1. Neuropsychological Predictors of On-Road Driving Performance Sadia Najmi 1, Christen M. Deveney 1, Seth Elkin-Frankston 2, Lissa R. Kappust 2, Ann M. Hollis 2, & Margaret O’Connor 2,3 1 Department of Psychology – Harvard University, 2 Department of Neurology – Beth Israel Deaconess Medical Center, 3 Harvard Medical School ABSTRACTRESULTS METHOD Participants Participants included 28 patients referred for driving evaluations through the DriveWise program at Beth Israel Deaconess Medical Center. Participants varied with respect to cognitive abilities, age, and medical status. Diagnostic statusn Dementia6 Stroke6 Parkinson’s Disease4 Cervical Spondylosis1 Encephalopathy1 Head Injury2 Guillain Barre1 Encephalitis1 Mild Cognitive Impairment5 No diagnosis1 Neuropsychological Assessment Procedure Trail Making Test A & B (Tombaugh, 2002) – Completion time (seconds) Wechsler Memory Scale, Logical Memory I & II (Weschler, 1997) – Raw score Color Trails Test 1 & 2 (D’Elia et al., 1994) – Completion time (seconds) Boston Naming Test (Kaplan et al., 2001) – Total number of correct responses Stroop Color and Word Test (Golden, 2002) – Color-Word Interference raw score Mattis Dementia Rating Scale – Revised (Jurica et al., 2001) – Total score Driving Evaluation Participants completed a 45 minute standardized road test which is a modified version of the Washington University Road Test (Hunt et al., 1997). The road test was conducted in a specially equipped car that had a brake pedal on the passenger side. An occupational therapist with expertise in driving assessments sat in the back seat of the vehicle to observe and grade the participant during the road test. A certified driving instructor sat in the front seat of the car. Standardized assessment criteria based on Dobbs et al. (1998) were used. Statistical Analysis Data were analyzed using SPSS. T-test analyses were conducted with road test outcome (Pass/Fail) as the independent variable and neuropsychological tests scores as the dependent variables. Pearson correlations were computed between neuropsychological test scores and road test outcome (Pass/Fail). Objective: Studies have shown that the Trail Making Test (TMT) predicts driving competence in elders with and without dementia. The TMT provides valuable information regarding visual attention and mental flexibility, skills critical for driving. However the TMT, may be of less value in the assessment of patients for whom English is not a primary language. In these cases, the Color Trails Test (CTT) might be a reasonable alternative. The goal of the current study is to examine the utility of the CTT in the prediction of driving performance measured by an on road driving exam. Participants and Methods: Participants (n=28) were referred for driving evaluations through the DriveWise program at Beth Israel Deaconess Medical Center. Participants varied with respect to cognitive abilities, age, and medical status. A brief set of neuropsychological tests was administered followed by a 45 minute road test. Results: Findings indicated significant correlation between Color Trails-1 completion- time and road-test outcome and between Color Trails-2 completion-time and road-test outcome. Road-test outcome also correlated significantly with performance on Trails-A, Trails-B, and Logical Memory I, and marginally with performance on Logical Memory II, but not with the Boston Naming Test or the Stroop Test. DISCUSSION Results are consistent with prior research studies indicating that performance on certain neuropsychological tests may be useful in the prediction of driving competence. Of particular interest, patients who failed a 45 minute road test were more impaired on the Color Trails Test 1 & 2 than were patients who passed the road test. These comparisons were marginally significant (p =.07), which is noteworthy given the small sample size. Hence, the CTT may be used as an additional neuropsychological predictor of driving ability, particularly when evaluating individuals for whom English is not the primary language. Current findings are consistent with prior studies indicating that performance on the TMT is significantly associated with driving ability. In addition, in this study performance on tests of immediate memory correlated significantly, and performance of delayed memory correlated marginally, with road-test outcome. Many studies of driving competence compare neuropsychological tests and driving performance of healthy controls to individuals who have already been diagnosed with dementia. Our sample of driving examinees differs from these in that it was heterogeneous with respect to age and medical diagnosis. As a result, we expect that conclusions from our study provide relevant data to the heterogeneous group of individuals referred for driving evaluations. Given the preliminary nature of this study and the small sample size, these results require replication and perhaps a more direct test of predictive ability in non-native English speaking populations. 78.0 (13.0)69.3 (15.1) 125.6 (12.4) 1 138.5 (4.5)133.7 (10.2)DRS-R 2 17.4 (3.0)16.6 (3.5)16.9 (3.3)Education 73.0 (14.7)Age Participants (fail) (n=12) Participants (pass) (n=16) Participants Total (n=28) Table 1. Descriptive Data and Neuropsychological Performance Data (Mean, SD) 1 Differences between groups p <.05 2 Only 19 participants completed the DRS-R in the time allotted for the evaluation REFERENCES BACKGROUND Prior research has shown that some neuropsychological tests predict driving performance. Performance on the TMT has been significantly associated with performance on road tests as well as with performance in driving simulators (Grace et al., 2005; Odenheimer et al., 1994; Reger et al., 2004; Rizzo et al., 1997; Uc et al., 2005). The TMT provides valuable information regarding skills that are critical for driving and it is easy to administer. Consequently, the TMT has been promulgated as an important screening instrument by a variety of health care groups including the American Medical Association (Wang et al., 2003). However, because the TMT requires a basic knowledge of the English language it is not clear whether individuals with limited knowledge of English may inadvertently be categorized as “at risk” drivers on the basis of low TMT test scores. The current study seeks to evaluate whether a selective attention task (i.e., the CTT) is an alternative predictor of on-road driving performance. The CTT requires individuals to connect numbered circles as quickly and accurately as possible. It is similar to the TMT; however, in the CTT, participants connect circles in numerical order and switch between pink and yellow-colored circles. Knowledge of the English alphabet is not needed to complete this task. -.36.37Logical Memory Test - I.14Boston Naming Test -.09Stroop Test- Interference Score -.47Trail Making Test - B -.40Trail Making Test - A -.42 Color Trails - 2 Color Trails - 1 r Table 3. Correlations between road test performance and neuropsychological tests.03.26.34.01.02.04 p value Logical Memory Test - II.31.07 Table 2. Differences in neuropsychological test performance between individuals who passed and those who failed the road test p value Pass Mean (SD) Fail t df 145.7 (64.4) Color Trails - 2 223.5 (110.0)-2.0213.07 48.2 (23.6) Trail Making Test - A -2.1825.04 119.7 (58.9) Trail Making Test - B 188.2 (77.0)-2.5724.02 1.7 (7.5) Stroop Interference 3.1 (6.7)-0.4322.67 48.9 (13.8) Boston Naming Test 44.9 (15.2)0.6723.51 30.4 (13.2) LM I 19.5 (14.9)1.9223.07 71.2 (50.9) Color Trails - 1 141.9 (133.4)-1.8924.07 81.5 (53.1) 16.3 (9.8) LM II 9.6 (11.4)1.5723.13 Brown, L.B., Ott, B.R., Papandonatos, G.D., Sui, Y., Ready, R.E. & Morris, J.C. (2005). Prediction of on-road performance in patients with early alzheimer’s disease. J Am Geriatr Soc, 53 (1), 94. D'Elia, L.F., Satz, P., Uchiyama, C.L. & White, T. (1994). Color Trails Test (CTT). 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