The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia

D Piersma; A B M Fuermaier; D de Waard; P P De Deyn; R J Davidse; J de Groot; M J A Doumen; R A Bredewoud; R Claesen; A W Lemstra; A Vermeeren; R Ponds; F Verhey; W H Brouwer; O Tucha

doi:10.1007/s13760-018-1036-3

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia

D Piersma^*, A B M Fuermaier, D de Waard, P P De Deyn, R J Davidse, J de Groot, M J A Doumen, R A Bredewoud, R Claesen, A W Lemstra, A Vermeeren, R Ponds, F Verhey, W H Brouwer, O Tucha

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Since Alzheimer's disease may affect driving performance, patients with Alzheimer's disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer's disease will pass or fail an on-road driving assessment. Patients with Alzheimer's disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811-819, 2017]. All patients with Alzheimer's disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer's disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer's disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.

Original language	English
Pages (from-to)	637–642
Number of pages	6
Journal	Acta Neurologica Belgica
Volume	118
Issue number	4
Early online date	2 Nov 2018
DOIs	https://doi.org/10.1007/s13760-018-1036-3
Publication status	Published - Dec 2018

Keywords

Alzheimer's dementia
Fitness to drive
Driving
MMSE
MINI-MENTAL-STATE
PERFORMANCE
DISEASE
CONSENSUS
SAFETY
Severity of Illness Index
Humans
Middle Aged
Male
Alzheimer Disease/diagnosis
Mental Status and Dementia Tests
Aged, 80 and over
Female
Aged
Automobile Driving/psychology

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Cite this

Piersma, D., Fuermaier, A. B. M., de Waard, D., De Deyn, P. P., Davidse, R. J., de Groot, J., Doumen, M. J. A., Bredewoud, R. A., Claesen, R., Lemstra, A. W., Vermeeren, A., Ponds, R., Verhey, F., Brouwer, W. H., & Tucha, O. (2018). The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia. Acta Neurologica Belgica, 118(4), 637–642. https://doi.org/10.1007/s13760-018-1036-3

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title = "The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia",

abstract = "Since Alzheimer's disease may affect driving performance, patients with Alzheimer's disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer's disease will pass or fail an on-road driving assessment. Patients with Alzheimer's disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811-819, 2017]. All patients with Alzheimer's disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer's disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer's disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.",

keywords = "Alzheimer's dementia, Fitness to drive, Driving, MMSE, MINI-MENTAL-STATE, PERFORMANCE, DISEASE, CONSENSUS, SAFETY, Severity of Illness Index, Humans, Middle Aged, Male, Alzheimer Disease/diagnosis, Mental Status and Dementia Tests, Aged, 80 and over, Female, Aged, Automobile Driving/psychology",

author = "D Piersma and Fuermaier, {A B M} and {de Waard}, D and {De Deyn}, {P P} and Davidse, {R J} and {de Groot}, J and Doumen, {M J A} and Bredewoud, {R A} and R Claesen and Lemstra, {A W} and A Vermeeren and R Ponds and F Verhey and Brouwer, {W H} and O Tucha",

year = "2018",

month = dec,

doi = "10.1007/s13760-018-1036-3",

language = "English",

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journal = "Acta Neurologica Belgica",

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Piersma, D, Fuermaier, ABM, de Waard, D, De Deyn, PP, Davidse, RJ, de Groot, J, Doumen, MJA, Bredewoud, RA, Claesen, R, Lemstra, AW, Vermeeren, A, Ponds, R, Verhey, F, Brouwer, WH & Tucha, O 2018, 'The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia', Acta Neurologica Belgica, vol. 118, no. 4, pp. 637–642. https://doi.org/10.1007/s13760-018-1036-3

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T1 - The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia

AU - Piersma, D

AU - Fuermaier, A B M

AU - de Waard, D

AU - De Deyn, P P

AU - Davidse, R J

AU - de Groot, J

AU - Doumen, M J A

AU - Bredewoud, R A

AU - Claesen, R

AU - Lemstra, A W

AU - Vermeeren, A

AU - Ponds, R

AU - Verhey, F

AU - Brouwer, W H

AU - Tucha, O

PY - 2018/12

Y1 - 2018/12

N2 - Since Alzheimer's disease may affect driving performance, patients with Alzheimer's disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer's disease will pass or fail an on-road driving assessment. Patients with Alzheimer's disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811-819, 2017]. All patients with Alzheimer's disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer's disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer's disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.

AB - Since Alzheimer's disease may affect driving performance, patients with Alzheimer's disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer's disease will pass or fail an on-road driving assessment. Patients with Alzheimer's disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811-819, 2017]. All patients with Alzheimer's disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer's disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer's disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.

KW - Alzheimer's dementia

KW - Fitness to drive

KW - Driving

KW - MMSE

KW - MINI-MENTAL-STATE

KW - PERFORMANCE

KW - DISEASE

KW - CONSENSUS

KW - SAFETY

KW - Severity of Illness Index

KW - Humans

KW - Middle Aged

KW - Male

KW - Alzheimer Disease/diagnosis

KW - Mental Status and Dementia Tests

KW - Aged, 80 and over

KW - Female

KW - Aged

KW - Automobile Driving/psychology

U2 - 10.1007/s13760-018-1036-3

DO - 10.1007/s13760-018-1036-3

M3 - Article

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SN - 0300-9009

VL - 118

SP - 637

EP - 642

JO - Acta Neurologica Belgica

JF - Acta Neurologica Belgica

IS - 4

ER -