Can we improve clinical prediction of at-risk older drivers?

Accid Anal Prev. 2013 Oct:59:537-47. doi: 10.1016/j.aap.2013.06.037. Epub 2013 Jul 16.

Abstract

Objectives: To conduct a pilot study to evaluate the predictive value of the Montreal Cognitive Assessment test (MoCA) and a brief test of multiple object tracking (MOT) relative to other tests of cognition and attention in identifying at-risk older drivers, and to determine which combination of tests provided the best overall prediction.

Methods: Forty-seven currently licensed drivers (58-95 years), primarily from a clinical driving evaluation program, participated. Their performance was measured on: (1) a screening test battery, comprising MoCA, MOT, Mini-Mental State Examination (MMSE), Trail-Making Test, visual acuity, contrast sensitivity, and Useful Field of View (UFOV) and (2) a standardized road test.

Results: Eighteen participants were rated at-risk on the road test. UFOV subtest 2 was the best single predictor with an area under the curve (AUC) of .84. Neither MoCA nor MOT was a better predictor of the at-risk outcome than either MMSE or UFOV, respectively. The best four-test combination (MMSE, UFOV subtest 2, visual acuity and contrast sensitivity) was able to identify at-risk drivers with 95% specificity and 80% sensitivity (.91 AUC).

Conclusions: Although the best four-test combination was much better than a single test in identifying at-risk drivers, there is still much work to do in this field to establish test batteries that have both high sensitivity and specificity.

Keywords: Driving safety; Multiple object tracking; Visual attention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Traffic / prevention & control*
  • Aged
  • Aged, 80 and over
  • Attention*
  • Automobile Driver Examination*
  • Automobile Driving / statistics & numerical data*
  • Cognition*
  • Contrast Sensitivity
  • Decision Support Techniques*
  • Female
  • Humans
  • Male
  • Mental Status Schedule
  • Middle Aged
  • Neuropsychological Tests
  • Pilot Projects
  • Predictive Value of Tests
  • Risk Assessment / methods
  • Trail Making Test
  • Visual Acuity
  • Visual Field Tests