The cognitive and socio-demographic influences on driving performance and driving cessation in post-stroke drivers

Abstract

Background: Driving is a complex and multifaceted occupation requiring highly integrated cognitive and perceptual functions can be negatively affected following a stroke. The decision to continue or cease driving after a stroke may not be exclusively dependent on deficits in cognitive and motor abilities. Instead, it is possible that social supports, alternative means of transportation, education level, income, self-regulation ability and the awareness of personal health problems, may influence the decision. Aim: The aim of this research was to explore the influence of personal and socioeconomic factors, in addition to existing cognitive impairment, on the decision of post-stroke adults to return to driving. Method: A case control design was employed to compare driving performance of 48 individuals who had experienced a stroke and 22 volunteer healthy control participants. Half of the post-stroke cohort (n=24) had continued driving and the other half had ceased driving. Socio-demographic and driving-related cognitive performance data were collected to characterise the comparison groups before driving performance was assessed in a driving simulator. Results: Overall, the post-stroke groups did not perform as well as the control participants in the cognitive and driving assessments. The perceived ability to drive after a stroke was not significantly correlated with participants’ actual driving ability. Other factors that influenced driving cessation in a post-stroke cohort were identified as: level of education and individual income.Conclusion: The decision to return to driving after a stroke is a complicated, multifactorial process. This study confirms previous research, which found that cognition and driving performance are impaired post-stroke. The findings also suggest that post-stroke drivers’ decision to return to driving was not linked to their ability to drive, but more to socio-demographic and environmental factors. The implications of these findings are concerning as they suggest that some post-stroke drivers lack insight into their declining abilities and continue to drive, despite the potential danger. Further screening tools and assessments to identify those at risk when returning to the road post-stroke are required.