On-road driving test performance in veterans: Effects of age, clinical diagnosis and cognitive measures

John P.K. Bernstein, Tonya Rich, Stefanie McKnight, Julie Mehr, John Ferguson, Adriana Hughes

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Veterans are at heightened risk of being in a motor-vehicle crash and many fail on-road driving evaluations, particularly as they age. This may be due in part to the high prevalence of age-associated conditions impacting cognition in this population, including neurodegenerative diseases (e.g., Alzheimer's Disease) and acquired neurological conditions (e.g., cerebrovascular accident). However, understanding of the impact of referral diagnosis, age and cognition on Veterans’ on-road driving performance is limited. Methods: 109 Veterans were referred for a driving evaluation (mean age = 72.0, SD = 11.5) at a driving assessment clinic at the Minneapolis Veterans Affairs Healthcare System. Of the 109 Veterans enrolled, 44 were referred due to a neurodegenerative disease, 37 due to an acquired neurological condition, and 28 due to a non-neurological condition (e.g., vision loss). Veterans completed collection of health history information and administration of cognitive tests assessing visual attention, processing speed, and executive functioning, as well as a standardized, on-road driving evaluation. Results: A total of 17.9% of Veterans failed the on-road evaluation. Clinical diagnostic group was not associated with failure rate. Age was not associated with failure rates in the full sample or within diagnostic groups. After controlling for age, poorer processing speed and selective/divided attention were associated with higher failure rates in the full sample. No cognitive tests were associated with failure rates within diagnostic groups. Conclusion: Referral diagnosis and age alone are not reliable predictors of Veterans’ driving performance. Cognitive performance, specifically speed of processing and attention, may be helpful in screening Veterans’ driving safety. Practical Applications: Clinicians tasked with assessing Veterans’ driving safety should take into account cognitive performance, particularly processing speed and attention, when making decisions regarding driving safety. Age and referral diagnosis, while helpful information, are insufficient to predict outcomes on driving evaluations.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalJournal of Safety Research
StatePublished - Jun 1 2021

Bibliographical note

Funding Information:
We thank the Veterans who participated in this study. We also thank Jessica Kiecker, OTR/L, DRS and David Lawler, OTR/L, CDRS who completed a portion of the pre-screens and the on-road assessments.

Publisher Copyright:
© 2021


  • Attention
  • Cognition
  • Driving
  • Older adults
  • Processing speed

PubMed: MeSH publication types

  • Journal Article


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