Millions of drivers may have a mild or other form of dementia.  Sometimes the symptoms are obvious.  Other times, they are not.  Drivers with dementia may not recognize the symptoms and, hence, may lack the ability to acknowledge that they have dementia and cease driving, if necessary.  This is a public health hazard that needs to be addressed:  Studies show that the incidence of dementia is expected to jump 400% over the next twenty years.¹  As people live longer and extend their mobility, more and more drivers may have symptoms of dementia and pose crash risks to themselves and other motorists.  Many dementia drivers, especially of the Alzheimer’s type, may continue to drive well into a disease that persists 8 to 10 years after the onset of symptoms.²  The recent verdict associated with the Santa Monica food market tragedy, where a driver with alleged cognitive impairment killed 10 people and injured more than 70 others, underscores the need for online cognitive screening tools and driver's license test and policy reforms.

Although dementia, typically characterized by loss of cognitive function due to brain disease or trauma,  can occur at any age, the greatest risk factor is increasing age. ³  Alzheimer’s disease, the most common form of dementia, appears in nearly 10 percent of all people age 65 years and older and approximately 50 percent of all people age 85 years and older. ⁴

According to Carr et al.⁵,  some of the symptoms of unsafe driving may include:

• Crashes

• Dents on car

• Difficulty understanding traffic signs

• Driving too fast or too slow

• Failure to notice street signs

• Getting lost in familiar areas

• Indecent gestures or horn honking from other drivers

• Miscalculating speed and distances

• "Near misses"

• Poor judgment

• Tickets for traffic violations

• Tunnel vision

Land Transport New Zealand ⁶ recommends a quick sign test (also available through SpecialtyAutomated) and notes additional warnings that may be associated with the early signs of dementia :

• confusion when stopping and changing lanes

• ignoring traffic lights and signs — confusing the color or order of the lights or failing to notice traffic lights, Stop signs or Give Way (Yield) signs

In some places, such as Ontario, Canada, physicians are required by law to report patients who have medical conditions that may negatively impact their driving performances. ²  Yet, most physicians are not trained to detect dementia drivers or other at-risk drivers.  Most physicians may not know how to identify these diseases in their patients without the use of specialized equipment or actual driving observations.  Others may not want to risk liability or jeopardize the physician/ patient relationship when the subject of driving and dementia need to be addressed. ³  In the USA, licensing agencies usually review anonymous and signed tips that address concerns about a driver's ability to drive.

It is important to note that diagnosis of a neuropsychologic or neuromotor disorder does not imply driving impairment. ³   However, in some cases, these diseases, especially in advanced stages, may disallow the safe operation of motor vehicles. 

The Clock Drawing Test is one of two cognition tests recommended by the American Medical Association (AMA) and the National Highway Traffic Safety Administration (NHTSA) for conducting a driving evaluation.  We offer both tests online, including the Trail Making Test, Part B.  No other cognitive tests are as sensitive or as powerful.   Online Trail Making Tests ™and Automatic Clock Drawing Tests ™supersede the recommendation for the cognitive testing component identified in the Automated Driver’s License Test and Vision Screening System, FHWA-AZ-05-559(1).

Abnormal scores on the Clock Drawing Test are associated with an increased crash risk and may also indicate the need for  further evaluation.⁷  Clock drawing tests, uniquely,  measure  attention, executive function, memory, and visuospatial skills. ⁵

Periodic screening with rapid, validated, and computerized tests, such as the Automatic Clock Drawing Test , will ensure that all drivers are cognitively screened and those with symptoms may be monitored on an ongoing basis so they may continue to drive as long and as safely as possible. ⁸

While there are various stages and varieties of dementia, it is necessary to periodically test drivers because conventional testing methods and self-screening assessments may not easily detect this condition. ³   No driver's license division requires or offers automated cognitive screening tests.  The current methods of driver's license tests are inadequate and therefore require significant improvement.^{9, 10 , 11 , 12}

Although driving is a complex activity, it should never jeopardize the life of the driver or another motorist.  The decision to report, monitor, or revoke the driver's license of a dementia driver should involve family members, driver's license staff members, and the police.  Alternative methods of transportation should be discussed. 

Furthermore, Automatic Clock Drawing Tests ™ are also a truly green approach to cognitive testing since no paper, software, CD-ROMs, and DVDs are needed.  Trees are therefore saved and landfills are reduced when online tests are administered on the Internet.

To find out more about the Automatic Clock Drawing Tests ™, please view our list of products, our catalog, or contact us.

FEATURED PRODUCTS

Our Automatic Clock Drawing Test ™ is featured
at the Advancement for Assistive Technology
of Europe, AAATE 2007

OCTOBER 2007

SpecialtyAutomated ™ is pleased to announce that its Automatic Clock Drawing Test™  was featured as part of the presentation and accompanying paper, “Standardization and
Computerization of the Clock Drawing Test: The Automatic Clock Drawing Test ™” at
Session 3, Dementia, at the 9th European Conference for the Advancement of
Assistive Technology in Europe, AAATE 2007, 3- 5 October 2007, in San Sebastián, Spain.
According to the AAATE website, the AAATE is an “….interdisciplinary pan-European association devoted to all aspects of assistive technology, such as use, research,
development, manufacture, supply, provision and policy” "to stimulate the advancement of
assistive technology for the benefit of people with disabilities, including elderly people".  Participants included government officials and clinicians from across the Europe and other
continents. A Director from Microsoft provided the keynote speech.

Our Automatic Clock Drawing Test is showcased at a University of Minnesota presentation

APRIL 2008

In April 2008, the Automatic Clock Drawing ™ was featured at a University of Minnesota presentation.  The topic was driver safety and safety within the transportation infrastructure.  Attendees from academia, the public sector, and various industries found the presentation to be very informative; the products, innovative and cutting edge.  A shortened version of the presentation is viewable at:

http://www.alumni.umn.edu/sites/d2e2f762-6a18-437f-ad49-168669330020/uploads/cognitive_testing.pdf

Importantly, it is now known that the Automatic Clock Drawing Test ™ more than satisfies the cognition test component of the Automated Driver's License Test.  In fact, it offers technological advances that are sorely lacking in other cognitive tests  that were initially reviewed and recommended. 

SpecialtyAutomated is finalist for prestigious award in technology due in part to the Automatic Clock Drawing Test ™

MAY 2008

SpecialtyAutomated was nominated for a prestigious award, the SFBJ 08 Technology Award, which recognizes the technological achievements of the high-tech firms in Florida.

SpecialtyAutomated is now a finalist for this award.  Other finalists include computer giant, Hewlett Packard. 

Testimonials

"Using online testing systems, such as the SpecialtyAutomated Automatic Clock Drawing Tests ™ .... enable testing to be done more quickly, ensure that the potential for tester bias is virtually eliminated, and in general conserve time and resources.   Seeing the Automatic Clock Drawing Test ™ work at Mae Volen was fascinating -- the seniors easily adapted to the computer-based testing and appeared to look upon taking the test as a personal challenge.  More importantly, the results of online testing mirrored the results that we know were obtained using the traditional assessments done of the individuals who used the automated tests.  And, in some cases the Automatic Clock Drawing Tests ™ identified individuals who had not  yet been formally diagnosed with a cognitive disorder. In sum, the  SpecialtyAutomated testing methods worked and worked quickly." 

Brenda K. Bryant, Vice President  Mae Volen Senior Center        

About the Mae Volen Senior Center

In 2008, the Mae Volen Senior Center will celebrate 40 years of serving  seniors in South Florida.  The Center provides a continuum of services to the South Florida community, ranging from in-home services, private care management, and adult day care to support groups and active senior programming like computer classes.  The Center emphasizes intergenerational living, provides activities that acknowledge what seniors can do, and strives to ensure that seniors and their families experience the joys of life, throughout life.

Mae Volen is a premier Senior facility that will soon celebrate its 40th year.  Happy Birthday, Mae Volen!

 

References

1 .    Whitmer, R.A.,, E. P. Gunderson, E. Barrett-Connor, C. P. Quesenberry Jr, K. Yaffe. 2005. “Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study.” British Medical Journal, doi:10.1136/bmj.38446.466238.E0  (published 29 April 2005). 2.    Hopkins, R. W., L. Kilik, D. J. A. Day, C. Rows, and H. Tseng. 2004. “Driving and Dementia in Ontario: A Quantitative Assessment of the Problem.” Canadian Journal of Psychiatry 49: 7: 434- 438. 3.     Straus, S. 2005. “New, Improved, Comprehensive and Automated Driver’s License Test and Vision Screening System”, Department of Transportation and Federal Highway Administration, FHWA-AZ-04-559(1). HTML. Sections. 4.     Evans, D.A., H. H. Funkenstein, and M. S. Albert. 1989. Prevalence of Alzheimer’s Disease in a Community Population of Older Persons: Higher than Previously Reported.  Journal of the American Medical Association 262:18: 2552 – 2556. 5.     Carr DB, Duchek JM, Meuser TM, Morris JC. 2006.  Older adult drivers with cognitive impairment.  Am Fam Physician. 2006 Mar 15;73(6):1029-34. 6.     Land Transport New Zealand. 2006. Factsheet 23- Dementia & Driving. 7.     American Medical Association (AMA), in conjunction with the National Highway Traffic Safety Administration. 2003.  Physician’s Guide to Assessing and Counseling Older Drivers. 8.      Straus, S. 2006.  "Improving Medical Care and Knowledge Through New and Rapid Automated Cognitive Impairment Screening Tools,"  Annals of Family Medicine, Electronic letter, Dec  2006. 9     Straus, S. 2005. “New, Improved, Comprehensive and Automated Driver’s License Test   and Vision Screening System”, Department of Transportation and Federal Highway Administration, FHWA-AZ-04-559(1), Research Note. 10.     Straus, S. 2005. “A Call for Transportation License Reforms”.  Presented to the United States Department of Transportation, Washington, DC, 28 September 2005. 11.    Straus, S. 2007.  Use of the Automatic Clock Drawing Test to rapidly screen for cognitive impairment in older adults, drivers, and the physically challenged. Journal of the American Geriatrics Society, Volume 55, Issue 2: 310-311. doi: 10.1111/j.1532-5415.2007.01055.x 12.    Straus, S. H. 2007.  "Standardization and Computerization of the Clock Drawing Test." Assistive Technology Research Series, Volume 20, 2007 Challenges for Assistive Technology - AAATE 07, Edited by Gorka Eizmendi, José Miguel Azkoitia, Gerald Craddock, ISBN 978-1-58603-791-8,  pp. 248- 253.

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