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Driving assessment for maintaining mobility and safety in drivers with dementia

  1. Alan J Martin1,*,
  2. Richard Marottoli2,
  3. Desmond O'Neill3

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 12 MAR 2013

DOI: 10.1002/14651858.CD006222.pub3

How to Cite

Martin AJ, Marottoli R, O'Neill D. Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD006222. DOI: 10.1002/14651858.CD006222.pub3.

Author Information

  1. 1

    Beaumont Hospital, Department of Geriatric and Stroke Medicine, Dublin 9, Ireland

  2. 2

    Yale University, Division of Geriatrics, New Haven, USA

  3. 3

    Trinity College Dublin, Centre for Ageing, Neuroscience and the Humanities, Dublin, Ireland

*Alan J Martin, Department of Geriatric and Stroke Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 31 MAY 2013


This is not the most recent version of the article. View current version (29 AUG 2013)


References to studies excluded from this review

  1. References to studies excluded from this review
  2. Additional references
Adler 2008 {published data only}
Akinwuntan 2007 {published data only}
  • Akinwuntan AE, Devos H, Feys H, Verheyden G, Baten G, Kiekens C, et al. Confirmation of the accuracy of a short battery to predict fitness-to-drive of stroke survivors without severe deficits. Journal of Rehabilitation Medicine 2007;39(9):698-702.
Anderson 2005 {published data only}
  • Anderson SW, Rizzo M, Shi Q, Uc EY, Dawson JD. Cognitive Abilities Related to Driving Performance in a Simulator and Crashing on the Road. Proceedings of the Third International Driving Symposium on Human Factors in Driver Assessment, Training and Vehicle Design; 2005 Jun 27-30; Rockport (ME). 2005.
Anstey 2009 {published data only}
  • Anstey KJ, Wood J, Caldwell H, Kerr G, Lord SR. Comparison of self-reported crashes, state crash records and an on-road driving assessment in a population-based sample of drivers aged 69-95 years. Traffic Injury Prevention 2009;10(1):84-90.
ANZSGM 2010 {published data only}
  • Australian and New Zealand Society for Geriatric Medicine. Australian and New Zealand Society for Geriatric Medicine position statement driving and dementia. Australas Journal of Ageing 2010;29(3):137-41.
Arai 2009 {published data only}
  • Arai Y, Arai A, Misuno Y. Automobile driving by dementia patients: a need for social support. Seishin Shinkeigaku Zasshi 2009;111(1):101-7.
Badenes 2007 {published data only}
  • Badenes Guia D, Casas Hernanz L, Aguilar Barbera M, Cejudo Bolivar JC. Assessment of dementia of car driving abilities in patients with mild cognitive impairment and dementia. Mapfre Medicina 2007;18(2):98-107. [MEDLINE: ISSN: 1130-5665]
Badenes-Guia 2008 {published data only}
  • Badenes Guia D, Casas Hernanz L, Cejudo Bolivar JC, Aguilar Barberà M. Evaluation of the capacity to drive in patients diagnosed of mild cognitive impairment and dementia. Neurologia 2008;23(9):575-82.
Ball 2006 {published data only}
Barrash 2010 {published data only}
  • Barrash J, Stillman A, Anderson SW, Uc EY, Dawson JD, Rizzo M. Prediction of driving ability with neuropsychological tests: demographic adjustments diminish accuracy. Journal of the International Neuropsychological Society 2010;16(4):679-86.
Berndt 2008 {published data only}
Breen 2007 {published data only}
Brown 2005 {published data only}
Bylsma 1990 {published data only}
Bylsma 1997 {published data only}
Carr 2000 {published data only}
Carr 2011 {published data only}
Clark 2005 {published data only}
  • Clark M, Hecker J, Cleland E, Field C, Berndt A, Crotty M, Snellgrove C. Dementia and Driving. Australian Transport Safety Bureau. CANBERRA ACT 2608, Australia, 2005.
Cooper 1993 {published data only}
Cotrell 1999 {published data only}
  • Cotrell V, Wild K. Longitudinal study of self-imposed driving restrictions and deficit awareness in patients with Alzheimers disease. Alzheimer Disease and Associated Disorders 1999;13(3):151-6.
Cox 1998 {published data only}
  • Cox DJ, Quillian WC, Thorndike FP, Kovatchev BP, Hanna B. Evaluating driving performance of outpatients with Alzheimer disease. Journal of the American Board of Family Practice 1998;11(4):264-71.
Cushman 1992 {published data only}
  • Cushman LA. The Impact of Cognitive Decline and Dementia on Driving in Older Adults. AAA Foundation for Traffic Safety. Washington DC: AAA Foundation for Traffic Safety, 1730 M Street, NW Suite 401 Washington DC, 20036, 1992.
Daiello 2010 {published data only}
  • Daiello LA, Ott BR, Festa EK, Friedman M, Miller LA, Heindel WC. Effects of cholinesterase inhibitors on visual attention in drivers with Alzheimer disease. Journal of Clinical Psychopharmacology 2010;30(3):245-51.
Dawson 2009 {published data only}
de Simone 2007 {published data only}
Devos 2007 {published data only}
Dobbs 1997 {published data only}
Drachman 1993 {published data only}
Dubinsky 1992 {published data only}
Duchek 2003 {published data only}
Ernst 2010 {published data only}
  • Ernst J, Krapp S, Schuster T, Förstl H, Kurz A, Diehl-Schmid J. Car driving ability of patients with fronto-temporal lobar degeneration and Alzheimer's disease. Nervenarzt 2010;81(1):79-85.
Fitten 1995 {published data only}
  • Fitten LJ, Perryman KM, Wilkinson CJ, Little RJ, Burns MM, Pachana N, et al. Alzheimer and vascular dementias and driving. A prospective road and laboratory study. JAMA 1995;273:1360–5.
Fox 1997 {published data only}
  • Fox GK, Bowden SC, Bashford GM, Smith DS. Alzheimer’s disease and driving: prediction and assessment of driving performance. Journal of the American Geriatrics Society 1997;45:949–53.
Friedland 1988 {published data only}
Frittelli 2009 {published data only}
Gilley 1991 {published data only}
  • Gilley DW, Wilson RS, Bennett DA, Stebbins GT, Bernard BA, Whalen ME, et al. Cessation of driving and unsafe motor vehicle operation by dementia patients. Archives of Internal Medicine 1991;151(5):941-6.
Grace 2005 {published data only}
  • Grace J, Amick MM, D'Abreu A, Festa EK, Heindel WC, Ott BR. Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease. Journal of the International Neuropsychological Society 2005;11(6):766-75.
Hunt 1993 {published data only}
  • Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type. Journal of the American Geriatrics Society 1993;41:747–52.
Hunt 1997 {published data only}
  • Hunt LA, Murphy CF, Carr D, Duchek JM, Buckles V, Morris JC. Reliability of the Washington University Road Test. A performance-based assessment for drivers with dementia of the Alzheimer type. Archives of Neurology 1997;54:707–12.
Hunt 2010 {published data only}
  • Hunt LA, Brown AE, Gilman IP. Drivers with dementia and outcomes of becoming lost while driving. American Journal of Occupational Therapy 2010;64(2):225-32.
Innes 2005 {published data only}
  • Innes CR, Jones RD, Dalrymple-Alford JC, Hayes S, Hollobon S, Severinsen J, et al. Sensory-motor and cognitive tests predict driving ability of persons with brain disorders. Journal of Neurological Science 2007;260(1-2):188-98.
  • Innes CRH, Jones R, Anderson T, Dalrymple-Alford J, Hayes S, Hollobon S, et al. Prediction of driving ability in persons with brain disorders using sensory-motor and cognitive tests. Conference Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2005; Vol. 5, issue 1:5439-5442.
Iverson 2010 {published data only}
  • Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M, Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: evaluation and management of driving risk in dementia. Neurology 2010;74(16):1316-24.
Johansson 1997 {published data only}
  • Johansson K, Lundberg C. The 1994 International Consensus Conference on Dementia and Driving: a brief report. Alzheimer Disease and Associated Disorders 1997;11:62-9.
Kamimura 2009 {published data only}
  • Kamimura N. Dementia and automobile driving. Seishin Shinkeigaku Zasshi. 2009;111(8):960-6.
Kawano 2009 {published data only}
  • Kawano N, Makino T, Suzuki Y, Umegaki H. Impact of driving cessation on daily transportation utility in elderly people with cognitive decline: a survey of patients in the memory clinic of  an urban university hospital. Nihon Ronen Igakkai Zasshi 2009;46(5):420-7.
Kay 2009 {published data only}
  • Kay LG, Bundy AC, Clemson LM. Predicting fitness to drive in people with cognitive impairments by using DriveSafe and DriveAware. Archives of Physical Medicine and Rehabilitation 2009;90(9):1514-22.
Lafont 2010 {published data only}
  • Lafont S, Marin-Lamellet C, Paire-Ficout L, Thomas-Anterion C, Laurent B, Fabrigoule C. The Wechsler Digit Symbol Substitution Test as the best indicator of the risk of impaired driving in Alzheimer disease and normal aging. Dementia and Geriatric Cognitive Disorders 2010;29(2):154-63.
Laks 1999 {published data only}
  • Laks J, Marinho VM, Rozenthal M, Engelhardt E. Driving, cognitive impairment, and dementia [Direçäo, comprometimento cognitivo e dem?]. Revista Brasiliera de Neurologia 1999;35(5):131-5.
Laks 2000 {published data only}
  • Laks J, Munk M, Pessanha MR, Pinto SP, Engelhardt E. Elderly and driving: evaluation in a nursing home [Idosos com habilitaçäo para dirigir veículos automotores: avaliaçäo em um lar abrigado]. Jornal Brasiliero de Psiquiatria 2000;49(10):399-404. [: ISSN: 0047-2085.]
Leproust 2008 {published data only}
  • Leproust S, Lagarde E, Salmi LR. Risks and advantages of detecting individuals unfit to drive: a Markov decision analysis. Journal of General Internal Medicine 2008;23(11):1796-803.
Lincoln 2006 {published data only}
Lincoln 2010 {published data only}
Love 2007 {published data only}
  • Love CM. Cognitive impairment and dangerous driving: a decision-making model for the psychologist to balance confidentiality with safety. Dissertation Abstracts International: Section B: The Sciences and Engineering 2007;68(3-B):1933. [: ISSN: 0419-4217.]
Lucas-Blaustein 1988 {published data only}
Lukas 2009 {published data only}
Man-Son-Hing 2007 {published data only}
Meuser 2006 {published data only}
  • Meuser TM, Carr DB, Berg-Weger M, Niewoehner P, Morris JC. Driving and dementia in older adults: implementation and evaluation of a continuing education project. Gerontologist 2006;46(5):680-7.
Meuser 2009 {published data only}
  • Meuser TM, Carr DB, Ulfarsson GF. Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri. Accident; Analysis and Prevention 2009;41(2):246-52.
Molnar 2006 {published data only}
Molnar 2007 {published data only}
  • Molnar FJ, Marshall SC, Man-Son-Hing M, Wilson KG, Byszewski AM, Stiell I. Acceptability and concurrent validity of measures to predict older driver involvement in motor vehicle crashes: An Emergency Department pilot case-control study. Accident; Analysis and Prevention 2007;39(5):1056-63.
Mosimann 2011 {published data only}
  • Mosimann UP, Bächli-Biétry J, Boll J, Bopp-Kistler I, Donati F, Kressig RW, et al. Consensus recommendations for the assessment of fitness to drive in cognitively  impaired patients. Praxis 2011;101(7):437.
Neitch 2011 {published data only}
  • Neitch SM, Madero G, Maynard S. Driving assessment results in patients with a diagnosis of Dementia. West Virginia Medical Journal 2011;107(3):54-8.
O'Connor 2010 {published data only}
  • O'Connor ML, Edwards JD, Wadley VG, Crowe M. Changes in mobility among older adults with psychometrically defined mild cognitive impairment. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 2010;65B(3):306-16.
Odenheimer 1994 {published data only}
  • Odenheimer GJ, Beaudet M, Jette AM, Albert MS, Grande L, Minaker KL. Performance-based evaluation of the elderly driver: safety, reliability and validity. Journal of Gerontology 1994;49(4):153-9.
Okonkwo 2009 {published data only}
Oswanski 2007 {published data only}
  • Oswanski MF, Sharma OP, Raj SS, Vassar LA, Woods KL, Sargent WM, et al. Evaluation of two assessment tools in predicting driving ability of senior drivers. American Journal of Physical Medicine and Rehabilitation 2007;86(3):190-9.
Ott 2005 {published data only}
Ott 2008 {published data only}
Parker 2000 {published data only}
Patomella 2010 {published data only}
  • Patomella AH, Tham K, Johansson K, Kottorp A. P-drive on-road: internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders. Scandinavian Journal of Occupational Therapy 2010;17(1):86-93.
Rapoport 2007 {published data only}
  • Rapoport MJ, Herrmann N, Molnar FJ, Man-Son-Hing M, Marshall SC, Shulman K, et al. Sharing the responsibility for assessing the risk of the driver with dementia. CMAJ 2007;177(6):599-601.
Rebok 1994 {published data only}
Reger 2004 {published data only}
  • Reger MA, Welsh RK, Watson GS, Cholerton B, Baker LD, Craft S. The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychology 2004;18(1):85-93.
Regtuijt 2007 {published data only}
  • Regtuijt EM, Kleinsman ACM, Slaets JPJ. Questioning the ability to drive in patients with cognitive disorders [Dutch]. Nederlands Tijdschrift Voor Geneeskunde 2007;151(36):1965-9. [: ISSN:0028-2162]
Rizzo 1997 {published data only}
Rizzo 2001 {published data only}
  • Rizzo M, McGehee DV, Dawson JD, Anderson SN. Simulated car crashes at intersections in drivers with Alzheimer disease. Alzheimer Disease and Associated Disorders 2001;15(1):10-20.
Ross 2009 {published data only}
Silva 2009 {published data only}
Singh 2007 {published data only}
Snellgrove 2000 {published data only}
  • Snellgrove CA. Cognitive screening for the safe driving competence of older people with mild cognitive impairment or early dementia, 2000. (accessed 2 April 2013).
Snyder 2009 {published data only}
  • Snyder KM, Ganzini L. Outcomes of Oregon's law mandating physician reporting of impaired drivers. Journal of Geriatric Psychiatry and Neurology 2009;22(3):161-5.
Soderstrom 2009 {published data only}
  • Soderstrom CA, Scottino MA, Joyce JJ, Burch C, Ho SM, Kerns TJ. Police referral of drivers to the Maryland Motor Vehicle Administration's Medical Advisory Board. Annals of Advances in Automotive Medicine 2009;53:105-16.
Staplin 2003 {published data only}
Staplin 2003a {published data only}
  • Staplin L, Lococo KH, Gish KW, Decina LE. Model driver screening and evaluation program final technical report: Vol. 2. Maryland Pilot Older Driver Study. (accessed 2 April 2013).
Stutts 1998 {published data only}
Szlyk 2002 {published data only}
  • Szlyk JP, Myers L, Zhang Y, Wetzel L, Shapiro R. Development and assessment of a neuropsychological battery to aid in predicting driving performance. Journal of Rehabilitation Research and Development 2002;39(4):483-96.
Taylor 2001 {published data only}
Trilling 2001 {published data only}
Trobe 1996 {published data only}
Tuokko 1995 {published data only}
  • Tuokko H, Tallman K, Beattie BL, Cooper P, Weir J. An examination of driving records in a dementia clinic. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 1995;50(3):S173-81.
Uc 2005 {published data only}
  • Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD. Driver landmark and traffic sign identification in early Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry 2005;76:764–8.
Uc 2006 {published data only}
Uc 2008 {published data only}
Vaux 2010 {published data only}
  • Vaux LM, Ni R, Rizzo M, Uc EY, Andersen GJ. Detection of imminent collisions by drivers with Alzheimer's disease and Parkinson's disease: a preliminary study. Accident; Analysis and Prevention 2010;42(3):852-8.
Wadley 2009 {published data only}
  • Wadley VG, Okonkwo O, Crowe M, Vance DE, Elgin JM, Ball KK, et al. Mild cognitive impairment and everyday function: an investigation of driving performance. Journal of Geriatric Psychiatry and Neurology 2009;22(2):87-94.
Wild 2003 {published data only}
  • Wild K, Cotrell V. Identifying driving impairment in Alzheimer disease: a comparison of self and observer reports versus driving evaluation. Alzheimer Disease and Associated Disorders 2003;17:27–34.
Withaar 2000 {published data only}
Woolf 2006 {published data only}
  • Woolf C, Heng K, Pan S, Layde MP, Zhu S. The elderly and motor vehicle crashes. Chinese Journal of Emergency Medicine 2006;15(1):6-12. [: ISSN: 1671-0282]
Zuin 2002 {published data only}

Additional references

  1. References to studies excluded from this review
  2. Additional references
Archer 2007
  • Archer HA, McFarlane F, Frost C, Cutler D, Fox NC, Rossor MN. Symptoms of memory loss as predictors of cognitive impairment: the use and reliability of memory ratings in a clinic population. Alzheimer Disease and Associated Disorders 2007;21(2):101-6.
de Raedt 2000
Dobbs 1998
Edwards 2003
  • Edwards CJ, Creaser JI, Caird JK, Lamsdale AM, Chisholm SL. Older and younger driver performance at complex intersections: implications for using perception-response time and driving simulation. Proceedings of the Second International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design, Park City, Utah. 2003:7-12.
Freeman 2006
Fuller 2005
George 2007
Giuliano 2003
  • Giuliano G, Hu H, Lee K. Travel Patterns in the Elderly: the Role of Land Usage. Los Angeles, CA: METRANS Transportation Center, 2003. [: METRANS project 00-8]
Hakamies-Blomqvist 1996
  • Hakamies-Blomqvist L, Johansson K, Lundberg C. Medical screening of older drivers as a traffic safety measure - a comparative Finnish-Swedish evaluation study. Journal of the American Geriatrics Society 1996;44(6):650-3.
Hakamies-Blomqvist 1998
Herrmann 2006
Langford 2004
  • Langford J, Fitzharris M, Newstead S, Koppel S. Some consequences of different older driver licensing procedures in Australia. Accident; Analysis and Prevention 2004;36(6):993-1001.
Lundberg 2003
Marottoli 1997
  • Marottoli RA, Mendes de Leon CF, Glass TA, Williams CS, Cooney LM Jr, Berkman LF, et al. Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly. Journal of the American Geriatrics Society 1997;45(2):202-6.
Marottoli 2000
  • Marottoli RA, de Leon CFM, Glass TA, Williams CS, Cooney LM Jr, Berkman LF. Consequences of driving cessation: decreased out-of-home activity levels. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences 2000;55(6):S334-40.
Martin 2005
  • Martin A, Balding L, O'Neill D. Are the media running elderly drivers off the road?. BMJ 2005;330:368.
Metz 2000
  • Metz DH. Mobility of older people and their quality of life. Transport Policy 2000;7(2):149-52.
Metz 2004
Michon 1985
  • Michon JA. A critical review of driver behaviour models: what do we know, what should we do?. In: Evans L, Schwing RC editor(s). Human Behaviour and Traffic Safety. New York: Plenum, 1985:487-525.
Morris 1994
Nouri 1992
  • Nouri FM, Lincoln NB. Validation of a cognitive assessment: predicting driving performance after stroke. Clinical Rehabilitation 1992;6:275–81.
Radford 2004
Ragland 2005
  • Ragland DR, Satariano WA, MacLeod KE. Driving cessation and increased depressive symptoms. Journals of Gerontology: Series A, Biological Sciences and Medical Science 2005;60A:399-403.
Ranney 1994
RevMan 2011
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Robinson 2004
  • Robinson D, O'Neill D. Ethics of driving assessment in dementia care, competence and communication. In: Rai GS editor(s). Medical Ethics and the Elderly. Oxford: Radcliffe Publications, 2004:103-12.
Rosenbloom 1993
  • Rosenbloom S. Transportation needs of the elderly population. Clinics in Geriatric Medicine 1993;9(2):297-310.
Rosenbloom 2003
  • Rosenbloom S, Ståhl A. Automobility among the elderly; the convergence of environmental, safety, mobility and community design issues. European Journal of Transport and Infrastructure Research 2003;2(3-4):197-214.
Satariano 2012
  • Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and aging: new directions for public health action. American Journal of Public Health 2012;102(8):1508-15.
Selander 2010
  • Selander H, Johansson K, Lundberg C, Falkmer T. The Nordic stroke driver screening assessment as predictor for the outcome of an on-road test. Scandinavian Journal of Occupational Therapy 2010;17(1):10-7.
Siren 2012
Spinney 2009
  • Spinney JEL, Scott DM, Newbold KB. Transport mobility benefits and quality of life: a time-use perspective of elderly Canadians. Transport Policy 2009;16(1):1-11.
Stalvey 1999
  • Stalvey BT, Owsley C, Sloane ME, Ball K. The Life Space Questionnaire: a measure of the extent of mobility of older adults. Journal of Applied Gerontology 1999;18:460.
Stutts 2003
Tant 2002
  • Tant MLM, Brouwer WH, Cornelissen FW, Kooijman AC. Driving and visuospatial performance in people with hemianopia. Neuropsychological Rehabilitation 2002;5:419-37.
Vernon 2002
  • Vernon DD, Diller EM, Cook LJ, Reading JC, Suruda AJ, Dean JM. Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996. Accident; Analysis and Prevention 2002;34(2):237-46.
Zanetti 1999
  • Zanetti O, Geroldi C, Frisoni GB, Bianchetti A, Trabucchi M. Contrasting results between caregiver's report and direct assessment of activities of daily living in patients affected by mild and very mild dementia: the contribution of the caregiver's personal characteristics. Journal of the American Geriatrics Society 1999;47(2):196-202.