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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: 29 AUG 2013

Assessed as up-to-date: 12 MAR 2013

DOI: 10.1002/14651858.CD006222.pub4

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 8. Art. No.: CD006222. DOI: 10.1002/14651858.CD006222.pub4.

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: 29 AUG 2013


Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Adler 2008Non-RCT

Review article

Akinwuntan 2007Stroke cohort, no dementia cases

Anderson 2005Non-RCT

Case-control study, 222 participants (70 with mild AD, 152 controls) compared composite neuropsychological test scores and simulated driving performance with prospective crash rate

Anstey 2009Non-RCT

Only 2 people with probable dementia included


Position statement

Arai 2009Non-RCT

Badenes 2007Non-RCT

Case control study, 187 participants, (92 MCI, 55 mild dementia, 40 controls) recruited from hospital population, compared neuropsychological testing with ASDE-driver test (a Spanish office-based measure of fitness to drive measuring: estimations of speed, coordination, reaction time, attention and concentration)

Badenes-Guia 2008Non-RCT

92 MCI, 55 mild dementia, 40 controls, tested with RBANS, TMT, Kohs block design compared with ASDE-driver test and UFOV. No on-road test

Ball 2006Non-RCT

Population-based older driver cohort, no dementia measures included. 2114 older drivers compared initial assessment (measures of vision, gross and fine motor skills and cognitive testing) with 4-5 years' follow-up for motor vehicle accidents

Barrash 2010Non-RCT

Prospective study, self selected, advert respondents, 24 healthy, 26 probable AD, 33 PD. All active drivers with MMSE > 26. People with AD and PD recruited from registry, used neuropsychological tests and on-road, unable to blind assessors (PD). Differences on neuropsychological tests but not road test failure. Scores did correlate with number of driving errors but effect diminished by demographic adjustments

Berndt 2008Non-RCT

Road test results in 117 people with dementia stratified by CDR score. Higher road test failure rate in higher CDR score

Breen 2007Non-RCT

Review article

Brown 2005Non-RCT

Case-control study, 75 participants (50 with mild to moderate AD, 25 controls) correlated neuropsychological tests with rating of safe or unsafe in on-road testing

Bylsma 1990Duplicate of Rebok 1994

Bylsma 1997Non-RCT

Review article

Carr 2000Non-RCT

Retrospective case-control study of 121 participants (63 with mild Ad and 58 controls) comparing state-recorded crash rates in both groups over the previous 5 years

Carr 2011Non-RCT

99 people with dementia referred for road test. Washington road test compared with visual, motor and cognitive test. no information on dementia subtype or severity

Clark 2005Non RCT

Cross-sectional study of 55 participants (41 with Ad, 6 with VaD, 2 with DLB, 4 with FTD and 2 age-associated memory loss) no controls. Correlated neuropsychological tests with a rating of safe or unsafe in on-road testing

Cooper 1993Non-RCT

Case-control study comparing retrospective crash rates of 165 older people from a dementia clinic with a random sample from the population of drivers in British Columbia

Cotrell 1999Non-RCT

Cross-sectional study of 35 people with AD (only 19 still driving), evaluated on MMSE, driving status and carer assessment of driving behaviour

Cox 1998Non-RCT

Cross-sectional study of 50 participants (29 with AD) comparing neuropsychological tests with simulated drive

Cushman 1992Non-RCT

Case-control study of 17 participants (8 with possible dementia, 9 without suspected dementia) comparing neuropsychological tests with a rating of safe or unsafe in on-road testing

Daiello 2010Non-RCT

24 early AD before and after cholinesterase inhibitor treatment, compared on computerised tests of visual attention and executive function. Also 35 early AD treated vs. matched non-treated. NO ROAD TEST. Simulated computer-based drive. Cholinesterase inhibitor improved simulated drive and visual attention

Dawson 2009Non-RCT

Case control, comparing 40 early AD vs. 115 healthy people on cognitive, visual, motor and driving tests. AD had more driving errors 42 vs. 33. Errors associated with older age, lower cognition status, and poorer performance on BVRT, CFT-copy, TMT-A and functional reach test

de Simone 2007Non-RCT

Case-control study of 30 participants (15 people with FTD and 15 healthy controls) were administered a driving simulation task. Measures of driving performance and neuropsychiatric symptoms were assessed

Devos 2007Non-RCT

Case-control study of 80 participants (40 people with Parkinson's disease and 40 controls). Included 11 people with PD and 3 controls with very mild cognitive decline (CDR 0.5). Participants were assessed using a driving simulator, driving history survey and the CDR. The people with PD also underwent a clinical test battery and an evaluation of fitness to drive performed by an official centre, which included visual, cognitive and on-road tests

Dobbs 1997Non-RCT

Case-control study of 115 older drivers with cognitive decline - mostly AD compared with 35 older and 23 younger controls. Comparisons made with cognitive testing and on-road driving test

Drachman 1993Non-RCT

Retrospective questionnaire-based survey comparing annual rates of occurrence and severity of all crashes based on responses of the carers of 130 people with AD and 112 age-matched control subjects (no dementia) and their spouses

Dubinsky 1992Non-RCT

Retrospective questionnaire based survey of 67 people with AD and their families and compared them with 100 elderly, non-spousal controls focused on driving habits, continued driving and the number of accidents per year for the past 10 years

Duchek 2003Non-RCT

Prospective case control study following 108 participants (50 with AD and 58 non-dementia) with sequential on-road testing

Ernst 2010Non-RCT

Carer interviews, 30 FTD, 26 AD. Reported differences in driving behaviour: AD: unsteady driving style, FTD: aggressive/ risky/lack of insight. 37% MVA vs. 19% for AD (NS)

Fitten 1995Non-RCT

Case-control study of 84 participants (15 with AD, 12 with VaD and 57 non-dementia subjects). Correlated neuropsychological tests with Sepulveda Road test score and retrospective crash and violation rate

Fox 1997Non-RCT

Cross-sectional study of 19 participants with AD, correlating road test with physician and neuropsychologist's assessment of fitness to drive and neuropsychological scores

Friedland 1988Non-RCT

Case-control study comparing retrospective crash rate of 30 people with AD with 20 people without dementia

Frittelli 2009Non-RCT

CCT comparing 20 AD (CDR 1), 20 MCI (CDR 0.5) and 19 healthy on computer-based driving simulator (STISTIM). All active drivers and not on treatment for AD. Poorer performance on length of run, mean time to collisions, off-road events in AD vs. MCI and controls. MCI shorter time to collisions than healthy controls. Reaction times longer for AD vs. MCI and healthy control. Driving not correlated with MMSE

Gilley 1991Non-RCT

Retrospective survey of 522 people and their collateral informants from a dementia clinic. Only 322 licensed to drive at onset of dementia and 93 active drivers at time of questionnaire. Questionnaire on driving cessation and unsafe driving in previous 6 months

Grace 2005Non-RCT

21 mild AD, 21 PD without dementia and 21 healthy controls. Compared neuro-psychological tests and on-road driving test, miles driven AD < PD < N.  Poorer performance on neuro-psychological testing correlated with unsafe or marginal performance. HVLT for AD and PD, TMT-A for AD. Hoehn and Yahr correlated with marginal driving performance

Hunt 1993Non-RCT

Case-control study of 38 participants (25 with AD, 13 without suspected dementia). Correlated neuropsychological tests with a rating of safe or unsafe in on-road testing

Hunt 1997Non-RCT

Case-control study of 94 participants (56 with AD, 38 without suspected dementia). Correlated neuropsychological tests with a rating of safe or unsafe in on-road testing

Hunt 2010Non-RCT

Observational retrospective cohort

Innes 2005Non-RCT

Cross-sectional study of 50 drivers with neurological disorders (4 with AD) referred to a Driving and Vehicle Assessment Service comparing a battery of computerised sensory-motor and cognitive tests and on-road driving assessment. Developed a model of sensory-motor and cognitive tests that would predict pass or fail on-road testing

Iverson 2010Non-RCT

Consensus statement

Johansson 1997Non-RCT

Review article

Kamimura 2009Non-RCT

Kawano 2009Non-RCT

Observational retrospective study

Kay 2009Non-RCT

Prospective multicentre study of 115 driving assessment referrals with functional impairment 96 neurological including 30 AD. Compared 2 standardised office tests with on-road assessment. Cut-offs for both scores predicted road test fail

Lafont 2010Non-RCT

Prospective population study 2104 participants, predictors of driving cessation, including neuro-psychological testing and dementia diagnosis. Dementia associated with driving cessation but not with crashes. Development of dementia later in the study was associated with crashes (OR 3.4). Poor performance on TMT-B associated with crashes (OR 7.7) 

Laks 1999Non-RCT

Review article

Laks 2000Non-RCT

Survey of cognitive performance and driving history (licensing and cessation) in 110 residents of sheltered accommodation for older people

Leproust 2008Non-RCT

Hypothetical study. Suggested on-road testing every 3 years for people over 85 years of age as preventing 569 crashes and inducing 270 adverse events. Based on crash risk or 2.0 for drivers with dementia

Lincoln 2006Non-RCT

Case-control study of 75 participants (42 with dementia, 33 without suspected dementia). Correlated neuropsychological tests with a rating of safe or unsafe in on-road testing. An algorithm to predict road-test failure was generated from the neuropsychological tests and validated on a cohort of 17 people with dementia

Lincoln 2010Non-RCT

Dementia cohort of 75 people with 34 AD, 14 VaD, 2 DLB, 1 FTD, 1 MCI, 4 mixed - 65 had on-road test. Dementia severity not recorded. 12 failed road test. Combination cognitive scoring gave sensitivity 80% and specificity 61.5% for predicting road test failure. Validated previous prediction rule correctly classifying 76% of people

Love 2007Non-RCT

Lucas-Blaustein 1988Non-RCT

Retrospective survey of driving history and crashes in 72 people referred to a dementia clinic

Lukas 2009Non-RCT

Review article

Man-Son-Hing 2007Non-RCT

Review article

Meuser 2006Non-RCT,

Trial of education for health professionals

Meuser 2009Non-RCT

Driving outcomes of reported impaired drivers in Missouri. Reporting resulted in lower crash rate and mortality in reported drivers - 96.5% had license revoked

Molnar 2006Non-RCT

Review article

Molnar 2007Non-RCT

Review article

Mosimann 2011Non-RCT

Consensus statement

Neitch 2011Non-RCT

Retrospective audit of 43 assessments comparing performance on standardised testing of 27 with and 25 without dementia

O'Connor 2010Non-RCT

More rapid decline in life space and driving in MCI vs. healthy controls, no driving assessment

Odenheimer 1994Non-RCT

Cross-sectional study of 30 licensed drivers with a broad range of cognitive skills (3 with AD, 3 with VaD), over age 60 years, were road tested on a closed course and in traffic by a driving instructor and 2 researchers. Driving instructor scores and cognitive test scores compared with research road test scores

Okonkwo 2009Non-RCT

Case-control study comparing 57 MCI vs. 68 healthy controls, on-road test as part of functional assessment. 70% vs. 50% had some difficulty on road test, non-significant difference in tendency to overestimate ability. No reported test failures

Oswanski 2007Non-RCT

Cross-sectional study of 232 drivers over 55 years referred for license renewal were given the Motor Free Visual Perceptual Test, clock test, and an on-road driving test. No dementia diagnosis included

Ott 2005Non-RCT

Cross-sectional study of 50 drivers with probable or possible AD (very mild to mild), from a longitudinal study of driving and dementia to compare office-based clinician rating of driving competence with on-road assessment. Clinician rated the drivers as safe, marginal or unsafe (based on chart review) and compared these ratings with total driving scores on a standardised road test and categorical ratings of driving competence from a professional driving instructor

Ott 2008Non-RCT

CCT: 65 probable AD, 23 possible AD (53 CDR 0.5, 35 CDR 1) and 45 healthy controls. In AD cases with CDI 0.5-1 maze test and neuropsychological test were compared to on-road testing. Road test failure noted in 1/45 controls and 17/88 AD. Road test score correlated with maze and neuropsychological tests

Parker 2000Non-RCT

Questionnaire survey of 1989 drivers aged 50 years or over (Manchester Driver Behavior Questionnaire) examined factors associated with crashes in older drivers. No dementia diagnosis

Patomella 2010Non-RCT

205 impaired drivers referred for on-road test. 128 had stroke, 43 with MCI and 34 with dementia

Rapoport 2007Non- RCT

Review article

Rebok 1994Non-RCT

Case-control study of 22 older drivers (10 with AD and 12 controls) compared on neuro-psychological tests, the Driver Performance test (subjects answer questions based on videotaped driving scenarios) and Driver Advisement System (computer-based measures of reaction time and coordination using steering wheel and pedals in front of monitor)

Reger 2004Non-RCT

Review article

Regtuijt 2007Non-RCT

Case report

Rizzo 1997Non-RCT

Case-control study of 39 drivers (21 with AD and 18 controls) comparing neuro-psychological testing with driving simulator performance and simulator crash rate

Rizzo 2001Non-RCT

Same design and participants as Rizzo 1997 but with hazards at intersections requiring rapid response to avoid crash

Ross 2009Non-RCT

Pooled data from 9 longitudinal studies in ageing, 5206 older adults no intervention, no assessment of driving ability

Silva 2009Non-RCT

Review article

Singh 2007Non-RCT

Cross-sectional study of 154 individuals with PD (22 with dementia: diagnosed by team consensus based on MMSE, 15 road sign recognition, visuospatial construction, Trail Making test, forward and reverse digit span, and a story recall) referred to a driving assessment centre. Group included 17 who stated that they had stopped driving by themselves before assessment. Driving ability determined by a combination of clinical tests, reaction times on a static test rig and an in-car driving test

Snellgrove 2005Non-RCT

Cross-sectional study of 115 community-dwelling older drivers with MCI or early dementia (recruited through a memory clinic). Participants completed the Maze Task, and immediately thereafter, a standardised on-road driving test. Results also compared with cognitive tests from memory clinic

Snyder 2009Non-RCT

Retrospective audit of 1664 impaired drivers mandatorily reported, 88% had cognitive impairment, reported by internists and general practitioners. Auto suspension all - 15% requested re-test, 3% contested and only 10% regained driving privileges. No data on impact on crashes or cessations

Soderstrom 2009Non-RCT

Retrospective audit of reasons for referral by police to medical advisor boards. 40% of all referrals for confusion disorientation but dementia only in 3%

Staplin 2003Non-RCT

Same as Staplin 2003a with further 1-year follow-up data for crashes

Staplin 2003aNon-RCT

Prospective cohort study of 2500 drivers over 55 years of age comparing cognitive and motor performance with prospective crash rate over 2 years following assessment. No dementia diagnosis

Stutts 1998Non-RCT

Retrospective cohort study of 3238 drivers aged 65 years and older applying for renewal of their driver's license. Compared cognitive assessments with crash involvement during the 3-year period prior to testing. No dementia diagnosis

Szlyk 2002Non-RCT

Initial survey of 292 licensed neuropsychologists on neuropsychological tests currently used to screen people for driving. Followed by development of 12-item neuropsychological battery used to screen 22 licensed drivers ranging in age from 67 to 91 years. Subjects were administered the neuropsychological battery, a driving simulator test and a Driving Habits Interview. No dementia diagnosis (subject classified as suspected dementia based on MMSE < 24)

Taylor 2001Non-RCT

Survey of 922 drivers whose licenses had been revoked or suspended due to dementia or suspected dementia. Questioned on the changes in household travel patterns and responsibilities following license revocation and on the psychological effects of these changes on affected household members. The survey was addressed to and in nearly all cases completed by the 'carer' of the former driver

Trilling 2001Non-RCT

Review article

Trobe 1996Non-RCT

Retrospective case-control study of 143 licensed people with AD and 715 licensed comparison subjects matched 5 to 1 in age (± 6 years), sex and county of residence. Compared crashes and violations from state driving records with neuropsychological test scores. A questionnaire-based inquiry on the influence of physician, family and state interventions on driving cessation was administered

Tuokko 1995Non-RCT

Retrospective case-control study of 249 people referred to an outpatient dementia clinic. People were divided into those who met criteria for dementia and those who did not and compared with controls for retrospective crash and traffic violation rate. For each group, control subjects matched on age, gender and location of residence were randomly selected from the records of all drivers in the province

Uc 2005Non-RCT

Case-control study of 33 drivers with probable AD of mild severity and 137 neurologically normal older adults comparing a battery of visual and cognitive tests in addition to driving safety and detection of specific landmarks and traffic signs along a segment of an on-road experimental drive

Uc 2006Non-RCT

Case-control study of 61 drivers with mild AD and 115 elderly controls using a driving simulator comparing crash rate and unsafe avoidance behaviour in a driving situation with a high risk of rear end collision

Uc 2008Non-RCT

Review article

Vaux 2010Non-RCT

Prospective case control study: 8 people with PD, 6 with AD and 18 healthy controls. Simulated drive on desktop computer tasked to identify whether moving spheres on a collisions course with them

Wadley 2009Non-RCT

Prospective case control stud: 46 MCI vs. 59 healthy controls compared on driving. MCI had more "less than optimal" performance on global measures but not outright fail

Wild 2003Non-RCT

Case-control study of 15 drivers with mild AD and 15 controls comparing questionnaire responses on self reported cognitive function and driving performance in addition to an on-road test

Withaar 2000Non-RCT

Review article

Woolf 2006Non-RCT

Review article

Zuin 2002Non-RCT

Retrospective case control study of 56 drivers with dementia (43 probable AD, 6 possible AD, 3 VaD, 1 DLB, 2 FTD, 1 unclassified). and 31 elderly controls. Motor vehicle crash and abnormal driving behaviour rates obtained from collateral informants and compared with detailed neurological, psychiatric and neuropsychological examinations