Changes in Driving Behavior Can Predict Cognitive Decline

A study of 131 older adults shows that driving behavior may be a good way to identify Alzheimer’s disease before other symptoms appear.

What: A study of 131 older adults shows that driving behavior may be a good way to identify Alzheimer’s disease before other symptoms appear.

Where: Babulal GM et al., “Identifying Preclinical Alzheimer’s Disease Using Everyday Driving Behavior: Proof of Concept,” Journal of Alzheimer’s Disease, 2021.

BrightFocus Connection: This project is supported by an Alzheimer’s Disease Research grant to first author Ganesh Babulal, PhD, of Washington University School of Medicine in St. Louis, MO.

Why It Is Important: Before overt Alzheimer’s disease (AD) symptoms show up, there is a period called preclinical AD – where AD-related changes can be detected in the brain, but do not result in obvious cognitive deficits. In previous work, researchers found that elevated levels of tau protein and widespread amyloid plaques detected by brain imaging are associated with more increased driving errors on a road test, and not necessarily with decreases in performance on traditional tests of cognitive function. In a new study, a team led by Dr. Babulal explored whether evaluation of driving behavior allows researchers to detect the subtle changes in cognition during preclinical AD that might be missed by traditional testing.

Between 2015 and 2019, Dr. Babulal and colleagues studied 131 adults over the age of 65 who received traditional cognitive assessments along with other tests measuring levels of tau protein and amyloid plaques in their brain (cerebral spinal fluid analysis and PET imaging). The researchers also installed GPS devices in participants’ vehicles that collected information about their driving behaviors, including length and frequency of trips, and how often they braked hard, accelerated suddenly, and drove above the speed limit. This technology, which they developed, is called the Driving Real-World In-Vehicle Evaluation System (DRIVES).

The team determined that it is possible to predict preclinical AD using the driving assessment alone, meaning that driving behavior could be a useful indicator of cognitive decline or AD progression. The researchers were able to identify AD even more accurately when they considered driving behaviors alongside the age of the subject, whether or not they had a version of the APOE gene that increased their risk of developing AD, and how they scored on traditional cognitive tests.

With support from BrightFocus, Dr. Babulal and colleagues plan to further develop their DRIVES system to explore how driving—a complex daily activity – could be combined with other biomedical information to predict both AD onset and stages of AD in various groups of people. This assessment of driving behavior potentially carries other benefits. According to the CDC, older adults account for about 19 percent of motor vehicle fatalities in the US, with 20 individuals killed and 700 injured each day in traffic accidents. Monitoring driving behavior and alerting the driver or their family members to unsafe driving could decrease the risk of death and injury from traffic collisions.