Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review

Abstract

Evidence has shown that although all individuals with dementia will eventually need to stop driving, most can continue to drive safely early in the disease. Fitness to drive needs to be monitored, and the use of cognitive testing to determine driver safety has been suggested. This review is the first to examine cognitive test results pertaining only to individuals with dementia. The aim was to examine the relationship between cognitive tests and driving to determine whether a cognitive assessment can be implemented as a tool to examine driver safety. A systematic review of 28 studies investigating the relationship between cognitive functioning and driving in individuals with dementia was conducted. The results of this review demonstrated a lack of consistency in the findings, with some studies showing a relationship between cognitive testing and driving performance for individuals with dementia, whereas others did not. Results relating to individual cognitive tests and measures confined to a single cognitive domain were variable and not consistently associated with driving performance. Studies consistently found that composite batteries predicted driving performance. The findings from this review support the use of composite batteries comprising multiple individual tests from different cognitive domains in predicting driving performance for individuals with dementia. Scores on individual tests or tests of a single cognitive domain did not predict driver safety. The composite batteries that researchers have examined are not clinically usable because they lack the ability to discriminate sufficiently between safe and unsafe drivers. Researchers need to develop a reliable, valid composite battery that can correctly determine driver safety in individuals with dementia.

Keywords: cognitive assessment; dementia; driving.