Fitness to drive in older drivers with cognitive impairment

This paper is a literature review on assessment of fitness to drive in older drivers with cognitive impairment. Early studies on dementia and driving generally failed to distinguish between safe and unsafe drivers on the basis of cognitive test performance. Predictive studies demonstrated that cognitively impaired persons as a group perform significantly worse than controls on both neuropsychological and driving measures. A high prevalence of cognitive impairment was found in groups of older drivers involved in traffic accidents and crashes. However, a large range in neuropsychological test scores has been found. Low to moderate correlations could be established between neuropsychological test results and on-road driving performance, making it difficult to discriminate between cognitively impaired subjects who are fit or unfit to drive. The review concludes with a discussion of methodological difficulties in the field of dementia and driving, including participant selection, the choice of neuropsychological tests, and the operationalization of driving performance

Fitness to drive after traumatic brain injury

This paper deals with the issue of fitness to drive in patients suffering from traumatic brain injury (TBI). Guidelines for assessment are proposed and three types of studies are reviewed: studies about impairments of attention and information processing, studies of driving competence, and driver selection studies, applying and evaluating the procedures for assessing fitness to drive. From these reviews a relicensing rate emerges of slightly over 50% for very severe TBI patients. Failures in relicensing particularly occur in patients with a very long duration of post-traumatic amnesia (exceeding 1 month), and with severe impairments of perception and judgement. Furthermore, a review of studies describing training of driving competence in traumatically brain-injured patients is presented. It is argued that graded procedures for (re)training should be developed and assessment should extend to training advice and prediction of training success. When expanding assessments according to this suggestion, evaluation procedures should not only focus on operational capacities, but should include measures of executive functions and learning potential as well