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



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


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.


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.


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.


Alzheimer’s disease African Americans Older adults Driving Race 



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.


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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

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