Advertisement

Differences in Driving Outcomes Among Cognitively Normal African American and Caucasian Older Adults

  • Ganesh M. BabulalEmail author
  • Sarah H. Stout
  • Monique M. Williams
  • Ganesh Rajasekar
  • Annie Harmon
  • Jonathon Vivoda
  • Megan Zuelsdorff
  • Tammie L.S. Benzinger
  • John C. Morris
  • Beau Ances
  • Catherine M. Roe
Article
  • 12 Downloads

Abstract

Objective

To examine the effect of race in driving performance and behavior prospectively among cognitively normal older adults.

Methods

Cognitively normal participants (Clinical Dementia Rating 0), ≥ 65 years of age (n = 177) were selected from prospective, longitudinal studies at the Knight Alzheimer Disease Research Center at Washington University. Self-reported driving behavior (Driving Habits Questionnaire) and driving performance (road test) were annually assessed. Daily driving behavior data were collected using the Driving Real World In-Vehicle Evaluation System (DRIVES). Baseline differences between African Americans and Caucasians were tested using t tests and general linear models. Amyloid imaging and cerebrospinal fluid Alzheimer disease (AD) biomarkers were compared across groups. Linear mixed models examined change in daily driving behavior over time. Survival analyses tested time to a marginal or fail rating on the road test.

Results

There were no differences between African Americans (n = 34) and Caucasians (n = 143) in age, sex, education, or vascular risk factors. Baseline self-reported driving behavior and road test performance were largely similar for both races. Longitudinal analyses using the DRIVES data aggregated monthly showed that African Americans had a greater reduction in number of trips made per month, miles driven per month, and trips with aggressive behavior compared to Caucasians. These effects remained after controlling for AD biomarkers, age, education, and sex.

Conclusions

In this sample of cognitively normal older adults, African Americans had a greater reduction of daily driving behavior compared to Caucasians. Observed racial differences may reflect differences in environmental/social factors, changes in cognition, and/or physical functioning.

Keywords

Alzheimer’s disease African Americans Older adults Driving Race 

Notes

Acknowledgments

The authors thank the participants, investigators/staff of the Knight ADRC Clinical, Biomarker, Genetics, and Neuroimaging Cores, and the investigators/staff of the Driving Performance in Preclinical Alzheimer’s Disease study (R01-AG056466).

Author Contribution

Study concept and design (GB, CR), data acquisition (GM, GR, BA, CR), data analysis (GB, GR, CR), and interpretation (GB, GR, SS, MW, JV, AH, MZ, BA, CR), drafting (GB, CR), and critical revision of manuscript (GB, GR, SS, MW, JV, AH, MZ, TLSB, JCM, BA, CR).

Funding Information

Funding for this study was provided by the Alzheimer’s Association [AARFD-16-439140]; the National Institute on Aging [R03-AG055482, R01-AG056466, R01-AG043434, R01-AG43434-03S1, P50-AG05681, P01-AG03991, P01-AG026276, R01-AG057680]; University Research Strategic Alliance [URSA] 2016; Fred Simmons and Olga Mohan, Paula and Rodger O. Riney Fund, the Brennan Fund, and the Charles and Joanne Knight Alzheimer’s Research Initiative of the Washington University Knight Alzheimer’s Disease Research Center (ADRC).

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Washington University Human Research Protection Office [201706043]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Babulal reports no disclosures or conflicts. Ms. Stout reports no disclosures. Dr. Williams reports no disclosures. Mr. Rajasekar reports no disclosures. Dr. Harmon reports no disclosures. Dr. Vivoda reports no disclosures. Dr. Zuelsdorff reports no disclosures. Dr. Benzinger is funded by NIH grants # P50AG005681; UF1AG032438; U01AG042791; 2P01AG003991; P01AG026276; R01AG043434; U54 MH091657; and the Barnes-Jewish Hospital Foundation. Dr. Benzinger reports no conflicts of interest. Dr. Morris and his family do not own stock or have equity interest (outside of mutual funds or other externally directed accounts) in any pharmaceutical or biotechnology company. Dr. Morris has participated or is currently participating in clinical trials of antidementia drugs sponsored by the following companies: Janssen Immunotherapy, Pfizer, Eli Lilly/Avid Radiopharmaceuticals, SNIFF (The Study of Nasal Insulin to Fight Forgetfullness) study, and A4 (The Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease) trial. Dr. Morris has served as a consultant for Lilly USA, and Charles Dana Foundation. He receives research support from Eli Lilly/Avid Radiopharmaceuticals and is funded by NIH grants # P50AG005681; P01AG003991; P01AG026276 and UF1AG032438. Dr. Morris reports no conflicts of interest. Dr. Ances reports no disclosures. Dr. Roe reports no disclosures.

References

  1. 1.
    Colby SL, Ortman JM. Projections of the size and composition of the US population: 2014 to 2060: Population estimates and projections 2017.Google Scholar
  2. 2.
    Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Washington, DC: US Census Bureau; 2014. p. 25–1140.Google Scholar
  3. 3.
    Hudomiet P, Parker AM, Rohwedder S. Many Americans follow nontraditional paths to retirement: cognitive ability and personality traits influence this process. 2018.CrossRefGoogle Scholar
  4. 4.
    The Federal Interagency Forum on Aging-Related Statistics. Older Americans 2016: key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics. 2016.Google Scholar
  5. 5.
    National Center for Statistics and Analysis. 2015 older population fact sheet. Washington, DC: National Highway Traffic Safety Administration. 2017.Google Scholar
  6. 6.
    National Highway Traffic Safety Administration. Traffic Safety Facts 2012 data: older population. 2014.Google Scholar
  7. 7.
    Insurance Institute for Highway Safety. Fatality facts 2013, Older people 2014. http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2013.
  8. 8.
    Sivak M, Schoettle B. Update: Percentage of young persons with a driver’s license continues to drop. Traffic Injury Prev. 2012;13(4):341.CrossRefGoogle Scholar
  9. 9.
    Langford J, Koppel S. Epidemiology of older driver crashes–identifying older driver risk factors and exposure patterns. Transport Res F: Traffic Psychol Behav. 2006;9(5):309–21.CrossRefGoogle Scholar
  10. 10.
    Antin JF, Guo F, Fang Y, Dingus TA, Perez MA, Hankey JM. A validation of the low mileage bias using naturalistic driving study data. J Saf Res. 2017;63:115–20.CrossRefGoogle Scholar
  11. 11.
    Dickerson AE, Reistetter T, Gaudy JR. The perception of meaningfulness and performance of instrumental activities of daily living from the perspectives of the medically at-risk older adults and their caregivers. J Appl Gerontol. 2013;32(6):749–64.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Centers for Disease Control Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). In: National Center for Injury Prevention and Control, CDC. 2017. https://www.cdc.gov/motorvehiclesafety/older_adult_drivers/index.html. 2017.
  13. 13.
    Alzheimer’s Association. 2018 Alzheimer’s disease facts and figures. Alzheimers Dement. 2018;14(3):367–429.CrossRefGoogle Scholar
  14. 14.
    Dubinsky RM, Williamson A, Gray CS, Glatt SL. Driving in Alzheimer’s disease. J Am Geriatr Soc. 1992;40(11):1112–6.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Drachman DA, Swearer JM, Collaborative Study G. Driving and Alzheimer’s disease The risk of crashes. Neurology. 1993;43(12):2448-.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Duchek JM, Carr DB, Hunt L, Roe CM, Xiong C, Shah K, et al. Longitudinal driving performance in early stage dementia of the Alzheimer type. J Am Geriatr Soc. 2003;51:1342–7.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Fox GK, Bowden SC, Bashford GM, Smith DS. Alzheimer’s disease and driving: prediction and assessment of driving performance. J Am Geriatr Soc. 1997;45(8):949–53.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Hunt LA, Murphy CF, Carr D, Duchek JM, Buckles V, Morris JC. Reliability of the Washington University Road Test: a performance-based assessment for drivers with dementia of the Alzheimer type. Arch Neurol. 1997;54(6):707–12.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Rizzo M, Reinach S, McGehee D, Dawson J. Simulated car crashes and crash predictors in drivers with Alzheimer disease. Arch Neurol. 1997;54(5):545–51.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Dubinsky RM, Stein AC, Lyons K. Practice parameter: Risk of driving and Alzheimer’s disease (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;54(12):2205–11.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M. Practice parameter update: evaluation and management of driving risk in dementia report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74(16):1316–24.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Ott BR, Heindel WC, Papandonatos GD, Festa EK, Davis JD, Daiello LA, et al. A longitudinal study of drivers with Alzheimer disease. Neurology. 2008;70(14):1171–8.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Hird MA, Egeto P, Fischer CE, Naglie G, Schweizer TA. A systematic review and meta-analysis of on-road simulator and cognitive driving assessment in Alzheimer’s disease and mild cognitive impairment. J Alzheimers Dis. 2016(Preprint):1-17.Google Scholar
  24. 24.
    Roe CM, Barco PP, Head DM, Ghoshal N, Selsor N, Babulal GM, et al. Amyloid imaging, cerebrospinal fluid biomarkers predict driving performance among cognitively normal individuals. Alzheimer Dis Assoc Disord. 2017;31(1):69–72.  https://doi.org/10.1097/wad.0000000000000154.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Roe CM, Babulal GM, Head DM, Stout SH, Vernon EK, Ghoshal N, et al. Preclinical Alzheimer’s disease and longitudinal driving decline. Alzheimers Dement. 2017;3(1):74–82.  https://doi.org/10.1016/j.trci.2016.11.006.CrossRefGoogle Scholar
  26. 26.
    Ott BR, Jones RN, Noto RB, Yoo DC, Snyder PJ, Bernier JN, et al. Brain amyloid in preclinical Alzheimer’s disease is associated with increased driving risk. Alzheimers Dement. 2017;6:136–42.Google Scholar
  27. 27.
    Babulal GM, Quiroz YT, Albensi BC, Arenaza-Urquijo E, Astell AJ, Babiloni C, et al. Perspectives on ethnic and racial disparities in Alzheimer’s disease and related dementias: Update and areas of immediate need. Alzheimers Dement. 2018.  https://doi.org/10.1016/j.jalz.2018.09.009.CrossRefGoogle Scholar
  28. 28.
    Centers for Disease C, Prevention. Health disparities experienced by black or African Americans--United States. MMWR Morb Mortal Wkly Rep. 2005;54(1):1-3.Google Scholar
  29. 29.
    Richardson LD, Norris M. Access to health and health care: how race and ethnicity matter. Mt Sinai J Med. 2010;77(2):166–77.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Shuey KM, Willson AE. Cumulative disadvantage and black-white disparities in life-course health trajectories. Res Aging. 2008;30(2):200–25.CrossRefGoogle Scholar
  31. 31.
    Yao L, Robert SA. The contributions of race, individual socioeconomic status, and neighborhood socioeconomic context on the self-rated health trajectories and mortality of older adults. Res Aging. 2008;30(2):251–73.CrossRefGoogle Scholar
  32. 32.
    Geronimus AT, Hicken MT, Pearson JA, Seashols SJ, Brown KL, Cruz TD. Do US black women experience stress-related accelerated biological aging? Hum Nat. 2010;21(1):19–38.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Gee GC, Hing A, Mohammed S, Tabor DC, Williams DR. Racism and the life course: taking time seriously. Am J Public Health. 2019;109(S1):S43–S7.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Bhat G, Naumann RB. Travel-related behaviors, opinions, and concerns of US adult drivers by race/ethnicity, 2010. J Saf Res. 2013;47:93–7.CrossRefGoogle Scholar
  35. 35.
    Babulal G, Williams M, Stout S, Roe C. Driving outcomes among older adults: a systematic review on racial and ethnic differences over 20 years. Geriatrics. 2018;3(1):12.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993.Google Scholar
  37. 37.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Tombaugh TN. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004;19(2):203–14.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Goodglass H, Kaplan E. Boston Naming Test: scoring booklet: Lea & Febiger; 1983.Google Scholar
  40. 40.
    Grober E, Buschke H, Crystal H, Bang S, Dresner R. Screening for dementia by memory testing. Neurology. 1988;38(6):900-.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Su Y, Blazey TM, Snyder AZ, Raichle ME, Marcus DS, Ances BM, et al. Partial volume correction in quantitative amyloid imaging. Neuroimage. 2015;107:55–64.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Su Y, D'Angelo GM, Vlassenko AG, Zhou G, Snyder AZ, Marcus DS, et al. Quantitative analysis of PiB-PET with FreeSurfer ROIs. PLoS ONE. 2013;8(11):e73377.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Fagan AM, Mintun MA, Mach RH, Lee SY, Dence CS, Shah AR, et al. Inverse relation between in vivo amyloid imaging load and cerebrospinal fluid Aβ42 in humans. Ann Neurol. 2006;59(3):512–9.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Fagan AM, Mintun MM, Shah AR, Aldea P, Roe CM, Mach RH, et al. Cerebrospinal fluid tau and ptau181 increase with cortical amyloid deposition in cognitively normal individuals: implications for future clinical trials of Alzheimer’s disease. EMBO Mol Med. 2009;1(8-9):371–80.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Schindler SE, Sutphen CL, Teunissen C, McCue LM, Morris JC, Holtzman DM, et al. Upward drift in cerebrospinal fluid amyloid β 42 assay values for more than 10 years. Alzheimers Dement. 2018;14(1):62–70.  https://doi.org/10.1016/j.jalz.2017.06.2264.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Vos SJB, Xiong C, Visser PJ, Jasielec MS, Hassenstab J, Grant EA, et al. Preclinical Alzheimer’s disease and its outcome: a longitudinal cohort study. Lancet Neurol. 2013;12(10):957–65.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Babulal GM, Addison A, Ghoshal N, Stout SH, Vernon EK, Sellan M et al. Development and interval testing of a naturalistic driving methodology to evaluate driving behavior in clinical research. F1000Research. 2016;5.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Babulal GM, Traub CM, Webb M, Stout SH, Addison A, Carr DB et al. Creating a driving profile for older adults using GPS devices and naturalistic driving methodology. F1000Research. 2016(5:2376). doi: https://doi.org/10.12688/f1000research.9608.1.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Carr DB, Barco PP, Wallendorf MJ, Snellgrove CA, Ott BR. Predicting road test performance in drivers with dementia. J Am Geriatr Soc. 2011;59(11):2112–7.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Owsley C, Ball K, McGwin G Jr, Sloane ME, Roenker DL, White MF, et al. Visual Processing impairment and risk of motor vehicle crash among older adults. JAMA. 1998;279(14):1083–8.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Babulal GM, Stout SH, Benzinger TLS, Ott BR, Carr DB, Webb M, et al. A naturalistic study of driving behavior in older adults and preclinical Alzheimer disease. J Appl Gerontol. 2017;0733464817690679.  https://doi.org/10.1177/0733464817690679.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Choi M, Mezuk B, Lohman MC, Edwards JD, Rebok GW. Gender and racial disparities in driving cessation among older adults. J Aging Health. 2012;24(8):1364–79.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Choi M, Mezuk B, Lohman MC, Edwards JD, Rebok GW. Gender and racial disparities in driving cessation among older adults. J Aging Health. 2012;25(8_suppl):147S-62S.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Choi M, O’Connor ML, Mingo CA, Mezuk B. Gender and racial disparities in life-space constriction among older adults. The Gerontologist. 2015;56(6):1153–60.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Dugan E, Lee CM. Biopsychosocial risk factors for driving cessation findings from the health and retirement study. J Aging Health. 2013;0898264313503493.Google Scholar
  56. 56.
    Vivoda JM, Heeringa SG, Schulz AJ, Grengs J, Connell CM. The influence of the transportation environment on driving reduction and cessation. The Gerontologist. 2016;57(5):824–32.PubMedCentralGoogle Scholar
  57. 57.
    Eby DW, Silverstein NM, Molnar LJ, LeBlanc D, Adler G. Driving behaviors in early stage dementia: a study using in-vehicle technology. Accid Anal Prev. 2012;49:330–7.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Seelye A, Mattek N, Sharma N, Witter IV, Brenner A, Wild K, et al. Passive assessment of routine driving with unobtrusive sensors: a new approach for identifying and monitoring functional level in normal aging and mild cognitive impairment. J Alzheimers Dis. 2017;59(4):1427–37.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Paire-Ficout L, Lafont S, Conte F, Coquillat A, Fabrigoule C, Ankri J, et al. Naturalistic Driving study investigating self-regulation behavior in early Alzheimer’s disease: a pilot study. J Alzheimers Dis. 2018(Preprint:1–10.Google Scholar
  60. 60.
    Howell JC, Watts KD, Parker MW, Wu J, Kollhoff A, Wingo TS, et al. Race modifies the relationship between cognition and Alzheimer’s disease cerebrospinal fluid biomarkers. Alzheimers Res Ther. 2017;9(1):88.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Morris JC, Schindler SE, McCue LM, Moulder KL, Benzinger TLS, Cruchaga C, et al. Assessment of racial disparities in biomarkers for Alzheimer disease. JAMA Neurol. 2019;76(3):264–73.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Price JL, McKeel DW Jr, Buckles VD, Roe CM, Xiong C, Grundman M, et al. Neuropathology of nondemented aging: presumptive evidence for preclinical Alzheimer disease. Neurobiol Aging. 2009;30(7):1026–36.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Williams MM, Scharff DP, Mathews KJ, Hoffsuemmer JS, Jackson P, Morris JC, et al. Barriers and facilitators of African American participation in Alzheimer’s disease biomarker research. Alzheimer Dis Assoc Disord. 2010;24(Suppl):S24.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Gleason CE, Norton D, Zuelsdorff M, Benton SF, Wyman MF, Nystrom N, et al. Association between enrollment factors and incident cognitive impairment in Blacks and Whites: Data from the Alzheimer’s Disease Center. Alzheimer’s & Dementia: Alzheimers Dement. 2019.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Ganesh M. Babulal
    • 1
    • 2
    Email author
  • Sarah H. Stout
    • 1
    • 2
  • Monique M. Williams
    • 3
  • Ganesh Rajasekar
    • 1
    • 2
  • Annie Harmon
    • 4
  • Jonathon Vivoda
    • 5
  • Megan Zuelsdorff
    • 6
  • Tammie L.S. Benzinger
    • 1
    • 7
    • 8
  • John C. Morris
    • 1
    • 2
    • 7
    • 9
    • 10
    • 11
    • 12
  • Beau Ances
    • 1
    • 2
    • 9
  • Catherine M. Roe
    • 1
    • 2
  1. 1.Charles F. and Joanne Knight Alzheimer’s Disease Research CenterSt. LouisUSA
  2. 2.Department of NeurologyWashington UniversitySt. LouisUSA
  3. 3.BJC Medical GroupSt. LouisUSA
  4. 4.Department of MedicineWashington UniversitySt. LouisUSA
  5. 5.Miami UniversityOxfordUSA
  6. 6.University of WisconsinMadisonUSA
  7. 7.Department of RadiologyWashington UniversitySt. LouisUSA
  8. 8.Department of NeurosurgeryWashington UniversitySt. LouisUSA
  9. 9.Hope Center for Neurological DisordersWashington UniversitySt. LouisUSA
  10. 10.Department of Pathology and ImmunologyWashington UniversitySt. LouisUSA
  11. 11.Department of Physical TherapyWashington UniversitySt. LouisUSA
  12. 12.Department of Occupational TherapyWashington UniversitySt. LouisUSA

Personalised recommendations