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Cognitive tests in assessing fitness to drive

For many people being able to drive is an important part of everyday life, and often plays a vital role in allowing people to work and taking part in leisure activities. Due to different cognitive impairments, such as after traumatic brain injury, stroke, mild dementia, or Parkinson disease, there might be a need to assess a person’s fitness to drive. To be forced to quit driving, permanently or temporarily, can however be both a sensitive matter and a difficult adjustment for many.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

Which evidence-based cognitive tests or instruments exist for the assessment of fitness to drive in persons with dementia or other cognitive impairments?

Identified literature

Table 1 Systematic reviews.
Included studies Population/intervention Outcome
Smedslund et al 2015 [1]
53 studies in 58 publications,
30 studies published in 2010, or later

Studies in which all participants had taken one or more screening test (index test) followed by an on-road test (reference test)		 Persons with suspected cognitive impairment taking cognitive screening tests designed to predict results on standardised driving tests.

(Most studies on patients with traumatic brain injury and/or stroke. Other diagnoses were Parkinson’s disease, dementia, Huntington’s disease, Multiple sclerosis)		 Sensitivity and specificity
Authors' conclusion:
“We have not found cognitive screening tests that have high quality evidence for diagnostic test accuracy for predicting driving ability assessed with on-road tests. Some of the tests are only developed for specific diagnoses (among others, SDSA), and in many cases analyses have been conducted only on single tests and not on batteries of tests. There is no single test per se that can detect all cognitive aspects relevant for driving a car.”
Bennett et al 2016 [2]
30 studies in 28 publications
(25 cross-sectional studies, 4 retrospective studies, 1 prospective longitudinal study; 15 cohort, 15 case- control studies)		 Persons with dementia (according to accepted diagnostic criteria) and standardised cognitive measures to determine fitness to drive. Measure of driving ability
Authors' conclusion:
“Scores on individual tests or tests of a single cognitive domain did not predict driver safety. The composite batteries that researchers have examined are not clinically usable because they lack the ability to discriminate sufficiently between safe and unsafe drivers.”
Fields et al 2017 [3]
Review of reviews
(10 systematic reviews, 4 meta-analyses published between 2004 and 2015)		 Off-road fitness-to-drive assessment of cognitive and/or perceptual skills across any medical condition Due to heterogeneity amongst included studies the results were qualitatively synthesised.
Authors' conclusions:
“No included reviews suggested that a single assessment tool or assessment of an individual component of cognition or perception, would be an adequate predictor of fitness-to-drive in isolation. […] Executive function, processing speed, visuospatial skills, attention, memory, mental flexibility, perception, concentration and praxis should be included within fitness-to-drive evaluations.”

References

  1. Smedslund G, Giske L, Fleitscher H, Brurberg KG. Screeningverktøy for kognitiv funksjon og bilkjøring. Rapport fra Kunnskapssenteret nr. 21−2015. Oslo: Nasjonalt kunnskapssenter for helsetjenesten, 2015.
  2. Bennett JM, Chekaluk E, Batchelor J. Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review. J Am Geriatr Soc 2016;64:1904-17.
  3. Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017;64:328-339.
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Published: Report no: ut201906 Registration no: 2018/263
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Literature search

Literature search.pdf

Project group

Laura Lintamo, Sally Saad, Sara Fundell and Miriam Entesarian Matsson at SBU.

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