Validity of the mini-mental state examination and the montreal cognitive assessment in the prediction of driving test outcome

Abstract

Objectives: To evaluate the effectiveness of two cognitive screening measures, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in predicting driving test outcome for individuals with and without cognitive impairment.

Design: Retrospective cohort study.

Setting: A clinical driving evaluation program at a teaching hospital in the United States.

Participants: Adult drivers who underwent assessment with the MMSE and MoCA as part of a comprehensive driving evaluation between 2010 and 2014 (N=92).

Measurements: MMSE and MoCA total scores were independent variables. The outcome measure was performance on a standardized road test.

Results: A preestablished diagnosis of cognitive impairment enhanced the validity of cognitive screening measures in the identification of at-risk drivers. In individuals with cognitive impairment there was a significant relationship between MoCA score and on-road outcome. Specifically, an individual was 1.36 times as likely to fail the road test with each 1-point decrease in MoCA score. No such relationship was detected in those without a diagnosis of cognitive impairment.

Conclusion: For individuals who have not been diagnosed with cognitive impairment, neither the MMSE nor the MoCA can be reliably used as an indicator of driving risk, but for individuals with a preestablished diagnosis of cognitive impairment, the MoCA is a useful tool in this regard. A score on the MoCA of 18 or less should raise concerns about driving safety.

Keywords: driving evaluation; driving safety; neuropsychological tests; older driver.