Common driving behaviors in older adults with dementia: Insights from a systematic literature review

Dementia impairs driving skills, but the specific driving behaviors affected are not fully understood. This project reviewed the literature on driving behaviors more common among people with dementia compared to age-matched healthy controls. A search of Scopus, Medline All, and Embase databases (1994 to September 2024) identified relevant studies. Articles were included if they addressed driving behaviors among drivers with dementia during on-road tests, simulator experiments, or naturalistic driving, and included comparisons with non-dementia controls. Of 2359 citations, 26 studies were included: 3 used naturalistic driving, 14 driving simulators, and 9 used on-road tests. Drivers with dementia showed higher standard deviations of mean speeds, more traffic light tickets, greater out-of-lane drifting, and increased variability in mean headway distance compared to controls. Findings highlight distinct driving behavior patterns among drivers with dementia. However, these results should be interpreted cautiously due to methodological limitations, including small samples, lack of confounding factors, and non-validated settings. HIGHLIGHTS: Drivers with dementia exhibit distinct driving patterns that consistently set them apart from cognitively intact drivers. Compared to age-matched controls, drivers with dementia are more likely to demonstrate greater variability in mean speeds, accumulate more traffic light violations, exhibit higher instances of lane drifting, and show increased variability in mean headway distance. Driving simulators, on-road tests, and naturalistic driving methods have been used to study driving in individuals with dementia, although most evidence comes from simulator studies, which may not fully reflect real-world driving conditions.