Attention and driving. Assessment in elderly individuals with dementia

Older drivers with dementia are involved in more crashes than healthy older drivers. Some investigators, therefore, have proposed that a diagnosis of dementia (DAT or other type) should lead to the automatic revocation of a driver's license. In the authors' view, however, renewal of license should be based on criteria related to driving competence rather than solely on chronologic age or a medical diagnosis. Unfortunately, current competency testing procedures do not assess the attentional factors discussed herewith that have been found to be important for safe driving. As the studies reviewed in this article reveal, there is good evidence that a skill test that predicts crash involvement in older drivers should incorporate attentional measures, in particular tests of attentional shifting based on dichotic listening and related tests. There is also evidence that attention-shifting measures are diagnostic of attention impairment in the early stages of Alzheimer-type dementia. Further research is needed to determine whether other attentional skills, such as sustained and divided attention, also need to be assessed. Additional work also is needed to refine attention tests for ease of use in the clinical setting. Lastly, although these attention measures account for only some of the variance contributing to crash involvement, they may allow for better predictive capability when combined with measures of other skills involved in driving. Driver training programs can complement driver testing procedures in serving the dual requirement for reducing crash risk among drivers with dementia while continuing to be responsive to their mobility needs. Information on the role of attention and other cognitive skills in safe driving should be made available, so that drivers (or their family members) who think they may have declining skills can seek further evaluation. Organizations such as automobile associations and retired persons groups can provide self-assessment inventories for completion by older drivers or referral for medical and neuropsychological evaluation. Finally, training techniques for improving attentional skills in drivers with DAT need to be developed and tested.