Driving difficulties as reported by older drivers with mild cognitive impairment and without neurological impairment

Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment. Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs. Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations. Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers' fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.