Preclinical Alzheimer's disease and longitudinal driving decline

Catherine M Roe; Ganesh M Babulal; Denise M Head; Sarah H Stout; Elizabeth K Vernon; Nupur Ghoshal; Brad Garland; Peggy P Barco; Monique M Williams; Ann Johnson; Rebecca Fierberg; M Scot Fague; Chengjie Xiong; Elizabeth Mormino; Elizabeth A Grant; David M Holtzman; Tammie L S Benzinger; Anne M Fagan; Brian R Ott; David B Carr; John C Morris

doi:10.1016/j.trci.2016.11.006

Preclinical Alzheimer's disease and longitudinal driving decline

Alzheimers Dement (N Y). 2017 Jan;3(1):74-82. doi: 10.1016/j.trci.2016.11.006.

Authors

Catherine M Roe^{1

2}, Ganesh M Babulal^{1

2}, Denise M Head^{1

3}, Sarah H Stout^{1

2}, Elizabeth K Vernon^{1

2}, Nupur Ghoshal^{1

2}, Brad Garland⁴, Peggy P Barco^{5

6}, Monique M Williams⁷, Ann Johnson⁸, Rebecca Fierberg^{1

2}, M Scot Fague^{1

9}, Chengjie Xiong^{1

9}, Elizabeth Mormino¹⁰, Elizabeth A Grant^{1

9}, David M Holtzman^{1

2}, Tammie L S Benzinger^{1

11

12}, Anne M Fagan^{1

2}, Brian R Ott¹³, David B Carr^{8

6}, John C Morris^{1

2

5

14

15}

Affiliations

¹ Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine.
² Department of Neurology, Washington University School of Medicine.
³ Department of Psychology, Washington University School of Medicine.
⁴ My Tutor Learning Center, Belleville, IL.
⁵ Department of Occupational Therapy, Washington University School of Medicine.
⁶ The Rehabilitation Institute of St. Louis.
⁷ VITAS Healthcare, St. Louis.
⁸ Department of Medicine, Washington University School of Medicine.
⁹ Division of Biostatistics, Washington University School of Medicine.
¹⁰ Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹¹ Department of Radiology, Washington University School of Medicine.
¹² Department of Neurosurgery, Washington University School of Medicine.
¹³ Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
¹⁴ Departments of Pathology and Immunology, Washington University School of Medicine.
¹⁵ Department of Physical Therapy, Washington University School of Medicine.

Abstract

Introduction: Links between preclinical AD and driving difficulty onset would support the use of driving performance as an outcome in primary and secondary prevention trials among older adults (OAs). We examined whether AD biomarkers predicted the onset of driving difficulties among OAs.

Methods: 104 OAs (65+ years) with normal cognition took part in biomarker measurements, a road test, clinical and psychometric batteries and self-reported their driving habits.

Results: Higher values of CSF tau/Aβ₄₂ and ptau₁₈₁/Aβ₄₂ ratios, but not uptake on PIB amyloid imaging (p=.12), predicted time to a rating of Marginal or Fail on the driving test using Cox proportional hazards models. Hazards ratios (95% confidence interval) were 5.75 (1.70-19.53), p=.005 for CSF tau/Aβ₄₂; 6.19 (1.75-21.88) and p=.005 for CSF ptau₁₈₁/Aβ₄₂.

Discussion: Preclinical AD predicted time to receiving a Marginal or Fail rating on an on-road driving test. Driving performance shows promise as a functional outcome in AD prevention trials.

Keywords: Alzheimer disease; aged; amyloid imaging; biomarker; cerebrospinal fluid; driving; functional outcome; older adults; preclinical; ptau; road test; tau.

Abstract

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