TY - JOUR
T1 - The utility of the Montreal Cognitive Assessment in predicting need for fitness to drive evaluations in older adults
AU - Kandasamy, Deepika
AU - Williamson, Kayla
AU - Carr, David B.
AU - Abbott, Diana
AU - Betz, Marian E.
N1 - Funding Information:
Funding Sources: This work was supported by a Paul Beeson Career Development Award Program [The National Institute on Aging; AFAR; The John A. Hartford Foundation; and The Atlantic Philanthropies; grant number K23AG043123]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies. No sponsor had any direct involvement in study design, methods, subject recruitment, data collection, analysis, or manuscript preparation.Conflicts of Interest: David B. Carr, MD receives support from NIA, NEI, Missouri Department of Transportation, and Encompass Health and has had consulting relationships in the last two years with the National Alzheimer's Association, The Traffic Injury Research Foundation, Sunnybrook Research Institute (University of Toronto), Medscape, and the AAA Foundation for Traffic Safety (East Carolina University). None of the other authors have any conflicts of interest to disclose.
Funding Information:
This work was supported by a Paul Beeson Career Development Award Program [The National Institute on Aging ; AFAR ; The John A. Hartford Foundation ; and The Atlantic Philanthropies ; grant number K23AG043123 ]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies. No sponsor had any direct involvement in study design, methods, subject recruitment, data collection, analysis, or manuscript preparation.
Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - Objectives: With age, older adults (≥65 years) become increasingly vulnerable to cognitive disorders that may impair driving ability. Health practitioners are often tasked with screening older drivers and may recommend fitness to drive (FTD) evaluations for those potentially needing driving rehabilitation or cessation. Here, we examine whether the Montreal Cognitive Assessment (MoCA), which mainly tests cognitive ability, may identify older adults who might benefit from FTD testing. Methods/design: 264 older drivers (≥65 years), recruited from three primary care clinics, completed the MoCA and FTD evaluation. We compared literature-based MoCA cut-points (≥26 and < 26, respectively) and sensitivity analysis-determined MoCA cut-points to participant demographic and health characteristics as related to their ability to predict FTD score. Results: Median age was 73, 89% were White, and 54% were male. Most (83%) had abnormal (fail or conditional pass) FTD test outcomes. Overall, 57% had abnormal literature-based MoCA scores. For participants with abnormal MoCA scores (<26), increasing 4-m Gait Speed test scores (OR = 11.81) and age (OR = 1.05) increased odds of abnormal FTD test scores. For those with normal MoCA scores (26–30), self-reported excellent health status versus fair health decreased likelihood of abnormal FTD test scores (OR = 0.33) while being female increased likelihood (OR = 2.93). Sensitivity analysis determined a separate abnormal MoCA score cutoff (<28); 81% had abnormal MoCA scores and were more likely to have abnormal FTD scores with increasing age (OR = 1.07). Those with normal MoCA scores (28–30) experienced increased likelihood of abnormal FTD scores when female (OR = 4.97) and decreased likelihood when they were able to follow road signs (OR = 0.12). Discussion: MoCA may be valuable when identifying those who might benefit from FTD evaluations among those with both normal and abnormal cognitive function, especially when accounting for factors like gait speed, age, and gender. Future research should further explore these factors’ roles in predicting abnormal FTD test outcomes.
AB - Objectives: With age, older adults (≥65 years) become increasingly vulnerable to cognitive disorders that may impair driving ability. Health practitioners are often tasked with screening older drivers and may recommend fitness to drive (FTD) evaluations for those potentially needing driving rehabilitation or cessation. Here, we examine whether the Montreal Cognitive Assessment (MoCA), which mainly tests cognitive ability, may identify older adults who might benefit from FTD testing. Methods/design: 264 older drivers (≥65 years), recruited from three primary care clinics, completed the MoCA and FTD evaluation. We compared literature-based MoCA cut-points (≥26 and < 26, respectively) and sensitivity analysis-determined MoCA cut-points to participant demographic and health characteristics as related to their ability to predict FTD score. Results: Median age was 73, 89% were White, and 54% were male. Most (83%) had abnormal (fail or conditional pass) FTD test outcomes. Overall, 57% had abnormal literature-based MoCA scores. For participants with abnormal MoCA scores (<26), increasing 4-m Gait Speed test scores (OR = 11.81) and age (OR = 1.05) increased odds of abnormal FTD test scores. For those with normal MoCA scores (26–30), self-reported excellent health status versus fair health decreased likelihood of abnormal FTD test scores (OR = 0.33) while being female increased likelihood (OR = 2.93). Sensitivity analysis determined a separate abnormal MoCA score cutoff (<28); 81% had abnormal MoCA scores and were more likely to have abnormal FTD scores with increasing age (OR = 1.07). Those with normal MoCA scores (28–30) experienced increased likelihood of abnormal FTD scores when female (OR = 4.97) and decreased likelihood when they were able to follow road signs (OR = 0.12). Discussion: MoCA may be valuable when identifying those who might benefit from FTD evaluations among those with both normal and abnormal cognitive function, especially when accounting for factors like gait speed, age, and gender. Future research should further explore these factors’ roles in predicting abnormal FTD test outcomes.
KW - Cognitive screening
KW - Mobility counseling
KW - Older drivers
UR - http://www.scopus.com/inward/record.url?scp=85062893533&partnerID=8YFLogxK
U2 - 10.1016/j.jth.2019.03.005
DO - 10.1016/j.jth.2019.03.005
M3 - Article
AN - SCOPUS:85062893533
SN - 2214-1405
VL - 13
SP - 19
EP - 25
JO - Journal of Transport and Health
JF - Journal of Transport and Health
ER -