Research Papers

Dementia and Driving: An updated knowledge synthesis

Version 1
Date added June 26, 2017
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Category 2017 CARSP XXVII Toronto
Tags Research and Evaluation, Session 2B
Author/Auteur Mark Rapoport
Stream/Volet Research and Evaluation

Slidedeck Presentation Only (no paper submitted)



National-level guidelines that physicians use to assess fitness to drive for dementia are limited in their currency, applicability, rigour of development, and integration of knowledge-user perspectives. Our objective is to determine the absolute and relative risk of motor vehicle collisions or clinically-relevant driving impairment caused by dementia, in order to inform international driving guidelines. We searched MEDLINE, CINAHL, Scopus, Embase, PsychINFO, the Transportation Research Information Database, and the Cochrane Central Register of Controlled Trails (1990 October 30th, 2015) for English language studies published after 2004. We considered all research containing participants with dementia of any severity (mild, moderate, or severe) and any type of diagnosis. We included primary study data that examined outcomes on the risks that dementia pose to safe driving, using on-road crash history and on-road driving examinations, in comparison to healthy control participants. Titles, abstracts, and full-texts were screened independently by pairs of reviewers and disagreements resolved by a third party arbiter to apply these criteria. Independent extraction was performed by pairs of multiple authors using standardized forms, in accordance with PRISMA and ADAPTE guidelines. Our primary outcome measures were related to: traffic/motor vehicle collisions (MVCs), using both self- or informant-reported data and database-recorded data; and on-road driving assessments skill performance and road test failure rates. We included eight studies in this analysis, from the retrieved 12860 search results, which involved 318 participants with dementia and 301 healthy controls. Two studies reported on self/informant-reported crash risk, one revealing a 4-fold increase in MVCs per 1000 miles driven per week in three years prior, and the other showing no statistically significant increase over the same time span. We found medium to large effects of dementia on driving performance in five of the six recent studies that examined driving impairment (e.g. more driving errors, higher number of lost trips, etc.). Lastly, in the four studies that presented on-road failure rate, we found that persons with dementia were much more likely to fail a road test than healthy controls (RR 10.77, 95% CI 3.00 - 38.62, z = 3.65, p < 0.001), with no significant heterogeneity (X2 = 1.50, p = 0.68, I2 = 0%). We conclude that dementia, even in the very mild or mild stages as measured by CDR, places an older adult at a higher risk to fail a performance-based road test, although data is indeterminate regarding crash risk. Since a substantial proportion of those at CDR 1 may pass an on-road test, it is likely that those at a CDR of 1 who wish to continue driving should be offered an appropriate assessment.

Mark Rapoport