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J Am Geriatr Soc. 2015 Nov;63(11):2358-64. doi: 10.1111/jgs.13776. Epub 2015 Oct 27.

Clinical Utility of the Trail-Making Test as a Predictor of Driving Performance in Older Adults.

Author information

1
Department of Biostatistics, Brown University, Providence, Rhode Island.
2
Department of Neurology, Warren Alpert Medical School, Brown University, and Rhode Island Hospital, Providence, Rhode Island.
3
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, and Rhode Island Hospital, Providence, Rhode Island.
4
Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, Missouri.
5
Department of Medicine and Neurology, School of Medicine, Washington University, St. Louis, Missouri.

Abstract

OBJECTIVES:

To assess the clinical utility of the Trail-Making Tests (TMTs) as screens for impaired road-test performance.

DESIGN:

Secondary analyses of three data sets from previously published studies of impaired driving in older adults using comparable road test designs and outcome measures.

SETTING:

Two academic driving specialty clinics.

PARTICIPANTS:

Older drivers (N = 392; 303 with cognitive impairment, 89 controls) from Rhode Island and Missouri.

MEASUREMENTS:

Standard operating characteristics were evaluated for the TMT Part A (TMT-A) and Part B (TMT-B), as well as optimal upper and lower test cut-points that could be useful in defining groups of drivers with indeterminate likelihood of impaired driving who would most benefit from further screening or on-road testing.

RESULTS:

Discrimination remained high (>70%) when cut-points for the TMTs derived from Rhode Island data were applied to Missouri data, but calibration was poor (all P < .01). TMT-A provided the best utility for determining a range of scores (68-90 seconds) for which additional road testing would be indicated in general practice settings. A high frequency of cognitively impaired participants unable to perform the TMT-B test within the allotted time limited the utility of the test (>25%). Mere inability to complete the test in a reasonable time frame (e.g., TMT-A > 48 seconds or TMT-B > 108 seconds) may still be a useful tool in separating unsafe from safe or marginal drivers in such samples.

CONCLUSION:

The TMTs (particularly TMT-A) may be useful as screens for driving impairment in older drivers in general practice settings, where most people are still safe drivers, but more-precise screening measures need to be analyzed critically in a variety of clinical settings for testing cognitively impaired older drivers.

KEYWORDS:

Trail-Making Test; cognition; driving assessment

PMID:
26503623
PMCID:
PMC4661063
DOI:
10.1111/jgs.13776
[Indexed for MEDLINE]
Free PMC Article

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