Cognitive impairment affecting self-regulation practises | CIA – Dove Medical Press

Cognitive impairment affecting self-regulation practises | CIA – Dove Medical Press


Driving is a complex activity, which requires the coordination of visual, physical and cognitive skills by an individual.1 In older drivers, the natural aging process can cause a decline in one, if not all three of these skills. Consequently, any changes in these abilities is likely to impact on their driving performance and behaviour.2,3

Driver self-regulation is a strategy used by older drivers to modify or restrict their driving to compensate for any decline in functional abilities.4 It can minimize their driving in hazardous situations while maintaining their independence and mobility.4 Self-awareness and perception are key components in driver self-regulation practices5; however for drivers with cognitive conditions such as dementia or mild cognitive impairment (MCI), deficits in cognitive ability may lead to inadequate self-regulation practices.6

Mild cognitive impairment (MCI) is a transitional cognitive state between normal cognitive aging and dementia, which affects approximately 20% of older adults aged 65+ years.7,8 Although cognitive decline may not be severe enough to impact activities of daily living, more demanding tasks such as driving may present challenges. Previous studies found that drivers with MCI were more likely to perform worse in on-road driving assessments in regards to driving errors and driver safety, when compared with drivers without cognitive impairment.9–11 Driving simulator studies also found that drivers with MCI had a shorter mean time to collision (time to contact the preceding vehicle if car is moving under constant velocity),12 were less likely to comply with stop signs13 and had greater trouble maintaining a proper headway from the vehicle in front.14 Drivers with MCI were also found to restrict their overall driving exposure,15,16 as well as limiting their driving in certain situations including on high-density roads,17 in wet conditions18 and at night.18 While most studies have found that drivers with cognitive impairment are more likely to undertake self-regulation practices, some studies have found no difference in self-regulation practices between drivers with and without MCI. A study by Katsouri et al found that self-reported avoidance of certain driving situations, such as driving at night or when it was raining, was not significantly different between drivers with MCI and healthy controls.19 Similarly, a more recent study by Vardaki et al found that both drivers with and without MCI showed similar patterns and frequency in driving situations including driving at night, driving in the rain and driving over long distances.20

Although there is significant research examining self-regulation patterns for drivers with MCI and without cognitive impairment, these were cross-sectional studies.17–20 However, examining changes in self-regulation practices can be particularly pertinent for older drivers with MCI due to the dynamic nature of the condition. One study which examined longitudinal changes in self-regulation practices in older drivers concluded that increases in self-regulation behaviour did not occur in conjunction with declines in functional abilities including vision and visual attention.21 An added complexity to examining changes in self-regulation practices is that while a diagnosis of MCI may increase the risk of developing dementia (~4–6% conversion per year in the community)22 many older adults with MCI may transition back to normal …….