JD, Emerson JL. et al. Naturalistic distraction and driving safety in older drivers. Hum Factors. 2013; 55: 841-853
    CrossrefPubMedGoogle Scholar
  • 16 Aksan N, Anderson SW, Dawson J. et al. Cognitive functioning differentially predicts different dimensions of older drivers’ on-road safety. Accid Anal Prev 2015; 75: 236-244
    CrossrefPubMedGoogle Scholar
  • 17 Talbot A, Bruce I, Cunningham CJ. et al. Driving cessation in patients attending a memory clinic. Age Ageing. 2005; 34: 363-368
    CrossrefPubMedGoogle Scholar
  • 18 Tuokko H, Tallman K, Beattie BL. et al. An examination of driving records in a dementia clinic. J Gerontol B Psychol Sci Soc Sci 1995; 50: S173-S181
    PubMedGoogle Scholar
  • 19 Eby DW, Molnar LJ. Cognitive impairment and driving safety. Accid Anal Prev 2012; 49: 261-262
    CrossrefPubMedGoogle Scholar
  • 20 Frittelli C, Borghetti D, Iudice G. et al. Effects of Alzheimer’s disease and mild cognitive impairment on driving ability: A controlled clinical study by simulated driving test. Int J Geriatr Psychiatry 2009; 24: 232-238
    CrossrefPubMedGoogle Scholar
  • 21 Petersen RC, Doody R, Kurz A. et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001; 58: 1985-1992
    CrossrefPubMedGoogle Scholar
  • 22 Petersen RC, Negash S. Mild cognitive impairment: An overview. CNS Spectr 2008; 13: 45-53
    PubMedGoogle Scholar
  • 23 Ganguli M, Snitz BE, Saxton JA. et al. Outcomes of mild cognitive impairment by definition: A population study. Arch Neurol. 2011; 68: 761-767
    PubMedGoogle Scholar
  • 24 McKhann G, Drachman D, Folstein M. et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939-944
    CrossrefPubMedGoogle Scholar
  • 25 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12: 189-198
    CrossrefPubMedGoogle Scholar
  • 26 Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry. 1984; 141: 1356-1364
    CrossrefPubMedGoogle Scholar
  • 27 Sunderland T, Hill JL, Mellow AM. et al. Clock drawing in Alzheimer’s disease. A novel measure of dementia severity. J Am Geriatr Soc. 1989; 37: 725-729
    CrossrefPubMedGoogle Scholar
  • 28 Reitan RM. Ward Halstead’s contributions to neuropsychology and the Halstead-Reitan Neuropsychological Test Battery. J Clin Psychol. 1994; 50: 47-70
    CrossrefPubMedGoogle Scholar
  • 29 Yesavage JA, Brink TL, Rose TL. et al. Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res. 1982; 17: 37-49
    CrossrefPubMedGoogle Scholar
  • 30 Gourlay T, Stefanou DC, Asimakopoulos G. et al. The effect of circuit surface area on CD11b(mac-1) expression in a rat recirculation model. Artif Organs. 2001; 25: 475-479
    CrossrefPubMedGoogle Scholar
  • 31 Johnson DK, Storandt M, Morris JC. et al. Cognitive profiles in dementia: Alzheimer disease vs healthy brain aging. Neurology 2008; 71: 1783-1789
    CrossrefPubMedGoogle Scholar
  • 32 Ala TA, Mattson MD, Frey 2nd WH. The clinical diagnosis of Alzheimer’s disease without the use of head imaging studies. A cliniconeuropathological study. J Alzheimers Dis. 2003; 5: 463-465
    PubMedGoogle Scholar
  • 33 Marie Dit Asse L, Fabrigoule C, Helmer C. et al. Automobile driving in older adults: factors affecting driving restriction in men and women. J Am Geriatr Soc. 2014; 62: 2071-2078
    CrossrefPubMedGoogle Scholar
  • 34 Naumann RB, Dellinger AM, Kresnow MJ. Driving self-restriction in high-risk conditions: How do older drivers compare to others?. J Safety Res 2011; 42: 67-71
    CrossrefPubMedGoogle Scholar
  • 35 Donorfio LK, D’Ambrosio LA, Coughlin JF. et al. Health, safety, self-regulation and the older driver: It’s not just a matter of age. J Safety Res. 2008; 39: 555-561
    CrossrefPubMedGoogle Scholar
  • 36 Seiler S, Schmidt H, Lechner A. et al. Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM). PLoS One 2012; 7: e52710
    CrossrefPubMedGoogle Scholar
  • 37 Stalvey BT, Owsley C. The development and efficacy of a theory-based educational curriculum to promote self-regulation among high-risk older drivers. Health Promot Pract 2003; 4: 109-119
    CrossrefPubMedGoogle Scholar
  • 38 Gosselin D, Gagnon S, Stinchcombe A. et al. Comparative optimism among drivers: an intergenerational portrait. Accid Anal Prev 2010; 42: 734-740
    CrossrefPubMedGoogle Scholar
  • 39 Lyketsos CG, Colenda CC, Beck C. et al. Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. Am J Geriatr Psychiatry 2006; 14: 561-572
    CrossrefPubMedGoogle Scholar
  • 40 Freund B, Szinovacz M. Effects of cognition on driving involvement among the oldest old: Variations by gender and alternative transportation opportunities. Gerontologist 2002; 42: 621-633
    CrossrefPubMedGoogle Scholar
  • 41 Hanson TR, Hildebrand ED. Are rural older drivers subject to low-mileage bias?. Accid Anal Prev 2011; 43: 1872-1877
    CrossrefPubMedGoogle Scholar