Driving Patterns May Reveal Early Cognitive Decline

Changes in everyday driving behavior may signal early cognitive decline before formal dementia diagnosis, according to a longitudinal study published in Neurology. The study investigators found that passively collected, in-vehicle global positioning system (GPS) data differentiated older adults with mild cognitive impairment (MCI) from cognitively normal peers more accurately than traditional risk markers alone. Models incorporating driving metrics achieved up to 87% accuracy in identifying MCI compared with 76% accuracy when demographic, genetic, and cognitive test data were used without driving information.

The prospective, observational cohort study included 298 community-dwelling older drivers enrolled in the Driving Real-World In-Vehicle Evaluation System Project at Washington University School of Medicine in St. Louis, MO. The study population included 56 individuals with MCI and 242 with normal cognition, with a mean age of 75.1 years. All participants were driving at least weekly at baseline and were similar in age, sex, race, APOE ε4 status, and most driving behaviors.. Participants underwent annual Clinical Dementia Rating (CDR) assessments, neuropsychologic testing, and apolipoprotein (APOE) ε4 genotyping, while their driving behavior was continuously monitored for up to 40 months using GPS-enabled in-vehicle dataloggers. Driving measures included trip frequency, distance, time of day, speeding events, hard braking, and spatial mobility indices such as entropy and maximum distance.

Key findings from the study include the following:

• Over time, drivers with MCI showed greater reductions in monthly trip frequency, nighttime driving, and variability in driving routes compared with cognitively normal drivers (all P<.001).
• Measures such as medium and maximum trip distance, speeding events, and spatial entropy differentiated MCI from normal cognition with an area under the curve (AUC) of 0.82 (95% CI, 0.75 to 0.89).
• Incorporating demographic factors, APOE ε4 status, and cognitive composite scores into the analysis of driving data improved AUC to 0.87 (95% CI, 0.81 to 0.93).

The study population was predominantly White and highly educated, which according to the study authors, limits the generalizability of these results.

Chen L, Carr DB, Singh RK, et al. Association of daily driving behaviors with mild cognitive impairment in older adults followed over 10 years. Neurology. 2025;105(12):e214440. doi:10.1212/WNL.0000000000214440