White Matter Hyperintensity Burden and Decline in Driving Performance Among Older Adults

Area of Science:

• Neurology
• Gerontology
• Transportation Safety

Background:

• White matter hyperintensity (WMH) burden correlates with cognitive decline in older adults.
• The impact of WMH on driving performance and the role of modifiable risk factors remain unclear.

Purpose of the Study:

• To assess the association between WMH burden and longitudinal driving performance in cognitively normal older adults.
• To investigate how cognitive decline and antihypertensive therapy moderate these associations.

Main Methods:

• Prospective longitudinal cohort study of community-dwelling older adults (≥65 years).
• Baseline MRI for WMH volume, continuous in-vehicle driving monitoring, and annual cognitive assessments over a mean follow-up of 5.6 years.
• Linear mixed-effects models were used to analyze associations, adjusting for demographic and vascular risk factors.

Main Results:

• Greater WMH burden was associated with reduced driving frequency, entropy, and unique destinations.
• Higher WMH burden predicted faster longitudinal declines in these driving metrics.
• Posterior WMH growth was linked to increased crash risk in those with cognitive impairment.
• Antihypertensive therapy showed a trend towards attenuating WMH-associated risky driving.

Conclusions:

• Increased WMH burden, especially in posterior regions, is associated with impaired driving self-regulation and increased errors in older adults, particularly those with cognitive impairment.
• Posterior WMH may serve as a biomarker for identifying at-risk drivers.
• Antihypertensive use may help preserve driving safety in the context of WMH.