My favorite cognitive test is a three-minute assessment known as the Mini-Cog. Often used during a senior’s routine check-up, the test requires the patient to remember a specific set of words while drawing the hands on a clock to indicate a certain time and then reciting the words uttered earlier.
The first time I took the test I could only recall three of the four words until the nurse provided some clues. There was no mention of any follow-up tests after I flunked that first attempt, which to my way of thinking makes it a very popular test. Who wants to dwell on their potential cognitive slippage?
Your loved ones or caregivers, on the other hand, might be curious about those results. And that’s why a new approach described last month in the journal Neurology may get some traction in the years to come. It would identify cognitive impairment by tracking an older adult’s driving patterns.
Ganesh Babulal, PhD, and his team of researchers at Washington University School of Medicine in St. Louis recruited 298 seniors with an average age of 75 — nearly one-fifth of whom had been diagnosed with mild cognitive impairment — and installed a GPS-tracking device in their vehicles. For more than three years, the team collected data on the participants’ driving behavior, tested their cognitive capacity annually, and discovered that how they operated a vehicle was a reliable indicator of neurological functioning.
“We found that, using a GPS data-tracking device, we could more accurately determine who had developed cognitive issues than [by] looking at just factors such as age cognitive test scores, and whether they had a genetic risk factor related to Alzheimer’s disease,” Babulal notes.
“We found that, using a GPS data-tracking device, we could more accurately determine who had developed cognitive issues than [by] looking at just factors such as age cognitive test scores, and whether they had a genetic risk factor related to Alzheimer’s disease,” Babulal notes.
The devices reported everything from frequency, duration, and distance of trips to speeding, abrupt braking, and route deviation. Analyzing this data, researchers were able to predict with 82 percent accuracy whether a participant had developed mild cognitive impairment. Despite the small, fairly homogenous sample (highly educated and white), Babulal believes the results could lead to a more effective public-health approach.
“Looking at people’s daily driving behavior is a relatively low-burden, unobtrusive way to monitor people’s cognitive skills and ability to function,” he says. “This could help identify drivers who are at risk earlier for early intervention, before they have a crash or near miss, which is often what happens now.”
This raises what, for many seniors and their loved ones, is a thorny question: How do you prepare for a time when you’re no longer cognitively capable of operating a vehicle? As you might expect, it’s not something most of us actively consider.
A recent University of Michigan survey shows that less than half of the nearly 3,000 seniors who responded to the poll had given much thought to when or how they would give up their car keys — even though a good portion of them admitted that they limited their driving under certain conditions. Fewer than one in five were aware of advance driving directives that would spell out conditions under which they’d stop driving. And just 6 percent said they’d discussed potential driving limitations with a healthcare provider.
“This demonstrates a major opportunity for primary care providers, vision-care professionals, occupational therapists, pharmacists, and others to discuss the potential impacts of specific conditions or medications on driving ability,” says Jeffrey Kullgren, MD, MPH, an associate professor of internal medicine at the University of Michigan Medical School, who directed the poll. “If an older adult is in the care of a specialist for a chronic condition such as arthritis, diabetes, or a neurological condition, or is having an operation, their specialists and surgical teams could also address potential driving impacts proactively.”
An advance driving directive, like the more common advance healthcare directive, describes the conditions under which an elderly driver would agree to give up their car keys and identifies specific people who are responsible for raising concerns when those conditions arise.
An advance driving directive, like the more common advance healthcare directive, describes the conditions under which an elderly driver would agree to give up their car keys and identifies specific people who are responsible for raising concerns when those conditions arise. The directive endorsed by the Alzheimer’s Association makes the process clear. By signing the nonbinding document, the driver states, “I understand that I may forget that I cannot drive anymore and may try to continue driving. If this happens, please know that I support all actions taken, including removing or disabling my car, to help ensure my safety and the safety of others.”
I’d be more than happy to give up driving if and when it becomes clear that I’m no longer comfortable behind the wheel (as long as I can still pedal a bike), but I’m less sanguine about tracking my driving patterns to determine my cognitive health. I’ve been known to hit 30 in a 25 miles-per-hour zone, I tend to sometimes interpret stop signs on city streets as an acronym for So Think Of Pausing, and just the other day I made a sudden left turn against traffic after realizing I was heading in the wrong direction.
Those sorts of transgressions under Babulal’s watchful eyes would likely suggest the need for further cognitive testing, and I’m guessing such prescribed assessments would be much more challenging than the Mini-Cog — even when I’m asked to remember four words rather than three.
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