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Open Access Research article

Cognitive deficits are associated with poorer simulated driving in older adults with heart failure

Michael L Alosco1*, Mary Beth Spitznagel1, Mary Jo Cleveland2 and John Gunstad1

Author Affiliations

1 Department of Psychology, Kent State University, Kent, OH, USA

2 Center for Senior Health, Summa Health System, Akron, OH, USA

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BMC Geriatrics 2013, 13:58  doi:10.1186/1471-2318-13-58

Published: 12 June 2013



Cognitive impairment is prevalent in older adults with heart failure (HF) and associated with reduced functional independence. HF patients appear at risk for reduced driving ability, as past work in other medical samples has shown cognitive dysfunction to be an important contributor to driving performance. The current study examined whether cognitive dysfunction was independently associated with reduced driving simulation performance in a sample of HF patients.


18 persons with HF (67.72; SD = 8.56 year) completed echocardiogram and a brief neuropsychological test battery assessing global cognitive function, attention/executive function, memory and motor function. All participants then completed the Kent Multidimensional Assessment Driving Simulation (K-MADS), a driving simulator scenario with good psychometric properties.


The sample exhibited an average Mini Mental State Examination (MMSE) score of 27.83 (SD = 2.09). Independent sample t-tests showed that HF patients performed worse than healthy adults on the driving simulation scenario. Finally, partial correlations showed worse attention/executive and motor function were independently associated with poorer driving simulation performance across several indices reflective of driving ability (i.e., centerline crossings, number of collisions, % of time over the speed limit, among others).


The current findings showed that reduced cognitive function was associated with poor simulated driving performance in older adults with HF. If replicated using behind-the-wheel testing, HF patients may be at elevated risk for unsafe driving and routine driving evaluations in this population may be warranted.

Driving simulation; Heart failure; Cognitive function; Driving ability