Eye-tracking and visual processing tests for assessing driving ability in individuals with dementia and mild cognitive impairment: A pilot study

Changes in visual processing have been found to be affected in the early stages of dementia, potentially limiting driving ability. This pilot study investigated the sensitivity and specificity of eye-tracking, visual processing, and dementia screening tests in evaluating driving abilities among older drivers with and without cognitive impairment. Twenty-three participants aged 65+ years (n = 10 with cognitive impairment, 13 healthy controls) underwent dementia screening assessments including Mini Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT), a Visual Sensitivity Test (VST) and eye-tracking tasks (prosaccade, antisaccade, prospective eye movements) and compared these against a computerised driving-related hazard perception test (HPT) and self-report driving measures. Correlation analyses and ROC curves were used to explore relationships among the outcome measures. Drivers with cognitive impairment did not report different subjective driving performance, but had significantly lower HPT scores, with most scoring below the Driving and Vehicle Licensing Agency (DVLA) requirement for licensure. Eye-tracking data (n = 19) showed that drivers with cognitive impairment exhibited greater prosaccade latency variability. Antisaccade latency and prospective eye movement tests both correlated with self-reported in-vehicle task performance. The VST and HVLT tests strongly correlated with HPT scores and were highly predictive of scoring below the HPT DVLA cut-off scores. The VST and HVLT demonstrated high sensitivity and specificity for screening poor hazard perception performance in older drivers with cognitive impairment. Impaired eye movements correlated with self-reported difficulties in operating in-vehicle tasks, but not with HPT performance. Further research is needed to verify these findings in on-road assessments and with a larger sample size. • Cognitively impaired drivers show greater variability in prosaccade latency. • Eye-tracking metrics correlate with self-reported in-vehicle task performance, not hazard perception. • Visual processing speed test strongly predicts hazard perception in dementia. • Visual screenings should be integrated into comprehensive assessments of driving.