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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 70, Number 14, April 1, 2008 All Versions of this Article: 01.wnl.0000294469.27156.30v1 70/14/1171    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Ott, B. R. Articles by Morris, J. C. PubMed PubMed Citation Articles by Ott, B. R. Articles by Morris, J. C.

A longitudinal study of drivers with Alzheimer disease

From the Department of Clinical Neurosciences (B.R.O., L.A.D.), the Department of Psychology (W.C.H., E.K.F.), the Department of Statistical Science (G.D.P.), and the Department of Psychiatry and Human Behavior (J.D.D.), Brown University, Providence, RI; and the Department of Neurology (J.C.M.), Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Dr. Brian R. Ott, Alzheimer’s Disease & Memory Disorders Center, Rhode Island Hospital–APC 6, 593 Eddy Street, Providence, RI 02903 BOtt{at}lifespan.org

Objective: The goal of this study was to define the natural progression of driving impairment in persons who initially have very mild to mild dementia.

Methods: We studied 128 older drivers, including 84 with early Alzheimer disease (AD) and 44 age-matched control subjects without cognitive impairment. Subjects underwent repeated assessments of their cognitive, neurologic, visual, and physical function over 3 years. Self-reports of driving accidents and traffic violations were supplemented by reports from family informants and state records. Within 2 weeks of the office evaluation, subjects were examined by a professional driving instructor on a standardized road test.

Results: At baseline, subjects with AD had experienced more accidents and performed more poorly on the road test, compared to controls. Over time, both groups declined in driving performance on the road test, with subjects with AD declining more than controls. Survival analysis indicated that while the majority of subjects with AD passed the examination at baseline, greater severity of dementia, increased age, and lower education were associated with higher rates of failure and marginal performance.

Conclusions: This study confirms previous reports of potentially hazardous driving in persons with early Alzheimer disease, but also indicates that some individuals with very mild dementia can continue to drive safely for extended periods of time. Regular follow-up assessments, however, are warranted in those individuals.

Abbreviations: AD = Alzheimer disease; CDR = Clinical Dementia Rating; MMSE = Mini-Mental State Examination; MVA = motor vehicle accident.

e-Pub ahead of print on January 23, 2008, at www.neurology.org.

Supported by grant #AG16335 from the National Institute on Aging to Dr. Ott.

Disclosure: The authors report no conflicts of interest.

Received May 15, 2007. Accepted in final form September 17, 2007.

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