Study detects cognitive changes in older drivers using in-vehicle sensors
Project provides first step toward widespread use of low-cost, early warning system
Peer-Reviewed PublicationIMAGE:
THE DRIVER-FACING CAMERA IS MOUNTED IN THE LEFT CORNER OF THE WINDSHIELD AND IS DIRECTED TO THE DRIVER’S FACE TO ANALYZE HIS/HER BEHAVIOR AND FACIAL EXPRESSIONS. THE FORWARD-FACING CAMERA IS MOUNTED UNDER THE REARVIEW MIRROR AND IS USED TO RECORD EVENTS EXTERNAL TO THE VEHICLE.
view moreCREDIT: JINWOO JANG, PH.D., FAU COLLEGE OF ENGINEERING AND COMPUTER SCIENCE
An estimated 4 to 8 million older adults with mild cognitive impairment are currently driving in the United States, and one-third of them will develop dementia within five years. Individuals with progressive dementias are eventually unable to drive safely, yet many remain unaware of their cognitive decline.
Currently, screening and evaluation services for driving can only test a small number of individuals with cognitive concerns, missing many who need to know if they require treatment.
Nursing, engineering and neuropsychology researchers at Florida Atlantic University are testing and evaluating a readily and rapidly available, unobtrusive in-vehicle sensing system they have developed. This technology could provide the first step toward future widespread, low-cost early warnings of cognitive change for this large number of older drivers in the U.S. and elsewhere.
In their study, published in the journal BMC Geriatrics, they are systematically examining how this system could detect anomalous driving behavior indicative of cognitive impairment. Few studies have reported on the use of continuous, unobtrusive sensors and related monitoring devices for detecting subtle variability in the performance of highly complex everyday activities over time. This significant proportion of older drivers constitutes a previously unexplored opportunity to detect cognitive decline.
“The neuropathologies of Alzheimer’s disease have been found in the brains of older drivers killed in motor vehicle accidents who did not even know they had the disease and had no apparent signs of it,” said Ruth Tappen, Ed.D., principal investigator, senior author and the Christine E. Lynn Eminent Scholar and Professor, FAU Christine E. Lynn College of Nursing. “The purpose of our study arose from the importance of identifying cognitive dysfunction as early and efficiently as possible. Sensor systems installed in older drivers’ vehicles may detect these changes and could generate early warnings of possible changes in cognition.”
The study uses a naturalistic longitudinal design to obtain continuous information on driving behavior that is being compared with the results of extensive cognitive testing conducted every three months for three years. A driver facing camera, forward facing camera, and telematics unit are installed in the vehicle and data is downloaded every three months when the cognitive tests are administered.
Researchers are gauging abnormal driving such as getting lost, ignoring traffic signals and signs, near-collision events, distraction and drowsiness, reaction time and braking patterns. They also are looking at travel patterns such as number of trips, miles driven, miles on the highway, miles during the night and daytime, and driving in severe weather.
The in-vehicle sensor network developed by FAU researchers in the College of Engineering and Computer Science, uses open-source hardware and software components to reduce the time, risks and costs associated with developing in-vehicle sensing units. In-vehicle sensor systems are kept simple and compact by minimizing complex wiring, limiting the size of the sensing units, and limiting the number of sensors in a vehicle to support the unobtrusiveness of in-vehicle sensors. Each in-vehicle sensor system is comprised of two distributed sensing units: one for telematics data and the other for video data.
Inertial measurement unit data is processed to determine hard braking, hard accelerations and hard turns and GPS data. It also includes a timestamp, latitude, longitude, altitude, course over ground and the number of communicating satellites.
The video unit has built-in artificial intelligence functions that analyze video in real-time. The driver-facing camera is mounted in the left corner of the windshield and is directed to the driver’s face to analyze his/her behavior and facial expressions. The forward-facing camera is mounted under the rearview mirror and is used to record events external to the vehicle.
Driver-facing indices include face detection, eye detection (open or closed), yawning, distraction, smoking and mobile phone use. Behavior indices include traffic sign detection (running a red light), object detection (pedestrian, cyclists, curbs, barriers or nearby vehicles), lane crossing, near-collision and pedestrian detection.
“These travel-pattern-related driver behavior indices are known to be indicative of the changes in older drivers’ cognition and physical functions since they tend to incorporate deliberate avoidance strategies to compensate for age-related deficits,” said Tappen. “Driver behavior indices are evaluated for each driver and are summarized on a daily, weekly and monthly basis and are classified into four categories.”
A total of 460 study participants will be recruited from Broward and Palm Beach counties in Southeast Florida and are classified into three diagnostic groups: mild cognitive impairment, early dementia and unimpaired (normal). The Louis and Anne Green Memory and Wellness Center operated by FAU’s College of Nursing serves as the testing site for a clinical battery including assessments of cognition, functioning in daily activities and mood (depression), and an additional set of tests including executive function and attention.
“The innovation of our research project lies in the unobtrusive, rapidly and readily available in-vehicle sensing and monitoring system built upon modern open-source hardware and software using existing techniques to develop and customize the components and configure them for this new purpose,” said Tappen.
The study is supported by a grant from the National Institute on Aging, National Institutes of Health (1R01AG068472) awarded to Tappen.
- FAU -
About the Christine E. Lynn College of Nursing
FAU’s Christine E. Lynn College of Nursing is nationally and internationally known for its excellence and philosophy of caring science. The College was ranked No. 11 nationwide by US News and World Report in 2021 for “Best Online Master’s in Nursing Administration Programs” and No. 32 for the “Best Online Master’s in Nursing Programs.” In 2020, FAU graduates earned a 95.9% pass rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) and a 100% AGNP Certification Pass Rate. The baccalaureate, master’s and DNP programs at Florida Atlantic University’s Christine E. Lynn College of Nursing are accredited by the Commission on Collegiate Nursing Education. The College is the only one in the U.S. to have all degree programs endorsed by the American Holistic Nursing Credentialing Corporation.
About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.
JOURNAL
BMC Geriatrics
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Study protocol for “In-vehicle sensors to detect changes in cognition of older drivers”
Safety assessments for older drivers would benefit from introducing spatial orientation tests
Older drivers who have worse spatial orientation ability experience greater difficulty when making turns across oncoming traffic, according to new research from the University of East Anglia (UEA).
Spatial orientation skills are the combination of skills that enable us to mentally determine our position, or the position of our vehicle and other vehicles, relative to the environment.
Lead author Sol Morrissey, a PhD researcher at UEA’s Norwich Medical School, said: “Driving safety is typically reduced in older adults due to changes that take place during the ageing process, but little is known about how changes in the brain influence driving behaviour.
“This study shows that older adults with worse spatial orientation ability are less likely to drive frequently, and they report greater difficulty during driving.
“Importantly, we establish that having worse spatial orientation ability is associated with greater difficulty when making turns across oncoming traffic – which is a significant risk factor for fatal road traffic accidents.
“Driving safety assessments may therefore look to implement spatial orientation tests in the future.”
A total of 804 older adults were recruited between February 2021 and August 2021 to complete the study, with an average of 71.05 years.
Participants needed to be 65 or older, hold a current driving licence, and be a regular motorist, driving at least once per week.
Those recruited then completed online questionnaires related to their demographic information, health status, driving history, driving habits, road traffic incident history, spatial memory, and navigation ability.
Following this, participants completed a set of neuropsychological tests that assessed for cognitive performance across a variety of areas.
The results showed that driving behaviour difficulty and avoiding difficult situations is associated with worse spatial orientation ability within healthy ageing.
The study also replicated previous findings that processing speed is a key area affecting driving behaviour in ageing.
Spatial orientation has clear relevance to driving behaviour, as deficits will lead to increased difficulty in judging the position of the vehicle in relation to the surrounding environment. Furthermore, spatial orientation was the only cognitive domain demonstrating a significant effect on driving behaviour across the older age spectrum.
Older adults are overrepresented particularly in intersection crashes that involve multiple vehicles, and therefore orientation deficits are a key individual risk factor for road collisions involving turns across oncoming traffic.
Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse spatial orientation, processing speed, and episodic memory performance.
Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory.
Prof Michael Hornberger, of Norwich Medical School, said: “The research showed that deficits in spatial orientation are a robust indicator of driving performance in older age.
“This should be considered in future ageing driving assessments, as it has clear relevance for road safety within the ageing population.
“The proportion of older drivers on the road is projected to increase significantly in future years.
“Driving is of great importance in maintaining independence in older age, but it is also well established that age-related physiological changes and health conditions in older age increase the risk for driving collisions, and that these incidents are more likely to be fatal than for younger drivers.”
To date, research on the impact of ageing on driving performance has largely focused on physical and sensory function.
By contrast, cognitive changes, which are known to be critical for driving performance, have been much less explored in healthy ageing populations.
Most large-scale cognitive driving studies have only employed cognitive screening tests and even those in-depth studies have not considered how spatial orientation/navigation, a critical process for everyday mobility, impacts driving performance in ageing.
This latest research provides large-scale normative data of cognitive functioning within healthy older adults using online cognitive assessments.
Prof Hornberger added: “Online assessment batteries are particularly relevant for screening for changes in driving fitness over time, as they can be employed more conveniently, are more resource-efficient, and offer more precise measurements than in-person psychometric tests.”
The researchers also said the role of spatial orientation in predicting driving difficulty provides a potential explanation as to why road safety is reduced for motorists who have Mild Cognitive Impairment (MCI) and Alzheimer’s disease.
The researchers note some limitations to the study. Firstly, driving behaviours were self-reported by participants, and therefore may be subject to inaccuracy and/or bias.
Secondly, they were unable to investigate the environment in which participants typically drive, for example comparing rural and urban areas, and how these could have a significant impact on mobility requirements, type of driving, and cognitive functioning.
Future research may look to employ naturalistic driving measurements, such as via GPS location devices, to provide objective measures of driving behaviour and performance.
Further investigation should also be conducted into how driving behaviour changes relates to trajectories in cognitive functioning over time, which will provide key information as to how often fitness to drive assessments should be implemented and how both driving behaviour and cognitive assessments can be monitored.
The research was led by the University of East Anglia, in partnership with the University of Exeter, the University of Leeds, the Norfolk and Norwich University Hospitals NHS Foundation Trust and the MemCheck Memory Clinic at Chester Wellness Centre.
The study was funded by the UK Department for Transport and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridge and Peterborough NHS Foundation Trust.
The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care (UK) or the Department for Transport.
Sol Morrissey’s studentship is jointly funded by the Faculty of Medicine & Health Sciences, University of East Anglia, and the Earle and Stuart Charitable Trust.
‘The impact of spatial orientation changes on driving behaviour in healthy ageing’ is published in the Journal of Gerontology: Psychological Sciences.
JOURNAL
Journal of Gerontology
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
The impact of spatial orientation changes on driving behaviour in healthy ageing
ARTICLE PUBLICATION DATE
1-Mar-2024
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