Brain changes associated with Alzheimer's disease and related chronic degenerative dementias may begin as long as 20 years before clinical symptoms become evident. There is increasing evidence that unobtrusive monitoring of older adults' performance of complex daily activities of living may allow us to detect some of these subtle early changes in cognition. The rapidly increasing use of sensors not only in commercial vehicles, but also in passenger vehicles, and large number of older drivers on U.S. roads suggest that sensor data may be reconfigured to provide this early warning system. In this longitudinal mixed methods study, we will recruit and enroll 750 older drivers, establish their baseline cognitive function and driving behavior profiles, and repeat the cognitive testing and in-vehicle sensor data downloading every three months for three years (12 data points). Over this time, we expect approximately 200 participants to have experienced measurable cognitive decline either from unimpaired to mild cognitive impairment levels and/or mild cognitive impairment to early stage dementia levels. We propose to install a sensor system which will include unobtrusive cameras, on-board diagnostics (OBD), GPS and inertial measurement units (IMU) configured to track and record driver behavior in the passenger vehicles of these 750 older adult (? 65) drivers. The recorded changes in driver behavior will be compared to results from a battery of cognitive tests (global cognition, executive function, memory, visuospatial, visual attention and language) with demonstrated ability to detect early cognitive changes and to predict driver risk. The innovation of this research project lies in the rigorous testing of an unobtrusive, rapidly and readily available in-vehicle sensing and monitoring system for its ability to detect early changes in cognition in older drivers. There is an estimated 4 to 8 million older drivers with mild cognitive impairment on the roads in the U.S. This significant number of older drivers poses a major concern for public safety. Moreover, the majority may be unaware of the cognitive changes occurring. Current dementia screening programs are able to test only a small number of older adults and the wellness visits covered by Medicare do not detect these early, subtle changes. Yet early detection offers many medical, emotional and financial benefits for the individual, family and society, opening a ?window of time? to intervene in the progression of the disease in the future (Alzheimer's Association 2019 Report). The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost, early warnings of change for the large number of older drivers in the U.S.
There is some intriguing evidence that changes in the way older individuals carry out a complex activity of daily living may herald the beginning of cognitive decline. One of these complex activities is driving. We propose testing the ability of the increasingly popular sensors placed in cars to track driver behavior (following too close, drifting out of one's lane, distracted driving) to provide early warnings of cognitive decline, allowing the individual time to seek further testing and treatment and to make plans for the future.
