Sophia Vardaki, Anne E. Dickerson, Ion Beratis, George Yannis, Sokratis G. Papageorgiou; Simulator Measures and Identification of Older Drivers With Mild Cognitive Impairment. Am J Occup Ther 2016;70(2):7002270030. https://doi.org/10.5014/ajot.2016.017673
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© 2021 American Occupational Therapy Association
This study examined whether a sign recall task on a driving simulator, self-report of driving ability, or age predicted differences in performance between drivers with mild cognitive impairment (MCI) and control participants. For the dependent measure, gathered using a driving simulator, working memory was subjected to interference at varying levels of driving task demands. Reliable between-groups differences in sign recall accuracy were demonstrated; recall declined under higher task demands. Recall scores, self-reported frequency of avoiding driving, and driver age did not predict MCI; only self-reported decline in global driving ability was significant. Findings support the use of driving simulators in practice and suggest that screening for age-related cognitive impairment should incorporate self-reported changes in driving proficiency for early identification of drivers who merit medical review. The results, although exploratory, have implications for practitioners.
In TC1, drivers experienced the lowest level of demand and were required to respond only to operational-level driving tasks.
In TC2, drivers made a double lane change that involved driving through a roadwork section containing large blocks (barriers) on each side of the road, causing the road to progressively narrow (1:20 taper ratio; lane width 3 m). These requirements were designed to produce an intermediate level of demand; thus, demand in this scenario was higher than in TC1.
In TC3, drivers were presented with the same roadwork section and associated steering requirements as in TC2, but after the forced lane changes, they were required to execute an additional lane change if a discriminative stimulus (activation of the brake lights on a lead vehicle) was presented. This decision rule was included in the predrive instructions. The addition of this working memory task was designed to result in the highest level of demand in this scenario.
Self-reported global changes in driving, the only significant factor in predicting a diagnosis of MCI, is important for practitioners to consider and can be assessed by asking the client an easy, informal question.
The trend toward poorer performance for the MCI group in simulator measures supports the use of interactive driving simulators in clinical settings with clients as a screening or assessment tool for MCI or for driving abilities.
The concept of grading driving simulator activity protocols by increasing task demands through a series of driving scenarios may increase the viability of using driving simulation as a critical intervention strategy.
The use of memory tasks and increased demands on relatively straight roads (rather than turns) allows clinicians to use the simulator with more clients by avoiding movements that increase the symptoms of simulator adaptation syndrome, more prevalent among older adults.
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