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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)637–642
Number of pages6
JournalActa Neurologica Belgica
Issue number4
Early online date2 Nov 2018
Publication statusPublished - Dec 2018


  • Alzheimer's dementia
  • Fitness to drive
  • Driving
  • MMSE
  • 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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