1. Neuropsychological Aspects of assessing driving safety in the elderly
Linas A. Bieliauskas, Ph.D.

2. Mental Health Service Department of Psychiatry Medical School
VA Ann Arbor Healthcare System
Department of Psychiatry
Medical School
Department of Psychology
School of Literature, Science
and the Arts
The University of Michigan

3. Some general findings
Wisconsin Card Sort correlates with ability to maintain center of lane; probably related to self-correction
Simple and choice reaction time predict ability of head-injured patients to navigate a track; not in elderly, probably due to different driving habits
Reaction time probably predicts potential for accident under challenge
Left turns are the most common accidents among the elderly
Bieliauskas, L.A., Roper, B.R., Trobe, J., Green, P., & Lacy, M. Cognitive Measures, Driving Safety, and Alzheimer Disease. Clin. Neuropsychol. 1998; 12:

4. Cognitive Changes and Retirement among
Senior Surgeons (CCRASS): Results from the
CCRASS Study
Bieliauskas et al., J Am Coll
Surg 2008;207:69–79

5. Number of Impaired Tests by Retirement Status Relative to Age-Corrected Norms

6. Main Lesson
Self-perception of cognitive change with aging is not related to objectively measured change

8. More Recent Research
Drivers with AD commit avg. of 42 safety errors compared to 33 safety errors for those without AD; lane violations most common
4.1 increase in safety errors for 1 SD in cognitive function on composite measure
Sig. increases in safety errors in AD with poorer scores on BVRT, Complex Figure-Copy, and Trail Making A
Rizzo lab: Dawson et al., Neurol 2009; 72:

10. To what are neuropsychological measures related?
Not simple ability to drive a car, but ability to respond to challenge
For example, we found no difference in accident rates between patients with and without Alzheimer disease; no relationship to neuropsychological data from Alzheimer Disease Center at U. of Michigan (Trobe, J.D., Waller, P.F., Cook-Flannagan, C.A., Teshima, S.M., & Bieliauskas, L.A. Crashes and violations among drivers with Alzheimer disease. Arch. Neurol. 1996; 53: )
Drivers adapt

11. What is the role of the neuropschologist?
While most of us would agree that we will not drive if we perceive our cognitive abilities to be impaired, the accuracy of self-perception of cognitive decline is clearly compromised, even among the brightest
The neuropsychologist provides objective evidence of cognitive weakness and decline
Validity of neuropsychological measures as predictors of driving safety needs to be continually verified from a political standpoint

12. Considerations in Evaluating Driving Safety in the Elderly
Bieliauskas
Brain Injury, March 2005; 19(3): 221–226

13. Algorithm 1 Brief Attention-based screening measure
Simple reaction time
UFOV-like test
Mass use and inexpensive; secretary-of state office

14. Algorithm 2 If failed, more extensive cognitive testing
measures with the highest odds ratio relationships to simulated crashes might be most efficient
Some measure of executive functioning should probably be included, perhaps a computerized version of the Wisconsin Card Sorting Task or a Trail Making Test
More expensive and time consuming

15. Algorithm 3
If performance on this evaluation suggests lack of capacity to drive safely
Choosing to accept the decision to suspend driving
standardized evaluation, with challenge, in a driving simulator and final decision

16. Basic need for research
Importance of measuring challenge
Need to do research in simulator
Goal – to start with a simple task which can be done in conjunction with standard driving evaluation
Algorithm:
Simple Task-> Neuropsychological Testing->Simulator Evaluation