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- Table 1.
Testing Order and Description of Questionnaire and Neuropsychological Tests of Older Drivers in Primary Care
Driving Questionnaire: An assessment of where, when, and how often and how far patients drive and a history of the patients’ crashes, violations, and ‘near misses,’ and driving self-appraisal of safety in driving over the two years prior to interview. Motor-Free Visual Perception Test, Visual Closure19: A multiple-choice test of visual perception. Participants are shown a card with a target figure and are asked to choose, from four choices of incomplete drawings, the one drawing that, if finished, would look like the target figure. Continuous Performance Task20: The patients are asked to use a test device that shows a screen flashing ‘X’s at the rate of about one per second. The task is to indicate that a complete ‘X’ was seen by pressing a button as rapidly as possible. Reaction time and accuracy are assessed. Visual Reproduction Test21: This is a test of immediate visual memory in which patients view a line drawing for 10 seconds and then must draw the design from memory. Four drawings are presented, one at a time. Trail-Making Test, Part A22: The patient is required to connect numbered dots on a page, 1 to 25, in order. The time to complete the task and the number of errors are recorded. Standardized Road Map of Directional Sense23: Patients trace a path through a simulated street map consisting of 32 possible right or left turns indicating correct directional judgment. Brief Test of Attention24: A tape recorder presents a series of interspersed digits and letters. In one condition, patients must count and report the number of digits presented. In the other condition, patients must count the number of letters presented. Mini-Mental State Examination2: An evaluation of cognitive performance including orientation to time and place, memory, and language. - Table 2.
Association of Test Scores and Crash Involvement in Primary Care Patients, as Shown to Family Physicians in Focus Groups
Test domain Odds Ratio* 95% Confidence Interval Attention 2.9 1.2–6.8 Visual closure 1.8 0.8–4.0 Reaction time 2.1 0.3–12.8 Directional sense 1.3 0.6–3.2 Trailmaking 2.1 0.9–5.2 Mini-Mental State Examination score <24 1.7 0.5–5.8 * Odds ratio represents the proportion of patients reporting involvement in crashes or near misses among persons in the poorest quintile of performance for each test compared to patients in the better performing quintiles.
▸ A 78-year-old woman with diabetes and hypertension who describes her overall health as ‘fair.’ ▸ She has been driving for 62 years. ▸ She reports that she drives anywhere but only during the daytime, in good weather, and not during rush hour. She reports driving between 11 and 50 miles per week for each of four roadway categories: in her neighborhood, in the city, on secondary roads, and on the freeway, for an estimated 6240 miles per year. ▸ She rates herself as 5/10 on ‘degree of safety while driving,’ where 10 is ‘extremely safe.’ ▸ She would ‘probably agree’ with the statement that her physician should be concerned about how well she drives and that she would follow her doctor’s advice about driving. Test Domain Quintile (5 = worst) Visual Closure 4 Reaction Time 3 Visual Memory 3 Trailmaking 3 Directional sense 5 Attention 5 Self-report Number reported Crashes in last 2 years 1 Near misses in last 2 years 12 Mini-Mental State Examination 25
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