Cognitive clinical assessments to predict performance on an on-road assessment: a scoping review.

Purpose: Staying current with emerging research is essential to ensure that cognitive assessments used to predict driving ability are based on current evidence. This review evaluated studies published since 2012 that compared clinical cognitive assessments with on-road driving outcomes. The focus was on predictive validity and clinical utility to support evidence-based decisions about medical fitness to drive and to highlight gaps in the research.

Materials and methods: A scoping review, conducted using the JBI framework, identified studies comparing cognitive assessments with on-road outcomes in older adults or individuals with health conditions affecting cognition. Data were systematically extracted and evaluated using established psychometric and clinical utility criteria.

Results: From 2247 articles, 77 met inclusion criteria, assessing 56 cognitive assessments or batteries. Only four met predefined psychometric standards, and of these, only DriveSafe DriveAware also met clinical utility criteria. Although many tools demonstrated clinical utility, their lack of psychometric strength limited their use as stand-alone alternatives to on-road testing.

Conclusion: This review highlighted both established and emerging tools for evaluating driving ability. Few met both psychometric and clinical utility standards. On-road assessments remain the gold standard, but functionally based tools like DriveSafe DriveAware, combined with clinical judgment, may assist driving outcome prediction.