Driving performance across the cognitive spectrum in active older adults: A simulator study

Cognitive decline is known to impair driving in older adults, yet how specific deficits emerge across the continuum from normal cognition to dementia remains insufficiently characterized.

To examine how gradations of cognitive impairment influence driving performance using a high-fidelity simulator.

In this retrospective study, 63 older drivers (79.32 ± 6.09 years) were classified into three cognitive groups: normal cognition (ND-D), mild cognitive impairment (MCI-D), and dementia (Dementia-D). Participants completed neuropsychological testing and simulator tasks assessing pedal control, traffic-sign recognition, and intersection navigation.

A clear performance gradient was observed across cognitive levels. The MCI-D group preserved basic vehicle control but demonstrated attention-related failures, including selection errors and sign omissions, compared with the ND-D group. In contrast, the Dementia-D group showed widespread impairments, such as inconsistent pedal use, increased operational errors, and reduced intersection speeds (p < 0.05). Frontal-executive function (FAB) and divided attention (TMT) were strongly associated with these deficits.

Driving performance declines systematically along the cognitive spectrum. Deficits in frontal-executive and attentional functions most strongly predict simulator errors, underscoring the importance of evaluating these domains when assessing driving safety.

Driving-risk assessments should consider stage-specific vulnerabilities across the cognitive continuum. Integrating cognitive profiles with behavioral driving patterns may support individualized interventions to promote safe mobility in older adults. These findings inform targeted interventions to preserve driving independence safely.