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Reliability of the Washington University Road Test: A Performance-Based Assessment for Drivers With Dementia of the Alzheimer Type

Reliability of the Washington University Road Test: A Performance-Based Assessment for Drivers... Abstract Objective: To assess the reliability and stability of a standardized road test for healthy aging people and those with dementia of the Alzheimer type (DAT). Design: A prospective study involving patients with DAT and age-matched healthy controls in which subjects' driving performance was evaluated by several raters in an initial and a follow-up road test. Setting: Urban medical school and urban highways and streets. Subjects: A convenience sample of 58 controls, 36 subjects with very mild DAT, and 29 subjects with mild DAT. Results: Analysis of road test ability of controls (2 subjects [3%] failed the test), very mild DAT subjects (7 subjects [19%] failed), and mild DAT subjects (12 subjects [41%] failed) disclosed a significant association between driving performance and dementia status (X2[4] =20.65 [N=123];P<.001; Kendallτ-b=0.306). Interrater reliability for assessment of driving performance ranged from k=0.85 to 0.96. One-month test-retest stability on the road test was 0.76 (quantitative scoring) and 0.53 (clinical judgment). Conclusions: Dementia adversely affects driving performance even in its mild stages, although some persons with DAT seem to drive safely for some time after disease onset. A traffic-interactive, performance-based road test that examines cognitive behaviors provides an accurate and reliable functional assessment of driving ability. References 1. Drachman DA, Swearer JM. Driving and Alzheimer's disease: the risk of crashes . Neurology . 1993;43:2448-2456.Crossref 2. Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type . J Am Geriatr Soc . 1993;41:747-753. 3. Rosenbloom S. Transportation needs of the elderly population . Clin Geriatr Med . 1993;9:297-310. 4. Cooper P, Tallman K, Tuokko H, Beattie BL. Vehicle crash involvement and cognitive deficiency in older drivers . J Safety Res . 1993;50:9-17.Crossref 5. Lucas-Blaustein MJ, Filipp CL, Dungan C, Tune L. Driving in patients with dementia . J Am Geriatr Soc . 1988;36:1087-1091. 6. Friedland RP, Koss E, Kumar A. Motor vehicle crashes in dementia of the Alzheimer type . Ann Neurol . 1988;24:782-786.Crossref 7. Rizzo M, Dingus T. Driving in neurological disease . Neurologist . 1996;2:150-168. 8. Fitten LJ, Perryman KM, Wilkinson CJ, et al. Alzheimer and vascular dementias and driving: a prospective road and laboratory study . JAMA . 1995:273:1360-1365.Crossref 9. Odenheimer GL, Beaudet M, Jette AM, Albert MS, Grande L, Minaker K. Performance-based driving evaluation of the elderly driver: safety, reliability, and validity . J Gerontol A . 1994;49:153-159.Crossref 10. Berg L, Hughes CP, Coben LA, Danziger WL, Martin RL. Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population . J Neurol Neurosurg Psychiatry . 1982;45:962-968.Crossref 11. Morris JC, McKeel DW, Fulling K, Torack RM, Berg L. Validation of clinical diagnostic criteria for Alzheimer's disease . Ann Neurol . 1988;24:17-22.Crossref 12. Berg L, Morris JC. Diagnosis . In: Terry RD, Katzman R, Bick KL, eds. Alzheimer Disease . New York, NY: Raven Press; 1994:9-25. 13. Faber-Langendoen K, Morris JC, Knesvich JW, LaBarge E, Miller JP, Berg L. Aphasia in senile dementia of the Alzheimer type . Ann Neurol . 1988;23:365-370.Crossref 14. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment . Am J Psychiatry . 1983;140:734-739. 15. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia . Br J Psychiatry . 1982;140:566-572.Crossref 16. Morris JC. Clinical Dementia Rating (CDR): current version and scoring rules . Neurology . 1993;43:2412-2414.Crossref 17. Berg L, Miller JP, Storandt M, et al. Mild senile dementia of the Alzheimer type, 2: longitudinal assessment . Ann Neurol . 1988;23:477-484.Crossref 18. Burke WJ, Miller JP, Rubin EG, et al. Reliability of the Washington University Clinical Dementia Rating . Arch Neurol . 1988;45:31-32.Crossref 19. McCulla M, Coats M, VanFleet N, et al. Reliability of nurse specialists in the staging of dementia . Arch Neurol . 1989;46:1210-1211.Crossref 20. Morris JC, McKeel DW Jr, Storandt M. Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathological distinction from normal aging . Neurology . 1991;37:1119-1124. 21. Rubin EH, Morris JC, Grant EA, Vendegna T. Very mild senile dementia of the Alzheimer type, 1: clinical assessment . Arch Neurol . 1989;46:379-382.Crossref 22. Berg L, McKeel DW Jr, Miller JP, Baty J, Morris JC. Neuropathologic indexes of Alzheimer's disease in demented and nondemented people aged 80 years and older . Arch Neurol . 1993;50:349-358.Crossref 23. Ratz M. An Evaluation of the California Drive Test in Theme and Variation, Volume 1: Treatment Development and Preliminary Evaluation . Sacramento: State of California; 1978:1-84. 24. McKnight AJ, Stewart MA. Development of a Competency Based Driver License Testing System . Landover, Md: National Public Services Research Institute; 1990. 25. Cushman LA. Cognitive capacity and concurrent driving performance in older drivers . J Int Assoc Traffic Safety Sci Res . 1996;20:38-45. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Reliability of the Washington University Road Test: A Performance-Based Assessment for Drivers With Dementia of the Alzheimer Type

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1997.00550180029008
Publisher site
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Abstract

Abstract Objective: To assess the reliability and stability of a standardized road test for healthy aging people and those with dementia of the Alzheimer type (DAT). Design: A prospective study involving patients with DAT and age-matched healthy controls in which subjects' driving performance was evaluated by several raters in an initial and a follow-up road test. Setting: Urban medical school and urban highways and streets. Subjects: A convenience sample of 58 controls, 36 subjects with very mild DAT, and 29 subjects with mild DAT. Results: Analysis of road test ability of controls (2 subjects [3%] failed the test), very mild DAT subjects (7 subjects [19%] failed), and mild DAT subjects (12 subjects [41%] failed) disclosed a significant association between driving performance and dementia status (X2[4] =20.65 [N=123];P<.001; Kendallτ-b=0.306). Interrater reliability for assessment of driving performance ranged from k=0.85 to 0.96. One-month test-retest stability on the road test was 0.76 (quantitative scoring) and 0.53 (clinical judgment). Conclusions: Dementia adversely affects driving performance even in its mild stages, although some persons with DAT seem to drive safely for some time after disease onset. A traffic-interactive, performance-based road test that examines cognitive behaviors provides an accurate and reliable functional assessment of driving ability. References 1. Drachman DA, Swearer JM. Driving and Alzheimer's disease: the risk of crashes . Neurology . 1993;43:2448-2456.Crossref 2. Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type . J Am Geriatr Soc . 1993;41:747-753. 3. Rosenbloom S. Transportation needs of the elderly population . Clin Geriatr Med . 1993;9:297-310. 4. Cooper P, Tallman K, Tuokko H, Beattie BL. Vehicle crash involvement and cognitive deficiency in older drivers . J Safety Res . 1993;50:9-17.Crossref 5. Lucas-Blaustein MJ, Filipp CL, Dungan C, Tune L. Driving in patients with dementia . J Am Geriatr Soc . 1988;36:1087-1091. 6. Friedland RP, Koss E, Kumar A. Motor vehicle crashes in dementia of the Alzheimer type . Ann Neurol . 1988;24:782-786.Crossref 7. Rizzo M, Dingus T. Driving in neurological disease . Neurologist . 1996;2:150-168. 8. Fitten LJ, Perryman KM, Wilkinson CJ, et al. Alzheimer and vascular dementias and driving: a prospective road and laboratory study . JAMA . 1995:273:1360-1365.Crossref 9. Odenheimer GL, Beaudet M, Jette AM, Albert MS, Grande L, Minaker K. Performance-based driving evaluation of the elderly driver: safety, reliability, and validity . J Gerontol A . 1994;49:153-159.Crossref 10. Berg L, Hughes CP, Coben LA, Danziger WL, Martin RL. Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population . J Neurol Neurosurg Psychiatry . 1982;45:962-968.Crossref 11. Morris JC, McKeel DW, Fulling K, Torack RM, Berg L. Validation of clinical diagnostic criteria for Alzheimer's disease . Ann Neurol . 1988;24:17-22.Crossref 12. Berg L, Morris JC. Diagnosis . In: Terry RD, Katzman R, Bick KL, eds. Alzheimer Disease . New York, NY: Raven Press; 1994:9-25. 13. Faber-Langendoen K, Morris JC, Knesvich JW, LaBarge E, Miller JP, Berg L. Aphasia in senile dementia of the Alzheimer type . Ann Neurol . 1988;23:365-370.Crossref 14. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment . Am J Psychiatry . 1983;140:734-739. 15. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia . Br J Psychiatry . 1982;140:566-572.Crossref 16. Morris JC. Clinical Dementia Rating (CDR): current version and scoring rules . Neurology . 1993;43:2412-2414.Crossref 17. Berg L, Miller JP, Storandt M, et al. Mild senile dementia of the Alzheimer type, 2: longitudinal assessment . Ann Neurol . 1988;23:477-484.Crossref 18. Burke WJ, Miller JP, Rubin EG, et al. Reliability of the Washington University Clinical Dementia Rating . Arch Neurol . 1988;45:31-32.Crossref 19. McCulla M, Coats M, VanFleet N, et al. Reliability of nurse specialists in the staging of dementia . Arch Neurol . 1989;46:1210-1211.Crossref 20. Morris JC, McKeel DW Jr, Storandt M. Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathological distinction from normal aging . Neurology . 1991;37:1119-1124. 21. Rubin EH, Morris JC, Grant EA, Vendegna T. Very mild senile dementia of the Alzheimer type, 1: clinical assessment . Arch Neurol . 1989;46:379-382.Crossref 22. Berg L, McKeel DW Jr, Miller JP, Baty J, Morris JC. Neuropathologic indexes of Alzheimer's disease in demented and nondemented people aged 80 years and older . Arch Neurol . 1993;50:349-358.Crossref 23. Ratz M. An Evaluation of the California Drive Test in Theme and Variation, Volume 1: Treatment Development and Preliminary Evaluation . Sacramento: State of California; 1978:1-84. 24. McKnight AJ, Stewart MA. Development of a Competency Based Driver License Testing System . Landover, Md: National Public Services Research Institute; 1990. 25. Cushman LA. Cognitive capacity and concurrent driving performance in older drivers . J Int Assoc Traffic Safety Sci Res . 1996;20:38-45.

Journal

Archives of NeurologyAmerican Medical Association

Published: Jun 1, 1997

References