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Drawing clocks and driving cars

Use of brief tests of cognition to screen driving competency in older adults

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Abstract

OBJECTIVE: The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competence.

DESIGN: Prospective cohort study.

SETTING: An outpatient driving evaluation clinic.

PARTICIPANTS: One hundred nineteen community-dwelling, active drivers with a valid driver’s license, aged 60 and older referred for driving evaluation.

MAIN OUTCOME MEASURES: The CDT and a driving test using a STISIM Drive simulator.

RESULTS: The CDT showed a high level of accuracy in predicting driving simulation outcome (area under the receiver-operator curve, 0.90; 95% confidence interval, 0.82 to 0.95). CDT scoring scales were comparable and all correlations between CDT scores and driving performance were negative, implying that as the CDT score decreases, the number of errors increases. Interrater reliability of CDT scores was 0.95. Subjects scoring less than 5 out of 7 points on the CDT made significantly more driving errors, hazardous and in total (P<.001).

CONCLUSIONS: The CDT can help establish problems with executive function and indicate the need for a formal driving evaluation. Our CDT scoring scale is a reliable, valid, and time-effective screening tool for identifying elderly drivers in need of further evaluation.

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Author information

Authors and Affiliations

  1. The Glennan Center for Geriatrics and Gerontology, Eastern Virginia Medical School, Norfolk, VA, USA

    Barbara Freund PhD, Stefan Gravenstein MD & Rebecca Ferris BS

  2. Epidemiology and Biometry Core, Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA

    Bonnie L. Burke MS

  3. Division of Gerontology, Medical College of Virginia, Richmond, VA, USA

    Elias Shaheen BS

Authors
  1. Barbara Freund PhD
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  2. Stefan Gravenstein MD
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  3. Rebecca Ferris BS
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  4. Bonnie L. Burke MS
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  5. Elias Shaheen BS
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Corresponding author

Correspondence to Barbara Freund PhD.

Additional information

The authors have no conflicts of interest to report. An earlier version of this article was presented at the 2002 American Geriatrics Society meeting, Washington, DC.

This research was supported in part by The Virginia Center on Aging, Alzheimer’s and Related Diseases Research Award Fund.

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Freund, B., Gravenstein, S., Ferris, R. et al. Drawing clocks and driving cars. J GEN INTERN MED 20, 240–244 (2005). https://doi.org/10.1111/j.1525-1497.2005.40069.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40069.x

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