Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment

Area of Science:

• Neuroscience
• Gerontology
• Traffic Safety

Background:

• Cognitive impairment (CI) significantly impacts driving abilities.
• Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) are established predictors of on-road driving outcomes.
• Previous studies often excluded drivers referred for comprehensive driving evaluations (CDEs), a group with typically more severe CI.

Purpose of the Study:

• To evaluate the predictive accuracy of Trails B and UFOV for on-road driving pass/fail outcomes in drivers with CI referred for CDEs.
• To compare the efficacy of Trails B and UFOV subtests in this specific high-risk driving population.

Main Methods:

• Retrospective data analysis of 100 drivers (mean age 76.2 years) with CI (Montreal Cognitive Assessment <26) undergoing CDEs.
• Assessment of predictive ability using area under the curve (AUC) for Trails B and UFOV subtests 2 and 3.
• Determination of sensitivity and specificity for established cut-points on both tests.

Main Results:

• Both Trails B (AUC = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) demonstrated predictive ability for on-road outcomes.
• UFOV subtest 3 showed superior prediction with a cut-point of ≥467 ms yielding 78.9% sensitivity and 73.5% specificity.
• Trails B, with a cut-point of ≥3.58 min, had lower predictive values (73.7% sensitivity, 61.8% specificity).

Conclusions:

• UFOV subtest 3 is a more effective predictor of on-road driving pass/fail outcomes than Trails B for drivers with more severe CI referred for CDEs.
• These findings support the use of UFOV subtest 3 in driving evaluations for cognitively impaired individuals to enhance road safety.