Cortical atrophy and leukoaraiosis, imaging markers of cerebrovascular small vessel disease, are associated with driving behavior changes among cognitively normal older adults

Background: Cerebral small vessel disease (CSVD) as measured by cortical atrophy and white matter hyper -intensities [leukoaraiosis], captured via magnetic resonance imaging (MRI) are increasing in prevalence due to the growth of the aging population and an increase in cardiovascular risk factors in the population. CSVD impacts cognitive function and mobility, but it is unclear if it affects complex, functional activities like driving.Methods: In a cohort of 163 cognitively normal, community-dwelling older adults (age >= 65), we compared naturalistic driving behavior with mild/moderate leukoaraiosis, cortical atrophy, or their combined rating in a clinical composite termed, aging-related changes to those without any, over a two-and-a-half-year period. Results: Older drivers with mild or moderate cortical atrophy and aging-related changes (composite) experienced a greater decrease in the number of monthly trips which was due to a decrease in the number of trips made within a one-to-five-mile diameter from their residence. Older drivers with CSVD experience a larger reduction in daily driving behaviors than drivers without CSVD, which may serve as an early neurobehavioral marker for functional decline. Conclusions: As CSVD markers, leukoaraiosis and cortical atrophy are standard MRI metrics that are widely available and can be used for screening individuals at higher risk for driving safety risk and decline in community mobility.

Automated summary

This study found that older drivers with mild or moderate cortical atrophy and aging-related changes experienced a decrease in the number of monthly trips, particularly within a one-to-five-mile range from their residence, over a two-and-a-half-year period. Drivers with cerebral small vessel disease (CSVD) showed a larger reduction in daily driving behaviors compared to those without CSVD, indicating it as an early neurobehavioral marker for functional decline. The findings suggest that magnetic resonance imaging can be used to identify high-risk elderly drivers to ensure driving safety and community mobility.