Skip to main content Accessibility help

Prediction of driving ability with neuropsychological tests: Demographic adjustments diminish accuracy



Demographically adjusted norms generally enhance accuracy of inferences based on neuropsychological assessment. However, we hypothesized that demographic corrections diminish predictive accuracy for real-world activities with absolute cognitive demands. Driving ability was assessed with a 45-minute drive along a standardized on-road route in participants aged 65+ (24 healthy elderly, 26 probable Alzheimer’s disease, 33 Parkinson’s disease). Neuropsychological measures included: Trail-Making A and B, Complex Figure, Benton Visual Retention, and Block Design tests. A multiple regression model with raw neuropsychological scores was significantly predictive of driving errors (R2 = .199, p = .005); a model with demographically adjusted scores was not (R2 = .113, p = .107). Raw scores were more highly correlated with driving errors than were adjusted scores for each neuropsychological measure, and among healthy elderly and Parkinson’s patients. When predicting real-world activities that depend on absolute levels of cognitive abilities regardless of demographic considerations, predictive accuracy is diminished by demographic corrections. (JINS, 2010, 16, 679–686.)


Corresponding author

*Correspondence and reprint requests to: Joe Barrash, Ph.D., Department of Neurology, 2155 RCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. E-mail:


Hide All
American Academy of Clinical Neuropsychology Board of Directors. (2007). American Academy of Clinical Neuropsychology (AACN) practice guidelines for neuropsychological assessment and consultation. The Clinical Neuropsychologist, 21, 209231.
Ardila, A., Rosselli, M., & Rosas, P. (1989). Neuropsychological assessment in illiterates: Visuospatial and memory abilities. Brain and Cognition, 11, 147166.
Ball, K., & Owsley, C. (1993). The Useful Field of View Test: A new technique for evaluating age-related declines in visual function. Journal of the American Optometry Association, 64, 7179.
Ball, K., & Owsley, C. (1994). Predicting vehicle crashes in the elderly: Who is at risk? In Johansson, K. & Lundberg, C. (Eds.), Aging and driving. (pp. 115128). Stockholm: Karolinska Institutet.
Benton, A.L., Eslinger, P.J., & Damasio, A.R. (1981). Normative observations on neuropsychological test performances in old age. Journal of Clinical Neuropsychology, 3, 3342.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155159.
Dawson, J.D., Anderson, S.W., Uc, E.Y., Dastrup, E., & Rizzo, M. (2009a). Predictors of driving safety in early Alzheimer’s disease. Neurology, 72, 521527.
Dawson, J.D., Uc, E.Y., Anderson, S.W., Dastrup, E., Johnson, A.M., & Rizzo, M. (2009b). Ascertainment of on-road safety errors based on video review. In Proceedings of Driving Assessment 2009: The Fifth International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design (pp. 419426). Iowa City, IA: The University of Iowa.
DeRaedt, R., & Ponjaert-Kristoffersen, I. (2001). Predicting at-fault car accidents of older drivers. Accident Analysis and Prevention, 33, 809818.
Golden, C., & van den Broek, A. (1998). Potential impact of age- and education-corrected scores on HRNB score patterns in participants with focal brain injury. Archives of Clinical Neuropsychology, 13, 683694.
Grace, J., Amick, M., Abreu, A., Festa, E., Heindell, W., & Ott, B. (2005). Neuropsychological deficits associated with driving performance in Parkinson’s and Alzheimer’s disease. Journal of the International Neuropsychological Society, 11, 766775.
Fitten, L.J., Perryman, K.M., Wilkinson, C.J., Little, R.J., Burns, M.M., Pachana, N., et al. . (1995). Alzheimer and vascular dementias and driving: A prospective road and laboratory study. Journal of the American Medical Association, 273, 13601365.
Folstein, M.F., Folstein, S.E., & McHugh, P.R., (1975). Mini-Mental State: A practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Heaton, R., Grant, I., & Matthews, C. (1991). Comprehensive norms for an expanded Halstead-Reitan neuropsychological battery: Demographic corrections, research findings, and clinical applications. Odessa, FL: Psychological Assessment Resources.
Heaton, R.K., Miller, S.W., Taylor, M.J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan battery: Demographically adjusted neuropsychological norms for African-American and Caucasian adults. Lutz, FL: Psychological Assessment Resources.
Hoops, S., Nazem, S., Siderowf, A.D., Duda, J.E., Xie, S.X., Stern, M.B. & Weintraub, D. (2009). Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson’s disease. Neurology, 73, 17381745.
Hunt, L., Morris, J.C., Edwards, D., & Wilson, B.S. (1993). Driving performance in persons with mild senile dementia of the Alzheimer’s type. Journal of the American Geriatrics Society, 41, 747753.
Ivnik, R. (2004). Normative psychology: A professional obligation? The Clinical Neuropsychologist, 19, 159161.
Kleinbaum, D.G., Kupper, L.L., Nizam, A., & Muller, K.E. (2008). Applied regression analysis and multivariable methods (4th ed.). London: International Thomason Publishing.
Lezak, M.D., Howieson, D., & Loring, D. (2004). Neuropsychological assessment (4thed.). New York: Oxford University Press.
Lundberg, C., Hakamies-Blomqvist, L., Almkvist, O., & Johansson, K. (1998). Impairments of some cognitive functions are common in crash-involved older drivers. Accident Analysis and Prevention, 30, 371377.
Massie, D.L., Campbell, K.L., & Williams, A.F. (1995). Traffic accident involvement rates by driver age and gender. Accident Analysis and Prevention, 27, 7387.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology, 34, 939944.
Meyer, G., Finn, S.E., Eyde, L.D., Kay, G.G., Moreland, K.L., Dies, R.R., et al. . (2001). Psychological testing and psychological assessment: A review of evidence and issues. American Psychologist, 56, 128165.
Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., et al. . (2007). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699.
Owsley, C., Ball, K., McGwin, G., Sloane, M.E., Roenker, D.L., White, M.F., & Overley, E.T. (1998). Visual processing impairment and risk of motor vehicle crash among older adults. Journal of the American Medical Association, 279, 10831088.
Reger, M., Welsh, R., Watson, G., Cholerton, B., Baker, L., & Craft, S. (2004). The relationship between neuropsychological functioning and driving ability in dementia: A meta-analysis. Neuropsychology, 18, 8593.
Reitan, R., & Wolfson, D. (2005). The effect of age and education transformations and neuropsychological test scores on persons with diffuse or bilateral brain damage. Applied Neuropsychology, 12, 181189.
Rizzo, M., McGehee, D., Petersen, A.D., & Dingus, T.A. (1997). Development of an unobtrusively instrumented field vehicle for objective assessment of driving performance. In Rothengatter, T. & Carbonnel, V.E. (Eds.), Traffic and transport psychology: Theory and application (pp. 203208). New York: Pergamon Press.
Shiroky, J.S., Schipper, H.M., Bergman, H., & Chertkow, H. (2007). Can you have dementia with an MMSE score of 30? American Journal of Alzheimer’s Disease and Other Dementias, 22, 406415.
Silverberg, N.D., & Millis, S.R. (2009). Impairment versus deficiency in neuropsychological assessment: Implications for ecological validity. Journal of the International Neuropsychological Society, 15, 94102.
Spooner, D.M., & Pachana, N.A. (2006). Ecological validity in neuropsychological assessment: A case for greater consideration of research with neurologically intact populations. Archives of Clinical Neuropsychology, 21, 327337.
Stutts, J.C., Stewart, J.R., & Martel, C. (1998). Cognitive test performance and crash risk in an older driver population. Accident Analysis and Prevention, 30, 337346.
Tallman, K.S. (1992). Driving performance in mild dementia. Doctoral dissertation, University of British Columbia, Vancouver, British Columbia, Canada. (UMI No. NN80842)
Tallman, K.S., Beattie, B.L., & Tuokko, H. (1994). The driving and aging study: Investigating the driving problems of those suffering from dementia. In Johansson, K. & Lundberg, C. (Eds.), Aging and driving. (pp. 143144). Stockholm: Karolinska Institutet.
Tranel, D. (2009). The Iowa-Benton school of neuropsychological assessment. In Grant, I. & Adams, K.M. (Eds.), Neuropsychological assessment of neuropsychiatric and neuromedical disorders (3rd ed., pp. 6683). New York: Oxford University Press.
Trobe, J.D., Waller, P.F., Cook-Flannagan, C.A., Teshima, S.M., & Bieliauskas, L.A. (1996). Crashes and violations among drivers with Alzheimer disease. Archives of Neurology, 53, 411416.
Uc, E.Y., Rizzo, M., Anderson, S.W., Sparks, J.D., Rodnitzky, R.L., & Dawson, J.D. (2007). Impaired navigation in drivers with Parkinson’s disease. Brain, 130, 24332440.
Uc, E.Y., Rizzo, M., Johnson, A.M., Dastrup, E., Anderson, S.W., & Dawson, J.D. (2009). Road safety in drivers with Parkinson disease. Neurology, 73, 21122119.
Van Gorp, W.G., Satz, P., & Mitrushina, M. (1990). Neuropsychological processes associated with normal aging. Developmental Neuropsychology, 6, 279290.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.): Administration and scoring manual. San Antonio, TX: Harcourt Brace & Co.
Whelihan, W., DiCarlo, M., & Paul, R. (2005). The relationship of neuropsychological functioning to driving competence in older persons with early cognitive decline. Clinical Neuropsychology, 20, 217228.
Williams, A.F., & Shabanova, V.I. (2003). Responsibility of drivers, by age and gender, for motor-vehicle crash deaths. Journal of Safety Research, 34, 527531.
Withaar, F.K., Brouwer, W.B., & Van Zomeren, A.H. (2000). Fitness to drive in older drivers with cognitive impairment. Journal of the International Neuropsychological Society, 6, 480490.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed