- Changes in driving frequency, complexity, and spatial range were associated with mild cognitive impairment in older adults.
- Trip distances, speeding, and destination variability distinguished mild impairment from normal cognition with strong predictive accuracy.
- Continuous, real-world driving data may signal impairment before safety events occur, researchers suggested.
Subtle shifts in driving patterns identified people with early cognitive decline, a longitudinal study showed.
Progressive changes in driving frequency, complexity, and spatial range were associated with mild cognitive impairment, reported Ganesh Babulal, PhD, OTD, of Washington University School of Medicine in St. Louis, and co-authors.
Four variables -- trips between 5 and 10 miles, speeding, destination variability, and maximum trip distance -- distinguished drivers with mild impairment from those with normal cognition with an area under the curve (AUC) of 0.82 (95% CI 0.75-0.89), Babulal and colleagues wrote in Neurology.
Adding demographic data, APOE4 status, and cognitive composite scores improved AUC to 0.87 (95% CI 0.81-0.93). By itself, the driving model outperformed a sociodemographic model that included APOE4 and cognitive scores (AUC 0.73, 95% CI 0.66-0.80).
The findings support naturalistic driving data as a potential unobtrusive digital biomarker for early cognitive decline, the researchers suggested.
"This could help identify drivers who are at risk earlier for early intervention, before they have a crash or near-miss, which is often what happens now," Babulal said in a statement. "Of course, we also need to respect people's autonomy, privacy, and informed decision-making, and ensure ethical standards are met."
Identifying older drivers at risk for traffic accidents is a public health priority that can be challenging and time-consuming, the researchers observed. There's no consensus on screening or formal testing of driving ability, they pointed out.
"Driving is one of the most cognitively demanding instrumental activities of daily living," said Sayeh Bayat, PhD, of the University of Calgary in Alberta, who wasn't involved with the study. "By passively tracking driving patterns over time, with appropriate safeguards, we can complement traditional cognitive tests, monitor change more sensitively, and tailor conversations about driving safety for our individuals with cognitive impairment."
"Continuous, real-world driving data give us a window into brain health," Bayat told MedPage Today.
"Subtle changes in how, when, and where someone drives -- like avoiding night driving or showing more variable speed control -- may flag emerging challenges in attention, visuospatial skills, and executive function long before we see overt safety events," she added.
The research builds on earlier findings, including Bayat's own work, that suggested measures like vehicle jerk (how smoothly someone drives) may flag preclinical Alzheimer's disease in people who seem cognitively normal.
Other studies have indicated that cognitive problems may be underdiagnosed in states with motor vehicle reporting mandates. The American Medical Association's code of ethics outlines a physician's responsibility to recognize impairments in a patient's driving that may pose a threat to public safety.
Babulal and colleagues evaluated data from a sample of older adults in the ongoing DRIVES project at Washington University. DRIVES participants agreed to have a GPS tracking device installed in their cars to record information about speed, hard braking, sudden acceleration, impact, time of day, and location.
The study included 242 people with normal cognition and 56 with mild cognitive impairment. Mean baseline age was 73, and women made up about half of the sample. There were no significant baseline differences between groups in age, sex, race, or APOE4 status.
The normal cognition group was followed for 32 months and the mild cognitive impairment group was followed for 39 months.
Over time, drivers with mild cognitive impairment showed greater reductions in monthly trip counts, nightly trips, and entropy (a measure of destination variability and trip unpredictability), suggesting they were progressively restricting their driving routines, the researchers noted.
Most participants were highly educated and white, and results may not apply to the overall population, Babulal and co-authors acknowledged. The study also lacked external validation, warranting cautious interpretation, they added.
Disclosures
This work was supported by the National Institute on Aging.
Babulal reported no disclosures. Co-authors reported relationships with the Traffic Injury Research Foundation, Hoffman La Roche, Eisai, and Biogen.
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