1st Place Poster Winner 

As a geriatrician deeply committed to advancing the quality of care for older adults, I am pleased to share insights from our recently conducted study, which explored the prevalence of Mild Cognitive Impairment (MCI) diagnoses and the importance of driving assessments for individuals with cognitive decline. This study, conducted at the Geriatric Division of Eisenhower Medical Center, highlights the urgent need for specialized geriatric interventions to address this pressing issue.

Our study underscores the pivotal role of geriatric clinics in early MCI detection and its critical impact on safety and independence, particularly when it comes to driving. I want to take this opportunity to share the key findings of our project and to raise awareness about the implications of driving with cognitive impairment.

What is MCI?

Mild Cognitive Impairment (MCI) is a transitional state between normal aging and dementia, characterized by cognitive decline that does not yet significantly impair daily life. Early diagnosis of MCI is crucial, as it provides patients access to emerging therapies, such as monoclonal antibody treatments, and preventive strategies targeting modifiable dementia risk factors.

Why Driving Assessments Matter

Driving is a complex activity requiring cognitive, physical, and sensory capabilities. Individuals with MCI often lack self-awareness of their limitations, posing potential safety risks on the road. Our study reveals that nearly 97% of MCI patients referred for driving assessments could potentially fail due to their cognitive deficits. Without intervention, these individuals remain at increased risk of motor vehicle accidents, endangering themselves and others.

Key Findings

• Significant Diagnostic Disparity:
  The geriatric clinic demonstrated markedly higher success in diagnosing MCI compared to the traditional primary care clinic. Specifically:

• 34 patients were formally diagnosed with MCI in the geriatric clinic.

• In contrast, 0 patients were diagnosed with MCI in the traditional primary care clinic during the same period.

• Driving Assessment Referrals and Outcomes:

• 17 patients diagnosed with MCI in the geriatric clinic were referred to the DMV for driving capability assessments.

• Of these, 8 patients (47.1%) completed the assessment.

• Among those evaluated, only 2 patients (25%) successfully passed the assessment, with a confidence range of 3% to 65.1%.

• Projected Driving Assessment Failures:

• Assuming the observed failure rate applies to the entire referred population, it is estimated that between 6 to 16 patients (34.9% to 97.0%) will fail the driving assessment.

• This finding highlights the critical need for routine and structured driving evaluations for individuals with MCI to mitigate potential risks.

What Should Be Done?

Based on our findings, we recommend the following actions to mitigate risks and improve outcomes for MCI patients:

1. Routine Cognitive and Driving Assessments:

• Implement standardized processes for MCI screening and driving evaluations in clinics.

• Collaborate with local DMVs to establish clear referral and testing guidelines.

2. Patient and Family Education:

• Raise awareness among families about the risks of driving with cognitive impairment.

• Provide resources and support for alternative transportation to maintain patients’ independence.

3. Nationwide Screening Initiatives:

• Advocate for a unified, nationwide approach to cognitive and driving evaluations, emphasizing both patient safety and autonomy.

4. Policy Changes:

• Develop and promote policies requiring structured evaluations and appropriate referrals for MCI patients.

• Encourage funding for public health initiatives aimed at reducing motor vehicle accidents among cognitively impaired drivers.

My Message to Families, Clinicians, and Policymakers

As our aging population grows, the need for specialized geriatric care will become increasingly evident. Families must engage in open conversations about driving safety, and clinicians must prioritize early MCI detection and routine assessments. Policymakers and healthcare leaders must collaborate to establish comprehensive systems that address cognitive decline and driving safety, safeguarding both patients and the broader community.

For more information, resources, or to discuss collaboration opportunities, I welcome the chance to connect. Together, we can foster a safer and more supportive environment for older adults living with MCI.

Kourosh A.P. Moshiri, MD, EMHA, FACP, AGSF, CMD, HMDC, FACCWS

Internal Medicine Section Chief, Eisenhower Medical Center
Associate Medical Director, Eisenhower Geriatric Medicine Fellowship Program
Medical Director, Desert Mountain Care Center
Associate Clinical Professor, UCR, School of Medicine

References

• Carr, D.B., & Ott, B.R. (2010). The older adult driver with cognitive impairment: "It's a very frustrating life". Journal of the American Geriatrics Society, 58(11), 2154-2163. DOI:10.1111/j.1532-5415.2010.03149.x

• O'Connor, M.G., Edwards, J.D., & Bannon, Y. (2019). Cognitive Impairment in MCI Patients and Its Impact on Driving Performance. Journal of Geriatric Psychiatry and Neurology, 32(6), 282-288. DOI:10.1177/0891988719884194

• Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. DOI:10.1016/S0140-6736(20)30367-6

• Marshall, S.C., Man-Son-Hing, M., & Molnar, F. (2007). The Impact of Cognitive Impairment on Driving Performance Among Older Adults: A Review. Canadian Journal of Public Health, 98(3), 179-182. DOI:10.1007/BF03404048

FULL POSTER PDF